Untreated gestational diabetes mellitus (GDM) carries significant risks for perinatal morbidity in all disease severity levels [1]. The prevalence of GDM is rising due to an increased rate of obesity and sedentary lifestyle [2]. Moreover, it carries long-term risks for the mothers and their offspring [3], [4], [5]. This disease imposes substantial social and economic burdens worldwide [6].

Optimal glycaemic control reduced the risk of adverse maternal, and neonatal outcomes [7]. Consequently several Societies edited recommendations for the diagnosis, treatment, and monitoring of GDM [8], [9], [10], [11], [12]. Classically, GDM monitoring has required the implication of patients and use of a diary to record six capillary glycaemia measurements per day and repeated face-to-face consultations (1 to 4 consultations during the course of the pregnancy) [13], [14].

Telemedicine interventions using smartphone applications have been available for about a decade. Several studies reported improved glycaemic control and decreased HbA1c level [15]. However conflicting results were observed concerning the clinical relevance of these findings [16]. Recently, Meykiechel et al. showed a decreased rate of fœtal macrosomia in the telemedicine group [17]. Moreover, little is known about the potential cost effectiveness of this policy since it involves only one face-to-face consultation with the remainder of the pregnancy being managed via the application.

Consequently, we wanted to know if GDM monitoring by an application (app group) was not inferior to classic medical care using a diary (control group) in a large cohort of GDM patients based on a composite variable consisting of maternal, fœtal, and neonatal adverse events.