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Semin Reprod Med 2024; 42(02): 140-150
DOI: 10.1055/s-0044-1791206
DOI: 10.1055/s-0044-1791206
Review Article
Impact of Digital Health Interventions on Birth Equity: A Review
Abstract
The rise in smartphone utilization and technology uptake has popularized digital health interventions as a means of supporting healthy pregnancies and optimizing maternal and child health. Digital health interventions include several modalities, such as telemedicine, remote patient monitoring, smartphone applications, web-based interventions, wearables, and health information technology. However, the impact of these interventions on improving maternal and infant health outcomes by race and socioeconomic status to achieve birth equity is unknown. This review summarizes current literature on the impact of digital health interventions on the outcomes of communities of color and lower socioeconomic status in the United States. We demonstrate there is emerging evidence of the impact of digital health interventions on maternal health outcomes, particularly for telemedicine, but evidence specifically focused on assessing outcomes by race and ethnicity and for other modalities, like mHealth apps or wearables, is limited. Digital health interventions may play a part in birth equity initiatives, but should not be considered a standalone solution, and instead should be integrated into other existing efforts to achieve birth equity, like diversifying the clinician workforce, expanding access to high-quality prenatal and postpartum care, or delivering respectful maternity care.
Publication History
Article published online:
30 September 2024
© 2024. Thieme. All rights reserved.
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References
- 1 Crear-Perry J. Black Maternal Health Inequities: New York State Task Force on Maternal Mortality and Disparate Racial Outcomes. National Birth Equity Collaborative; 2018: 8 . Accessed May 14, 2024 at: https://www.health.ny.gov/community/adults/women/task_force_maternal_mortality/docs/meeting1/2018-06_crear-perry_nys_mm.pdf
- 2 Gunja M, Gumas E, Williams II R. The U.S. Maternal Mortality Crisis Continues to Worsen: An International Comparison, to the Point by the Commonwealth Fund. Published December 1, 2022. Accessed May 14, 2024 at: https://www.commonwealthfund.org/blog/2022/us-maternal-mortality-crisis-continues-worsen-international-comparison
- 3 Trost S, Beauregard J, Nije F. Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017–2019. Centers for Disease Control and Prevention, US Department of Health and Human Services; 2022. . Accessed May 14, 2024 at: https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/data-mmrc.html
- 4 Hoyert D. Maternal mortality rates in the United States, 2021. NCHS Health E-Stats. Published online 2023. Accessed September 3, 2024 at:
- 5 Centers for Disease Control and Prevention. Working Together to Reduce Black Maternal Mortality. www.cdc.gov. Published April 8, 2024. Accessed May 14, 2024 at: https://www.cdc.gov/healthequity/features/maternal-mortality/index.html
- 6 Hill L, Artiga S, Ranji U. Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them. 2022 . Accessed May 14, 2024 at: https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/
- 7 Petersen EE, Davis NL, Goodman D. et al. Racial/Ethnic disparities in pregnancy-related deaths - United States, 2007-2016. MMWR Morb Mortal Wkly Rep 2019; 68 (35) 762-765
- 8 Impact RH. National Committee for Quality Assurance. The Birth Equity Measurement Framework: A Quality Measurement Strategy to Promote Equitable Birthing Care. 2023. Accessed May 14, 2024 at: https://www.ncqa.org/wp-content/uploads/BEAM-Framework-Report.pdf
