eHealth as the Next-Generation Perinatal Care: An Overview of the Literature

Abstract

BackgroundUnrestricted by time and place, electronic health (eHealth) provides solutions for patient empowerment and value-based health care. Women in the reproductive age are particularly frequent users of internet, social media, and smartphone apps. Therefore, the pregnant patient seems to be a prime candidate for eHealth-supported health care with telemedicine for fetal and maternal conditions.ObjectiveThis study aims to review the current literature on eHealth developments in pregnancy to assess this new generation of perinatal care.MethodsWe conducted a systematic literature search of studies on eHealth technology in perinatal care in PubMed and EMBASE in June 2017. Studies reporting the use of eHealth during prenatal, perinatal, and postnatal care were included. Given the heterogeneity in study methods, used technologies, and outcome measurements, results were analyzed and presented in a narrative overview of the literature.ResultsThe literature search provided 71 studies of interest. These studies were categorized in 6 domains: information and eHealth use, lifestyle (gestational weight gain, exercise, and smoking cessation), gestational diabetes, mental health, low- and middle-income countries, and telemonitoring and teleconsulting. Most studies in gestational diabetes and mental health show that eHealth applications are good alternatives to standard practice. Examples are interactive blood glucose management with remote care using smartphones, telephone screening for postnatal depression, and Web-based cognitive behavioral therapy. Apps and exercise programs show a direction toward less gestational weight gain, increase in step count, and increase in smoking abstinence. Multiple studies describe novel systems to enable home fetal monitoring with cardiotocography and uterine activity. However, only few studies assess outcomes in terms of fetal monitoring safety and efficacy in high-risk pregnancy. Patients and clinicians report good overall satisfaction with new strategies that enable the shift from hospital-centered to patient-centered care.ConclusionsThis review showed that eHealth interventions have a very broad, multilevel field of application focused on perinatal care in all its aspects. Most of the reviewed 71 articles were published after 2013, suggesting this novel type of care is an important topic of clinical and scientific relevance. Despite the promising preliminary results as presented, we accentuate the need for evidence for health outcomes, patient satisfaction, and the impact on costs of the possibilities of eHealth interventions in perinatal care. In general, the combination of increased patient empowerment and home pregnancy care could lead to more satisfaction and efficiency. Despite the challenges of privacy, liability, and costs, eHealth is very likely to disperse globally in the next decade, and it has the potential to deliver a revolution in perinatal care.

Home-based telemonitoring versus hospital admission in high risk pregnancies: a qualitative study on women’s experiences

“…Besides conventional care during clinical admission, recent technological advances resulted in e-Health, defined as health services and information delivered or enhanced through the Internet and related technologies [13]. Potential positive effects of the use of e-Health include increased patient engagement and satisfaction, better access to health care and the possibility to reduce clinic costs with equal or better health outcomes [14,15]. e-Health has already found its way in perinatal care and its implementation is likely to disperse globally in the next decade [14].…”

“…Potential positive effects of the use of e-Health include increased patient engagement and satisfaction, better access to health care and the possibility to reduce clinic costs with equal or better health outcomes [14,15]. e-Health has already found its way in perinatal care and its implementation is likely to disperse globally in the next decade [14].…”

“…Through a secured internet portal, data are integrated in the electronic patient record system making access possible for health care professionals. In recent years, several comparable systems for remote monitoring of maternal and fetal condition have been developed and found feasible with regards to usability, acceptability and clinical usefulness [14]. As an addition to prenatal care, telemonitoring can result in increased adherence to appointments, reduced clinic visits and enhanced patient engagement [14].…”

“…In recent years, several comparable systems for remote monitoring of maternal and fetal condition have been developed and found feasible with regards to usability, acceptability and clinical usefulness [14]. As an addition to prenatal care, telemonitoring can result in increased adherence to appointments, reduced clinic visits and enhanced patient engagement [14]. However, safety of use for perinatal outcomes of these digital telemonitoring platforms has not been studied extensively in highrisk pregnancy.…”

Diagnostic equivalency of mobile CTG devices and remote analysis to conventional on-site nonstress test

“…5 Telemedicine applications in obstetrics can be categorized depending on the form of service provided (educational, teleconsultations, remote monitoring) or depending on the problem addressed (lifestyle issues, gestational diabetes, mental health, etc.). Many of the applications have been tested in the past few years and positive effects have been shown (reviewed by van den Heuvel et al 6 ); however, most of the studies lack an endpoint related to its clinical impact, which still remains to be determined.…”