Telehealth Visits, Remote Monitoring Linked to Improved Obstetric Outcomes

Nathaniel DeNicola, MD

Telehealth interventions improved a plethora of obstetric outcomes for women, according to a systematic review conducted by investigators at George Washington University.

Using technology-centric methods of care, patients reported improvements in perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics.

The review, led by Nathaniel DeNicola, MD, highlighted a gap in knowledge of telehealth-based interventions in women’s healthcare.

DeNicola, an assistant professor of obstetrics and gynecology at the George Washington School of Medicine and Health Sciences, and colleagues analyzed 47 of nearly 4000 published abstracts (including 31,967 participants) to review the effectiveness of telehealth interventions for improving obstetric and gynecologic outcomes.

The investigative team was made up of clinical and methodologic experts to design the review. They included studies that had a comparison group; were conducted in countries ranked high on the United Nations Human Development Index; published in English; and evaluated relevant outcomes.

The team designed the review to identify and analyze existing evidence on the effects of mobile media; remote monitoring and care-delivery; patient-generated data; and virtual visits in women’s healthcare delivery.

One emerging theme from the review was that text messaging could be a helpful tool to reinforce certain health behaviors, including smoking cessation during pregnancy, breastfeeding, and contraception adherence.

DeNicola and the team reviewed 4 randomized controlled trials with a total of 1889 participants. Those in the intervention group received texts throughout their pregnancies with content on the effects of smoking during pregnancy and the techniques and benefits to remaining abstinent. Across all 4 trials there was a 15.3% reduction in self-reported smoking at 30 days in the control group (95% CI, 12.08-18.58) compared with 9.6% in the treatment group (95% CI, 6.95-12.32).

Text messaging, however, was not efficient to help initiate a behavior or treatment, such as started a new contraceptive method.

Another theme DeNicola and the team observed was that remote monitoring and virtual visits could play in settings where there are barriers to care in a facility. In 1 study, patients who remotely monitored their blood pressure and communicated the results via text messages showed a significant increase in measurements obtained in the first 10 days after birth and 84% in the text-based surveillance met guidelines for blood pressure recording at 3-4 and 7-10 days postpartum.

Patient-generated data using remote monitoring and mobile phones led to fewer scheduled outpatient visits for the management of diabetes and hypertension.

Telehealth improved access to early abortion and improved asthma control in patients. In 1 study, women who participated in a telehealth intervention had improved asthma control (95% CI, -.66 to -.07) and asthma-related quality of life (95% CI, .29-1.16) at 6 months follow-up.

The investigators found that the safety and effectiveness of telehealth services was equivalent to in-person care.

Additional studies should examine how such interventions could help patients access other services that are often inaccessible, including contraception provision and management.

The study, “Telehealth Interventions to Improve Obstetric and Gynecologic Health Outcomes,” was published online in the journal Obstetrics & Gynecology.