- 9 FDA. What is Digital Health? FDA. Published online September 22, 2020. Accessed May 14, 2024 at: https://www.fda.gov/medical-devices/digital-health-center-excellence/what-digital-health
- 10 Osterman MJK, Hamilton BE, Martin JA, Driscoll AK, Valenzuela CP. Births: final data for 2022. Natl Vital Stat Rep 2024; 73 (02) 1-56
- 11 CDC. Gestational Diabetes. Centers for Disease Control and Prevention. Published May 30, 2019. Accessed May 14, 2024 at: https://www.cdc.gov/diabetes/basics/gestational.html
- 12 Leslie M, Briggs L. Preeclampsia Foundation Position Paper: Preeclampsia and Future Cardiovascular Disease.; 2020. Accessed May 14, 2024 at: https://www.preeclampsia.org/public/frontend/assets/img/gallery/pdf/FINAL_PE_CVD_POSITION-PAPER_2020.pdf
- 13 Ferranti EP, Jones EJ, Bush S. et al. A call to action: cardiovascular-related maternal mortality: inequities in black, indigenous, and persons of color. J Cardiovasc Nurs 2021; 36 (04) 310-311
- 14 Federal Communications Commission. Telehealth, Telemedicine and Telecare: What's What? FCC. Published September 17, 2014. Accessed May 14, 2024 at: https://www.fcc.gov/general/telehealth-telemedicine-and-telecare-whats-what
- 15 Connolly G. Consolidated Appropriations Act, 2023.; 2021. Accessed May 14, 2024 at: https://www.congress.gov/bill/117th-congress/house-bill/2617
- 16 Firth S. House Members Struggle to Craft Road Map for Future of Telehealth. Medpagetoday.com. Published April 11, 2024. Accessed May 14, 2024 at: https://www.medpagetoday.com/practicemanagement/telehealth/109617
- 17 Kern-Goldberger AR, Srinivas SK. Telemedicine in obstetrics. Clin Perinatol 2020; 47 (04) 743-757
- 18 Kilpatrick S, Papile L, Macones G, Watterberg K. American Academy of Pediatrics Committee on Fetus and Newborn; American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Guidelines for Perinatal Care. 8th ed.. American Academy of Pediatrics; 2017
- 19 Holcomb DS, Pengetnze Y, Steele A, Karam A, Spong C, Nelson DB. Geographic barriers to prenatal care access and their consequences. Am J Obstet Gynecol MFM 2021; 3 (05) 100442
- 20 Phillippi JC. Women's perceptions of access to prenatal care in the United States: a literature review. J Midwifery Womens Health 2009; 54 (03) 219-225
- 21 Wolf ER, Hochheimer CJ, Sabo RT. et al. Gaps in well-child care attendance among primary care clinics serving low-income families. Pediatrics 2018; 142 (05) e20174019
- 22 Wolf ER, Donahue E, Sabo RT, Nelson BB, Krist AH. Barriers to attendance of prenatal and well-child visits. Acad Pediatr 2021; 21 (06) 955-960
- 23 March of Dimes. Nowhere to Go: Maternity Care Deserts across the U.S.; 2022. Accessed May 14, 2024 at: https://www.marchofdimes.org/sites/default/files/2022-10/2022_Maternity_Care_Report.pdf
- 24 Peahl AF, Zahn CM, Turrentine M. et al. The Michigan Plan for appropriate tailored healthcare in pregnancy prenatal care recommendations. Obstet Gynecol 2021; 138 (04) 593-602
- 25 The American College of Obstetricians and Gynecologists. Redesigning Prenatal Care Initiative. www.acog.org Accessed May 14, 2024 at: https://www.acog.org/programs/redesigning-prenatal-care-initiative
- 26 Danilack VA, Nunes AP, Phipps MG. Unexpected complications of low-risk pregnancies in the United States. Am J Obstet Gynecol 2015; 212 (06) 809.e1-809.e6
- 27 Wu KK, Lopez C, Nichols M. Virtual visits in prenatal care: an integrative review. J Midwifery Womens Health 2022; 67 (01) 39-52
- 28 Woo VG, Lundeen T, Matula S, Milstein A. Achieving higher-value obstetrical care. Am J Obstet Gynecol 2017; 216 (03) 250.e1-250.e14
