“We hope we can convince you that digital health can be harnessed to improve not just perinatal outcomes but perinatal health equity,” began Adam Lewkowitz, MD, assistant professor of Obstetrics & Gynecology at Brown University, and Associate Program Director for the Maternal-Fetal Medicine Fellow at Women & Infants Hospital of Rhode Island in Providence, at his joint MedED talk with Melissa Wong, MD, assistant professor, Maternal Fetal Medicine, at Cedars-Sinai Medical Center in Los Angeles, California, and Alisse Hauspurg, MD, assistant professor, Department of Obstetrics, Gynecology & Reproductive Sciences at the University of Pittsburgh School of Medicine in Pennsylvania.
Lewkowitz’ talk took a personal turn when he explained his reasons for getting into medicine in the first place, one of which, he confessed, “satisfies my inner health care socialist: pregnancy is the only time in the Unites States where insurance coverage is essentially guaranteed.” Equity, however, needs to be extended beyond that period, considering the essential needs of postpartum care for weeks and months after delivery.
Aside from government intervention to extend insurance benefits, Lewkowitz noted, “we can’t wait for congress to act.” Lewkowitz’ solution: patient-centered smartphone apps. Cost-efficient, virtually anyone can use apps, even without a Wi-Fi or data plan. “Many apps have been created to take care of this loophole. From an obstetric perspective, your patients can download an app during a prenatal care visit using clinic Wi-Fi and retain access to content, regardless of their finances.”
Lewkowitz continued to sing the praises of apps, including their scalability, ability to be downloaded anywhere around the world and disseminated in diverse settings. Bottom line: when it comes to diversity, equity, and inclusion, apps are all over it.
At this point, Lewkowitz introduced his own studies with an app aimed to increase breastfeeding rates for low-income women, which he was motivated to research, “because patients basically told me it would be helpful to them.” Thus, the birth of Breastfeeding Friend, or BFF. The app, Lewkowitz explained, offers interactive education on breastfeeding, contraception, postpartum depression, and normal infant behavior and development. While in a randomized controlled trial, BFF did not change breastfeeding choices, Lewkowitz feels that updated versions of the apps, incorporating valuable feedback from trial participants, will be more effective. “I must emphasize the strengths in apps, in their potential for increasing postpartum equity, not only to breastfeeding, but other postpartum outcomes.”
Alisse Hauspurg began her segment by saying, “I am going to try to convince you why we need innovative care for the management of postpartum hypertension,” italicizing that remote technology can be an effective tool in this management. Hauspurg empathized with the challenges of bringing a new mother with hypertension back into the hospital for a blood pressure check. “Patients are discharged home with a newborn, potentially many of them having had major abdominal surgery,” said Hauspurg, and then possibly having to deal with weather barriers, multiple transportation methods, and, for rural patients, potentially long distances. Considering that hypertension, which worsens after delivery, is the most common reason for postpartum hospital readmission, implementing remote blood pressure monitoring simply makes sense.
A study that looked at sending mothers home with a BP cuff and having them send in their BP results, either through an app or text messaging, proved to be feasible: in the study, over 90% of women had a BP measured during the first 10 days postpartum. Additionally, the study showed that any racial disparities that existed in having a BP measurement at 10 days was completely eliminate with remote monitoring.
Currently, Medicaid and insurance companies to not cover the cost of a blood pressure cuff, so “we will need to continue to think of other ways to overcome the cost barrier, such as harnessing the sensors in Apple watches and cell phones to create BP monitoring, noted Hauspurg. “Imagine,” Hauspurg concluded, “2 years from now, before a patient leaves the hospital, you teach them to check their blood pressure using their smartphones and validate the measure prior to discharge. You can create a robust safety net for the management of postpartum hypertension, harnessing the capabilities of your institution’s medical record system to deliver the care the patient needs.”
Melissa Wong shared with the audience her view of the power of artificial intelligence (AI) in pregnancy. Wong gave examples of what artificial intelligence could do for pregnancy care, including algorithms that can read and clear much of a fetal ultrasound scan; systems in hospitals that can read and interpret a fetal heart rate; and “what I personally find the most exciting applications of AI,” says Wong, “augmenting our clinical decision-making to develop ongoing predictions of mode of delivery in labor.” Wong worked with her mentor, Kim Gregory, MD, and a data intelligence team to create a model that could predict, with nearly 90% accuracy, the mode of delivery for a laboring patient within 4 hours of her arrival.
Said Wong, “I really do believe that AI in obstetrics is already beginning to change the world.”
Lewkowitz AK, Wong M, Hauspurg A. Technology and obstetrics: how new interventions can improve perinatal outcomes. 2022 American College of Obstetricians and Gynecologists Annual Clinical And Scientific Meeting. May 6, 2022. San Diego, California.