Testing the Feasibility of Remote Patient Monitoring in Prenatal Care Using a Mobile App and Connected Devices: A Prospective Observational Trial

Abstract

BackgroundExcessive weight gain and elevated blood pressure are significant risk factors for adverse pregnancy outcomes such as gestational diabetes, premature birth, and preeclampsia. More effective strategies to facilitate adherence to gestational weight gain goals and monitor blood pressure may have a positive health benefit for pregnant women and their babies. The impact of utilizing a remote patient monitoring system to monitor blood pressure and weight gain as a component of prenatal care has not been previously assessed.ObjectiveThe objective of this study is to determine the feasibility of monitoring patients remotely in prenatal care using a mobile phone app and connected digital devices.MethodsIn this prospective observational study, 8 women with low risk pregnancy in the first trimester were recruited at an urban academic medical center. Participants received a mobile phone app with a connected digital weight scale and blood pressure cuff for at-home data collection for the duration of pregnancy. At-home data was assessed for abnormal values of blood pressure or weight to generate clinical alerts to the patient and provider. As measures of the feasibility of the system, participants were studied for engagement with the app, accuracy of remote data, efficacy of alert system, and patient satisfaction.ResultsPatient engagement with the mobile app averaged 5.5 times per week over the 6-month study period. Weight data collection and blood pressure data collection averaged 1.5 times and 1.1 times per week, respectively. At-home measurements of weight and blood pressure were highly accurate compared to in-office measurements. Automatic clinical alerts identified two episodes of abnormal weight gain with no false triggers. Patients demonstrated high satisfaction with the system.ConclusionsIn this pilot study, we demonstrated that a system using a mobile phone app coupled to remote monitoring devices is feasible for prenatal care.

The impact of a remote monitoring program on the prenatal follow-up of women with gestational hypertensive disorders

“…Although a multivariate analysis showed that these parameters did not influence our principal findings, smoking during pregnancy has adverse outcomes, although a reduced risk of developing of GHD in women who smoke has been demonstrated in many studies [4,9]. There is insufficient or conflicting evidence suggesting that immunological diseases influence the development of GHD [10][11][12][13]. The last limitation is that interference by family doctors or community midwives cannot be excluded.…”

“…However, Marko et al (2016) reported a feasibility study of the use of a mobile phone app and connected digital devices (weight scale and blood-pressure monitor) for women at risk for adverse pregnancy outcomes. They concluded that this system is feasible for prenatal care [13]. Several studies of RM programs that assist nonpregnant patients with hypertension to control their blood pressure have been reported.…”

The Association between Travel Time and Prenatal Care Attendance

“…Most recently, Minnesota, Washington, D.C., and Washington state piloted a promising intervention that couples virtual visits with in-person appointments. [56][57][58] Of note, none of these interventions focuses on the first prenatal care visit nor change the content of the first visit. Sentinel work on the establishment of prenatal care content and timing delineates the importance of developing a risk-responsive approach to prenatal care for women at risk (i.e., underserved, substance addiction, abuse-related issues, adolescents); their report underscored the importance of early care initiation to identify patient needs and perform interventions that may improve outcomes and increase compliance.…”

Ecological momentary assessment of stress, racism and other forms of discrimination during pregnancy using smartphone technology

“…30 Compared with a laboratory setting, remote, real-time data collection using EMA reduces recall bias, is reliable, has ecological validity, and provides opportunities for more data points. 30,31 Data collection with EMA is feasible in diverse populations, including pregnant populations, [32][33][34][35][36][37][38][39][40] and has high participant satisfaction and completion rates up to 89%. 32,41,42 Given that many people carry their smartphones with them, participants can regularly complete short EMA surveys in their natural setting, limiting the reliance on in-person visits for data collection.…”