By Esther Sang Myung Han
Pregnancy care is a universal concern. According to the World Health Organization, 810 women die everyday from preventable causes related to pregnancy and childbirth, and 2.6 million stillbirths occur annually. Despite the fact that there are 165 million pregnancies every year and 50 million of those are high-risk, much less research is invested into pregnancy than other less common conditions (Johnson, 2019). But why is this the case?
The Pregnancy Perception
A belief may exist that pregnancy is a temporary state and therefore a temporary problem. As Diana Bianchi, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development stated, “Probably most people think pregnancy is a time-limited experience, and therefore, because it lasts only nine months, we don’t need to invest that many resources in it — because it’ll be over soon” (Johnson, 2019). People tend to forget that those 9 months lead to the next 90 years of someone’s life, and that a significant number of women go through pregnancy every year.
There is an underlying belief that pregnant women need to be protected from anything new – research, potentially helpful drugs, technology – rather than benefiting from these advancements. For example, obstetricians still rely on the CTG (Cardiotocography) to measure fetal heart rate, even though it was developed over 50 years ago. Most professionals in the obstetrics field consider the old age of the CTG as a sign that it has passed the test of time and therefore gained its place at the center of the obstetric care decision making process (Ayres-de-Campos, 2018). In many other fields and professions, a 50-year-old technology would be considered outdated or available for improvements.
An outdated technology will naturally lead to gaps in the care process. In the CTG’s case, only trained professionals are able to operate it, leading pregnancy care to be labor intensive and costly. Additionally, due to the immobile nature of the CTG machine, monitoring is fragmented, resulting in incomplete data and consequently less effective complication prevention measures. Patients are also forced to make frequent visits to the clinic, which is time-consuming and also costly – and during the pandemic, could even be dangerous.
The idea that pregnancy care is a temporary risk and already “good enough” needs to be reevaluated in order to make room for advancements and further research. Fortunately, due to concern from physicians and advocates, research and technological advancements have shown promise for the future of obstetrics, spanning from remote monitoring to AI-powered data analytics.
Remote Monitoring for Advanced Pregnancy Care
An up-and-coming game-changer is the use of remote monitoring, which in the medical industry refers to the use of technology to monitor patients outside of the clinical or hospital setting. It has been utilized in the successful advancement of disease management for other medical conditions, such as diabetes, human immunodeficiency virus (HIV), and sickle cell anemia (Marko, et al., 2019).
Within obstetrics, remote monitoring can be used to collect vital data from expecting mothers during the 99% of time they’re not in the clinic for a prenatal visit, giving clinicians access to data they didn’t have before. Consequently, remote monitoring for fetal and maternal health could provide benefits ranging from better care outcomes to higher clinician and patient satisfaction.
Remote monitoring offers lower costs as an additional benefit. Usually, high-risk pregnant women are admitted to the hospital solely for the purpose of monitoring, so telemonitoring can decrease overall costs during pregnancy for both high-risk pregnant women and hospitals at an estimated cost of 145,822 euros per year (Buysse, et al., 2008). As such, remote monitoring can not only reduce financial burden from expecting mothers but also optimize efficiency of care in hospitals, as simple monitoring visits are moved to virtual monitoring sessions, freeing up clinical space and staff capacity for other in-clinic procedures.
The Patient and Clinician Experience
Pregnant women are receptive to the idea of incorporating remote monitoring and other digital health into their antenatal care routine, a sentiment that has been further encouraged by the pandemic. They are also a relatively young and healthy population, making them a highly favorable group for remote monitoring (Marko, et al., 2019). Biorithm, a Singaporean medical technology start-up, recently conducted a survey of 85 women who were or are recently pregnant during COVID-19 prevention measures and found this sentiment reflected by the majority (Figure 1).
Figure 1: According to the survey results, a majority of women who experienced at least a part of their pregnancy during the pandemic are favorable towards the idea of including telemedicine in their future care. This online survey was conducted by Biorithm.
As a result of the risks of going into a clinic in present time, as well as changing clinic procedures to ensure the safety of patient and clinician, mothers are seeing increased value in new technology and methods clinicians can provide them. Of course, remote monitoring alone will not change the face of obstetric care. However, combined with the power of advanced data analytics in the form of AI (Artificial Intelligence) and a holistic care platform to deliver this data from the patient to the clinician, there exists a whole new level of care available for pregnant women in the future (Figure 2).
Figure 2: While remote monitoring pregnancy care workflows can vary with each solution provider, this figure illustrates a generalized idea of how a holistic remote pregnancy care system might work.
Care providers also benefit from the addition of remote monitoring to their care routine for pregnant women. On top of having more data that can enable them to provide more comprehensive patient insights and better detect signs of early complication, remote monitoring solutions should be complemented with advanced algorithms and AI-powered data analytics to help clinicians with complex processes like risk stratification. Only in a holistic platform such as this can remote monitoring truly make an impactful difference on the patient and clinician experience.
Times are changing, with the COVID-19 pandemic as the catalyst. The way healthcare is provided – not only to pregnant women but to all – needs to shift in concurrence with the way the world is evolving. As Amrish Nair, the CEO of Biorithm said, “We’ve always had the basic assumption that people need to go into hospitals to get healthcare. Now is a great time to shift that paradigm from the hospital as a building which we go to for healthcare, to hospital as a building which manages information to create better health for everyone” (Biorithm, 2020). It’s time for pregnancy to also shift its paradigm and amplify its care model to fit today’s rapidly-evolving world.
Ayres-de-Campos, D. (2018, June 1). Electronic fetal monitoring or cardiotocography, 50 years later: what’s in a name? American Journal of Obstetrics & Gynecology, 218(6), 545-546. https://doi.org/10.1016/j.ajog.2018.03.011.
Biorithm (2020, December 3). Healthcare outside hospital walls. Retrieved from Hospital Insights Asia: https://hospitalinsightsasia.com/sponsored/healthcare-outside-hospital-walls/
Buysse, H., De Moor, G., Van Maele, G., Baert, E., Thienpont, G., & Temmerman, M. (2008, July). Cost-effectiveness of telemonitoring for high-risk pregnant women. International Journal of Medical Informatics, 77(7), 470-476. https://doi.org/10.1016/j.ijmedinf.2007.08.009.
Hechtman, J. (2017, May 16). The overlooked pregnancy epidemic: Premature birth. Retrieved from U.S. News & World Report: https://health.usnews.com/health-care/for-better/articles/2017-05-16/the-overlooked-pregnancy-epidemic-premature-birth
Johnson, C. Y. (2019, March 6). Long overlooked by science, pregnancy is finally getting attention it deserves. Retrieved from The Washington Post: https://www.washingtonpost.com/national/health-science/long-overlooked-by-science-pregnancy-is-finally-getting-attention-it-deserves/2019/03/06/a29ae9bc-3556-11e9-af5b-b51b7ff322e9_story.html
Marko, K. I., Ganju, N., Krapf, J. M., Gaba, N. D., James, B. A., Joshua, B. J., . . . Meltzer, A. C. (2019, May). A mobile prenatal care app to reduce in-person visits: Prospective controlled trial. JMIR mHealth and uHealth, 7(5), e10520. https://doi.org/10.2196/10520.
About the Author
Esther Sang Myung Han is a marketing & communications professional with a background in copywriting and a passion for all things creative. She is currently starting up a Strategic Branding & Digital Marketing Consultancy. Esther is a previous employee of Biorithm and believes in the vision to improve pregnancy care for all women. You can find her on LinkedIn or through her website.