- 29 Butler Tobah YS, LeBlanc A, Branda ME. et al. Randomized comparison of a reduced-visit prenatal care model enhanced with remote monitoring. Am J Obstet Gynecol 2019; 221 (06) 638.e1-638.e8
- 30 Theiler RN, Butler-Tobah Y, Hathcock MA, Famuyide A. OB Nest randomized controlled trial: a cost comparison of reduced visit compared to traditional prenatal care. BMC Pregnancy Childbirth 2021; 21 (01) 71
- 31 Pflugeisen BM, McCarren C, Poore S, Carlile M, Schroeder R. Virtual visits: managing prenatal care with modern technology. MCN Am J Matern Child Nurs 2016; 41 (01) 24-30
- 32 Ghimire S, Martinez S, Hartvigsen G, Gerdes M. Virtual prenatal care: a systematic review of pregnant women's and healthcare professionals' experiences, needs, and preferences for quality care. Int J Med Inform 2023; 170: 104964
- 33 Kumar NR, Arias MP, Leitner K, Wang E, Clement EG, Hamm RF. Assessing the impact of telehealth implementation on postpartum outcomes for Black birthing people. Am J Obstet Gynecol MFM 2023; 5 (02) 100831
- 34 Thomas MP, Ammann G, Brazier E, Noyes P, Maybank A. Doula services within a healthy start program: increasing access for an underserved population. Matern Child Health J 2017; 21 (Suppl. 01) 59-64
- 35 Ramey-Collier K, Jackson M, Malloy A, McMillan C, Scraders-Pyatt A, Wheeler SM. Doula Care: a review of outcomes and impact on birth experience. Obstet Gynecol Surv 2023; 78 (02) 124-127
- 36 Karwa S, Jahnke H, Brinson A, Shah N, Guille C, Henrich N. Association between doula use on a digital health platform and birth outcomes. Obstet Gynecol 2024; 143 (02) 175-183
- 37 Gonzalez D, Kenney GM, McDaniel M, O'Brien C. Racial, Ethnic, and Language Concordance between Patients and Their Usual Health Care Providers. Robert Wood Johnson Foundation; 2022. Accessed September 3, 2024 at: https://www.rwjf.org/en/insights/our-research/2022/03/racial-ethnic-and-language-concordance-between-patients-and-their-usual-healthcare-providers.html
- 38 Greenwood BN, Hardeman RR, Huang L, Sojourner A. Physician-patient racial concordance and disparities in birthing mortality for newborns. Proc Natl Acad Sci U S A 2020; 117 (35) 21194-21200
- 39 Acoba JD, Yin C, Meno M. et al. Racial disparities in patient provider communication in telehealth versus face-to-face visits, a focus on Asian and Native Hawaiian and other Pacific Islander cancer patients: a cross sectional analysis. JMIR Cancer 2022; 8 (04)
- 40 U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. Projections of Supply and Demand for Women's Health Service Providers: 2018–2030.; 2021. Accessed May 14, 2024 at: https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/projections-supply-demand-2018-2030.pdf
- 41 Orgera K, Mahmood H, Grover A. Training location preferences of U.S. medical school graduates post Dobbs v. Jackson Women's Health Organization Decision. Association of American Medical Colleges. Published online June 29, 2023. Accessed September 3, 2024 at: 10.15766/rai_2rw8fvba
- 42 Pew Research Center. Internet, Broadband Fact Sheet. Pew Research Center. Published January 31, 2024. Accessed May 14, 2024 at: https://www.pewresearch.org/internet/fact-sheet/internet-broadband/?tabItem=480dace1-fd73-4f03-ad88-eae66e1f4217
- 43 Farrell RM, Craighead C, Collart C. et al. The impact of telehealth on the delivery of prenatal care during COVID-19: a mixed methods study of barriers and opportunities to improve healthcare communication in discussions about pregnancy and prenatal genetic testing (preprint). JMIR Form Res 2022; 6 (12) e38821
