PregnaDigit EU

Facilitating remote digital pregnancy care

The challenge

There are about 4 million childbirths in Europe every year,[1] and globally about 140 million.[2] There are several pregnancy complications which may compromise maternal or foetal health, turning a pregnancy from low risk into high risk. Hypertensive complications are the most common.

Most high-risk pregnancies lead to long hospitalisation, usually extending through (pre-term) delivery and further inpatient days far into the postpartum period.[3] These hospital admissions deeply impact patient experience and quality of life for the patient and their families, as well as increasing both healthcare costs and clinical workload. Currently, around ten percent of pregnancies across the EU are considered high risk, and this number is further increasing.[4]

The current standard of care, hospitalisation, is challenged by this rising need for medical care, increasing costs, and a growing shortage of obstetric healthcare professionals. Increasing demand and decreasing supply may result in substandard care. So, there is an urgent need to innovate and improve medical pregnancy care.

One of the most promising solutions is remote digital pregnancy care (RDPC), which replaces most of the in-hospital admission days for pregnancy complications, moving care from hospital to home when possible. To enable the adoption of this technology there needs to be a change in process, including infrastructural change, telecommunication, and IT system integration, and a different approach in communication between healthcare professionals and patients.

The required MedTech innovations for RDPC are validated, certified and readily available. These include digital medical devices to monitor the pregnant woman and her unborn child’s vital signs, such as maternal blood pressure (MBP) and foetal heart rate (FHR) patterns by cardiotocography (CTG).

RDPC is ready to be brought to the next level, but its widespread implementation is hampered by knowledge gaps in areas such as correct reimbursement and cost-effectiveness. Implementation is also hindered by a lack of enabling methodologies including digital care paths, change models, and data infrastructure to embed RDPC in care paths and the electronic medical record (EMR). Although ‘point solutions’ are available, both the MedTech and healthcare sectors need innovative ‘system solutions’ to overcome these knowledge and methodology gaps together and work towards large-scale application of RDPC.

The solution

Medical pregnancy care is at a crossroads, facing issues of accessibility, affordability, and sustainability. Digital transformation offers a promising solution, enabling a shift from hospital-based to home-based high-risk pregnancy care whenever feasible. Recent advancements in key enabling technologies, including home-monitoring devices for maternal and foetal health plus their connecting data platforms, provide the basis for this transformation.

The PregnaDigit EU project, to be run in three leading academic hospitals in the Netherlands, Spain, and Sweden, will offer remote digital pregnancy care (RDPC) instead of hospital care to a cohort of 400 high-risk pregnant women.

Implementing RDPC as a new standard of medical pregnancy care requires systemic innovation and change management around new ways of providing, organising, governing, and reimbursing care. The PregnaDigit project aims to create a manual for the health care industry at large, describing the clinical, technical, organisational, and financial steps needed to implement RDPC and transform medical pregnancy care.

To show the effectiveness of RDPC within the project, the team will measure results using the ICHOM (International Consortium for Health Outcomes Measurement) for Pregnancy and Childbirth.[5] This consists of standard measurements for – among other things – obstetric and medical history, survival, severe maternal and neonatal morbidity, and patient-reported health and quality of life status next to experience measures for both patients and clinicians. The team will also measure process indicators such as inpatient admission days, days of telemonitoring, and amount of clinician-patient contact.

Expected impact

The PregnaDigit EU project team expect to reduce hospital admissions, contributing to a more resilient, affordable, equitable, and sustainable medical pregnancy care. Reducing hospital admissions will also reduce the cost of care per patient.

RDPC will positively impact not only mothers and their unborn child through higher satisfaction with the received care, but also family members (such as fathers and siblings) through allowing the mothers to remain in the safety of their home.

Next to this, there is significant environmental impact through lower work absenteeism among family members and a lower CO2 footprint through reduced in-hospital days and less traffic to and from hospitals. RDPC will not only impact patients and their families but also positively impact the health care professionals by decreasing their workload.

The team expect the overall social and societal impact to grow substantially through the increasing implementation of RDPC in and by more hospitals throughout Europe. By facilitating RDPC the project enhances patient outcomes, experiences, and access to care. The anticipated reduction in in-hospital admission days not only alleviates the burden on families but also on the health care professionals, fostering a more sustainable healthcare system.

External Partners

• Commercial – ICT HealthCare Technology Solutions
• Clinical – University Medical Center Utrecht
• Payor – Zilveren Kruis

References

^[1] ‘Eurostat’ (2024) available at: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Fertility_statistics (Accessed: 15 February 2024).

^[2] ‘WHO’ (2024) available at: https://platform.who.int/data/maternal-newborn-child-adolescent-ageing/indicator-explorer-new/mca/number-of-births-(thousands) (Accessed: 15 February 2024).

^[3] Van Den Heuvel, J.F.M. et al. (2020) ‘Home-Based Monitoring and Telemonitoring of Complicated Pregnancies: Nationwide Cross-Sectional Survey of Current Practice in the Netherlands,’ Jmir Mhealth and Uhealth, 8(10), p. e18966.

^[4] Leeman, L. et al. (2016). ‘Hypertensive Disorders of Pregnancy,’ American Family Physician, 93(2), pp.121–127.

^[5] Nijagal, M.A. et.al. (2018) ‘Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal’. BMC Health Services Research (18):953