Integration of telehealth into clinical care has expanded following the COVID-19 pandemic, improving access to antenatal services. Gestational diabetes mellitus (GDM) requires close monitoring to optimise glycaemia and reduce adverse pregnancy outcomes. While telehealth offers advantages, impact on maternal and foetal outcomes in GDM populations remains uncertain.

Aim:
To evaluate the effect of telehealth-integrated care on maternal and neonatal outcomes in an Australian GDM population.

Methods:
A retrospective comparative study compared 157 women with GDM managed through traditional in-person consultations (September 2019-March 2020) compared to 160 telehealth-integrated (TH) model-of-care (January 2023-June 2023) at a tertiary Australian centre were included. Baseline data included maternal demographics, obstetric history, and glycaemic control were collected. Maternal and neonatal outcomes included gestational weight gain, glycaemic control and mode of delivery, birthweight, incidence of large-for-gestational-age (LGA) infants, neonatal hypoglycaemia, and neonatal intensive care unit (NICU) admission.

Results:
157 participants were included, with approximately two-thirds born overseas. Patients of Afghan ethnicity were underrepresented in the TH-group (8% compared to 13%), suggesting potential language or digital literacy barriers.  Women in the TH-care model were referred earlier and attended more clinic reviews (10% attended >10 clinics compared to 3% of in-person consultation).  A slightly higher prevalence of macrosomia was observed in the TH-cohort (39% vs to 27%).  Despite these differences, rates of emergency and elective caesarean section were similar.  Maternal outcomes, including excessive gestational weight gain were comparable. Glycaemic management was also similar, with comparable proportions managed with diet alone or insulin requiring therapy.  Notably, a higher proportion of women in the TH-group were on ADIPs glycaemic targets; however, this did not translate into improved neonatal outcomes.

Conclusion:
Telehealth-integrated-care facilitates earlier engagement and more frequent follow-up while achieving maternal and neonatal outcomes comparable to traditional in-person models. Observed disparities in access among culturally and linguistically diverse populations highlight the need for targeted strategies to ensure equity.  These findings support the continued incorporation of telehealth into antenatal care as a safe, flexible and effective alternative without compromising outcomes. Further prospective studies are warranted to confirm findings, evaluate patient satisfaction and long-term outcomes alongside strategies to address equity in access.