- 44 U.S. Department of Health and Human Services. Telehealth and Remote Patient Monitoring. telehealth.hhs.gov . Published May 11, 2023. Accessed May 14, 2024 at: https://telehealth.hhs.gov/providers/preparing-patients-for-telehealth/telehealth-and-remote-patient-monitoring
- 45 Yue SW, Zhou J, Li L. et al. Effectiveness of remote monitoring for glycemic control on maternal-fetal outcomes in women with gestational diabetes mellitus: a meta-analysis. Birth 2024; 51 (01) 13-27
- 46 Atkinson J, Hastie R, Walker S, Lindquist A, Tong S. Telehealth in antenatal care: recent insights and advances. BMC Med 2023; 21 (01) 332
- 47 Corlin T, Raghuraman N, Rampersad RM, Sabol BA. Postpartum remote home blood pressure monitoring: the new frontier. AJOG Glob Rep 2023; 3 (03) 100251
- 48 Choi E, Kazzi B, Varma B. et al. The fourth trimester: a time for enhancing transitions in cardiovascular care. Curr Cardiovasc Risk Rep 2022; 16 (12) 219-229
- 49 Saldanha IJ, Adam GP, Kanaan G. et al. Delivery strategies for postpartum care: a systematic review and meta-analysis. Obstet Gynecol 2023; 142 (03) 529-542
- 50 Brown MA, Magee LA, Kenny LC. et al; International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertensive disorders of pregnancy. Hypertension 2018; 72 (01) 24-43
- 51 Johnson S, Liu B, Kalafat E, Thilaganathan B, Khalil A. Maternal and perinatal outcomes of white coat hypertension during pregnancy. Hypertension 2020; 76 (01) 157-166
- 52 Vogel B, Acevedo M, Appelman Y. et al. The Lancet women and cardiovascular disease commission: reducing the global burden by 2030. Lancet 2021; 397 (10292): 2385-2438
- 53 Mehta LS, Velarde GP, Lewey J. et al; American Heart Association Cardiovascular Disease and Stroke in Women and Underrepresented Populations Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Hypertension; Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Lifestyle and Cardiometabolic Health; Council on Peripheral Vascular Disease; and Stroke Council. Cardiovascular disease risk factors in women: the impact of race and ethnicity: a scientific statement from the American Heart Association. Circulation 2023; 147 (19) 1471-1487
- 54 Sanghavi M, Packard E, Sperling S. et al. Telemedicine may increase visit completion rates in postpartum patients with preeclampsia. PLoS One 2022; 17 (10) e0275741
- 55 Lewey J, Murphy S, Zhang D. et al. Effectiveness of a text-based gamification intervention to improve physical activity among postpartum individuals with hypertensive disorders of pregnancy: a randomized clinical trial. JAMA Cardiol 2022; 7 (06) 591-599
- 56 Hirshberg A, Downes K, Srinivas S. Comparing standard office-based follow-up with text-based remote monitoring in the management of postpartum hypertension: a randomised clinical trial. BMJ Qual Saf 2018; 27 (11) 871-877
- 57 de Mooij MJM, Hodny RL, O'Neil DA. et al. OB Nest: reimagining low-risk prenatal care. Mayo Clin Proc 2018; 93 (04) 458-466
- 58 Steele DW, Adam GP, Saldanha IJ. et al. Postpartum home blood pressure monitoring: a systematic review. Obstet Gynecol 2023; 142 (02) 285-295
- 59 Homko CJ, Santamore WP, Whiteman V. et al. Use of an internet-based telemedicine system to manage underserved women with gestational diabetes mellitus. Diabetes Technol Ther 2007; 9 (03) 297-306
- 60 Pew Research Center. Mobile Fact Sheet. Pew Research Center. Published January 31, 2024. Accessed May 14, 2024 at: https://www.pewresearch.org/internet/fact-sheet/mobile/?tabItem=64e32376-5a21-4b1d-8f8b-5f92406db984
- 61 Peragallo Urrutia R, Berger AA, Ivins AA, Beckham AJ, Thorp Jr JM, Nicholson WK. Internet use and access among pregnant women via computer and mobile phone: implications for delivery of perinatal care. JMIR Mhealth Uhealth 2015; 3 (01) e25
