The impact of a remote monitoring program on the prenatal follow-up of women with gestational hypertensive disorders

Abstract

Objectives: In 2015, we showed the value of a remote monitoring (RM) follow-up program for women diagnosed with gestational hypertensive disorders (GHDs) compared with women who received conventional care (CC). We want to confirm or refute the conclusions drawn in 2015, by including data from 2016. Study design: A two year retrospective study in which all women diagnosed with GHD, who underwent prenatal follow-up at the outpatients prenatal clinic of Ziekenhuis Oost-Limburg (Genk, Belgium) during 2015 and 2016, were included. Of the 320 women diagnosed with GHD, ninety (28.13%) were monitored with RM. The other 230 (71.88%) GHD pregnancies were monitored with CC. Differences in continuous and categorical variables in maternal demographics and characteristics were tested using Unpaired Student's two sampled t-test or Mann Whitney U test and the c(2) test. Both a univariate and multivariate analysis were performed for analyzing prenatal follow up and gestational outcomes. All statistical analyses are done at nominal level a = 0.05. Results: The RM group had more women diagnosed with gestational hypertension but less with pre-eclampsia when compared to the CC group (69.77% versus 42.79% and 19.77% versus 44.19% respectively). In both uni- and multivariate analyses, the RM group had, when compared to the CC group, less prenatal admission (51.62% versus 71.63%), less prenatal admissions until the moment of the delivery (31.40% versus 57.67%), less induced starts of the birth process (43.00% versus 32.09%), more spontaneous starts of the birth process (32.86% versus 46.51%), more births after 37 weeks of gestational age in pregnancies complicated with gestational hypertension (91.67% versus 53.33%) and pregnancies complicated with pre-eclampsia (58.82% versus 53.33%). In multivariate analysis, a reduction in total number of prenatal visits was visible in the RM group when compared to the CC group (b = -1.76; Cl = -2.74-0.77). Only in the univariate analysis was the mean gestational age at delivery between 34 and 37 weeks of gestation in pregnancies complicated with gestational hypertension higher in the CC group versus the RM group (35 w 4/7 (+/- 0.49) versus 34 w 6/7 (+/- 0.00). These conclusions were almost the same as in the analyses of 2015, except (1) there wasn't a difference anymore in NICU admissions between the RM and CC group in the analyses of 2015-2016 and (2) a significant decrease in total number of visits is reported in the RM group in the dataset of 2015-2016, which wasn't visible in the dataset of 2015. Conclusions: This study demonstrates that RM provides opportunities to offer timely interventions to pregnant women who require them. (C) 2018 The Author(s). Published by Elsevier B.V.