With a shift towards greater patient involvement in healthcare across the world, there has been a rapid improvement in self-monitoring technology and widespread accessibility of devices that can be used in telemonitoring, such as smartphones. The use of telemonitoring in pregnancy has been an area of interest, with the aim of reducing the number of antenatal visits and providing a safe and cost-effective alternative to hospital admission.
A recent study published in The Lancet Digital Health by Mireille N Bekker and colleagues has shed light on the effectiveness of telemonitoring in high-risk pregnancies. The HoTeL study was a randomised, multicentre, non-inferiority trial that included pregnant women with a range of antenatal morbidities, who required daily monitoring but were not expected to need intervention within 48 hours.
Criteria
The participants were randomly assigned to either hospital admission or telemonitoring, which involved monitoring cardiotocography (with an internet portal), blood pressure, and temperature, and with daily midwife contact. The study found that telemonitoring was at least as safe as hospital admission, with fewer primary outcome events in the telemonitoring group.
The women in the study required daily monitoring due to pre-eclampsia, fetal growth restriction, fetal anomaly, preterm rupture of membranes, reduced fetal movements, or a history of fetal death, and were therefore at high risk of serious adverse events. This research adds confidence that these high-risk women might be able to safely be monitored as outpatients with the appropriate support.
The outcome
The study also found high degrees of satisfaction in the telemonitoring group and a reduction in cost, predominantly driven by a reduction in admission, despite an intensive intervention. This is an important finding, as those at high risk, such as those in the study by Bekker and colleagues, require more intensive (and therefore costly) interventions.
Self-monitoring and conclusions
While some forms of self-monitoring have perhaps moved ahead of the evidence, the study by Bekker and colleagues provides important evidence that adds to the growing body of work on telemonitoring in pregnancy. The results suggest that telemonitoring can reduce the number of antenatal visits, with consequent reductions in cost, and is accepted and valued by women.
However, there is a need to understand how to integrate novel interventions into daily practice. Such organisational change can be difficult, and barriers include practical issues such as provision and management of equipment, and the costs of new technology, including reimbursement, with novel interventions sometimes not funded by the healthcare service.
Additionally, there is a need to ensure health equity with evidence that those from underserved groups might be less likely to be included in trials, when there is a need to ensure that interventions or health technology is effective for all.
The study by Bekker and colleagues provides important evidence that telemonitoring in pregnancy is safe, cost-effective, and acceptable.