- 62 IMS Institute for Healthcare Informatics. Patient Adoption of MHealth: Use, Evidence and Remaining Barriers to Mainstream Acceptance. IMS Institute for Healthcare Informatics; 2015. Accessed May 14, 2024 at: https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/patient-adoption-of-mhealth.pdf
- 63 Schela J. The State of App Discovery. Business of Apps. Published August 5, 2020. Accessed May 14, 2024 at: https://www.businessofapps.com/insights/the-state-of-app-discovery
- 64 Lee Y, Moon M. Utilization and content evaluation of mobile applications for pregnancy, birth, and child care. Healthc Inform Res 2016; 22 (02) 73-80
- 65 Goetz M, Müller M, Matthies LM. et al. Perceptions of patient engagement applications during pregnancy: a qualitative assessment of the patient's perspective. JMIR Mhealth Uhealth 2017; 5 (05) e73
- 66 Wallwiener S, Müller M, Doster A. et al. Pregnancy eHealth and mHealth: user proportions and characteristics of pregnant women using Web-based information sources-a cross-sectional study. Arch Gynecol Obstet 2016; 294 (05) 937-944
- 67 Jang J, Dworkin J, Hessel H. Mothers' use of information and communication technologies for information seeking. Cyberpsychol Behav Soc Netw 2015; 18 (04) 221-227
- 68 Kraschnewski JL, Chuang CH, Poole ES. et al. Paging “Dr. Google”: does technology fill the gap created by the prenatal care visit structure? Qualitative focus group study with pregnant women. J Med Internet Res 2014; 16 (06) e147
- 69 Lupton D. The use and value of digital media for information about pregnancy and early motherhood: a focus group study. BMC Pregnancy Childbirth 2016; 16 (01) 171
- 70 Salvatore GM, Bercovitz I, Arigo D. Women's comfort with mobile applications for menstrual cycle self-monitoring following the overturning of Roe v. Wade . mHealth 2023; 10 (01) 1
- 71 Solomon Center for Health Law and Policy Yale Law School, Strathmore Health Strategy. A Path to Patient-Centered Digital Health Regulation. (Knox R, Tenenbaum C, eds.). Yale Law School; 2021. Accessed May 14, 2024 at: https://law.yale.edu/sites/default/files/area/center/solomon/document/digital_health_policy_paper_final.pdf
- 72 Narasimhulu DM, Karakash S, Weedon J, Minkoff H. Patterns of Internet use by pregnant women, and reliability of pregnancy-related searches. Matern Child Health J 2016; 20 (12) 2502-2509
- 73 Phillips JC, Alfano AR, Barfield LC. et al. Exploring maternal and infant health app development and effectiveness research: scoping review. JMIR Pediatr Parent 2024; 7: e46973
- 74 Hughson JP, Daly JO, Woodward-Kron R, Hajek J, Story D. The rise of pregnancy apps and the implications for culturally and linguistically diverse women: narrative review. JMIR Mhealth Uhealth 2018; 6 (11) e189
- 75 Guendelman S, Broderick A, Mlo H, Gemmill A, Lindeman D. Listening to communities: mixed-method study of the engagement of disadvantaged mothers and pregnant women with digital health technologies. J Med Internet Res 2017; 19 (07) e240
- 76 Amante DJ, Hogan TP, Pagoto SL, English TM, Lapane KL. Access to care and use of the Internet to search for health information: results from the US National Health Interview Survey. J Med Internet Res 2015; 17 (04) e106
- 77 Van Dijk MR, Huijgen NA, Willemsen SP, Laven JS, Steegers EA, Steegers-Theunissen RP. Impact of an mHealth platform for pregnancy on nutrition and lifestyle of the reproductive population: a survey. JMIR Mhealth Uhealth 2016; 4 (02) e53
