Virtual vs In-person Care in Gestational Diabetes Management: A Retrospective Cohort Analysis

The rising prevalence of gestational diabetes (GDM) presents a challenge to health-care systems. Virtual care has emerged as a potential solution to alleviate this burden, but limited data exist on its effectiveness. In this study, we evaluated maternal and neonatal outcomes in individuals with GDM managed with virtual care vs in-person care.

A retrospective cohort study was conducted among individuals with GDM attending interdisciplinary diabetes in pregnancy clinics in Calgary, Alberta, between 2017 and 2022. The primary exposure was modality of the initial visit (virtual or in-person) with a certified diabetes educator. Logistic regression models were used to analyze the relationship between visit modality and outcomes, adjusting for multiples, socioeconomic status, maternal age, infant sex, parity, and before vs during the severe acute respiratory syndrome coronavirus-2 (COVID-19) pandemic.

Of the 9,511 individuals included, 4,236 had an initial virtual visit. Those in the virtual care group had lower odds of delivering large-for-gestational-age infants (adjusted odds ratio [aOR] 0.79, 95% confidence interval [CI] 0.65 to 0.97) and undergoing cesarean section (aOR 0.88, 95% CI 0.79 to 0.99). They also had lower odds of missing at least 1 appointment (aOR 0.89, 95% CI 0.77 to 0.99) and greater odds of being prescribed both insulin and metformin (aOR 1.30, 95% CI 1.16 to 1.46). No significant differences were found in rates of operative vaginal birth, induction of labour, small-for-gestational-age infants, 5-minute Apgar score <7, or neonatal intensive care unit admission.

This study highlights the potential of virtual care to enhance GDM management. Further research is needed to assess its broader impact and optimize implementation strategies for diverse populations.