- 78 Hussain T, Smith P, Yee LM. Mobile phone-based behavioral interventions in pregnancy to promote maternal and fetal health in high-income countries: systematic review. JMIR Mhealth Uhealth 2020; 8 (05) e15111
- 79 Lazarevic N, Lecoq M, Bœhm C, Caillaud C. Pregnancy apps for self-monitoring: scoping review of the most popular global apps available in Australia. Int J Environ Res Public Health 2023; 20 (02) 1012
- 80 Brewer LC, Jenkins S, Hayes SN. et al. Community-based, cluster-randomized pilot trial of a cardiovascular mobile health intervention: preliminary findings of the FAITH! Trial. Circulation 2022; 146 (03) 175-190
- 81 IRTH. IRTH App. Published 2024. Accessed May 14, 2024 at: https://irthapp.com/?gad_source=1&gclid=CjwKCAjw9IayBhBJEiwAVuc3fldPIJbdKg2Fhv2-BmCbR6cHsAHq4JGLJ3fizGpRBtwyp5D1WSCO-BoCG74QAvD_BwE
- 82 Hospital Pilot Program. IRTH App. Published 2024. Accessed May 14, 2024 at: https://irthapp.com/hospital-pilot-program/
- 83 Dhingra LS, Aminorroaya A, Oikonomou EK. et al. Use of wearable devices in individuals with or at risk for cardiovascular disease in the US, 2019 to 2020. JAMA Netw Open 2023; 6 (06) e2316634-e2316634
- 84 Vogels EA. 21% of Americans say they use smart watches or fitness trackers. Pew Research Center. Published January 9, 2020. Accessed May 14, 2024 at: https://www.pewresearch.org/short-reads/2020/01/09/about-one-in-five-americans-use-a-smart-watch-or-fitness-tracker/ft_2020-01-09_fitnesstrackers_01a-png/
- 85 Maugeri A, Barchitta M, Agodi A. How wearable sensors can support the research on foetal and pregnancy outcomes: a scoping review. J Pers Med 2023; 13 (02) 218
- 86 Runkle J, Sugg M, Boase D, Galvin SLC, C. Coulson C. Use of wearable sensors for pregnancy health and environmental monitoring: descriptive findings from the perspective of patients and providers. Digit Health 2019; 5 (06) 2055207619828220
- 87 Azizi Z, Adedinsewo D, Rodriguez F, Lewey J, Merchant RM, Brewer LC. Leveraging digital health to improve the cardiovascular health of women. Curr Cardiovasc Risk Rep 2023; 17 (11) 205-214
- 88 Jasinski SR, Rowan S, Presby DM, Claydon EA, Capodilupo ER. Wearable-derived maternal heart rate variability as a novel digital biomarker of preterm birth. PLoS One 2024; 19 (01) e0295899-e0295899
- 89 Erickson EN, Gotlieb N, Pereira LM, Myatt L, Mosquera-Lopez C, Jacobs PG. Predicting labor onset relative to the estimated date of delivery using smart ring physiological data. NPJ Digit Med 2023; 6 (01) 153
- 90 American Family Physician. Don't promote induction or augmentation of labor and don't induce or augment labor without a medical indication; spontaneous labor is safest for woman and infant, with benefits that improve safety and promote short- and long-term maternal and infant health. www.aafp.org . Published 2024. Accessed September 3, 2024 at: https://www.aafp.org/pubs/afp/collections/choosing-wisely/307.html
- 91 Holko M, Litwin TR, Munoz F. et al. Wearable fitness tracker use in federally qualified health center patients: strategies to improve the health of all of us using digital health devices. . Digit Med 2022; 5 (01) 1-6
- 92 Slachta A. Medical wearables market projected to surpass $29B by 2026. cardiovascularbusiness.com. Published April 24, 2019. Accessed May 14, 2024 at: https://cardiovascularbusiness.com/topics/healthcare-management/healthcare-economics/medical-wearables-market-surpass-29b-2026#:~:text=Wearable%20medical%20devices%20are%20used
- 93 Goodday SM, Karlin E, Brooks A. et al. Better understanding of the metamorphosis of pregnancy (BUMP): protocol for a digital feasibility study in women from preconception to postpartum. NPJ Digit Med 2022; 5 (01) 40