Effectiveness of remote foetal health monitoring in improving maternal and foetal outcomes among high-risk pregnancies: A systematic review and meta-analysis.

BACKGROUND

Adverse perinatal outcomes remain a significant global health challenge, exacerbated by limited access to healthcare and the need for intensified surveillance in high-risk pregnancies. Traditional foetal monitoring methods have been complemented by emerging telemedicine solutions, which provide opportunities for continuous remote monitoring. However, the synthesis of evidence regarding their clinical effectiveness in high-risk populations remains insufficiently explored.

OBJECTIVE

This systematic review aims to evaluate the effectiveness of remote foetal health monitoring in improving maternal-foetal outcomes among high-risk pregnancies.

METHODS

We systematically searched Web of Science, Embase, PubMed, Scopus, CINAHL, Cochrane Library, the China Biomedical Literature Service System (Sino-Med), CNKI, Wanfang, and VIP Database from their inception until December 31, 2024. The search focused on randomised controlled trials comparing remote foetal health monitoring with routine prenatal care in high-risk pregnancies. The primary outcomes included maternal-foetal adverse outcomes and the detection rate of abnormal non-stress test. Two researchers independently conducted the study selection, data extraction, and risk-of-bias assessment using the Cochrane RoB 2 tool. Random-effects meta-analyses were performed using Review Manager version 5.4 and Stata version 18, with subgroup analyses based on predefined covariates, and the certainty of evidence was assessed using the GRADE framework.

RESULTS

A total of seventeen randomised controlled trials (n = 2782 participants) were included in this analysis, with the majority (15 trials) were conducted in China. Compared to traditional prenatal care, remote foetal health monitoring among high-risk pregnancies significantly reduced the likelihood of neonatal asphyxia (RR = 0.25, 95 % CI 0.17-0.37, p < 0.001) and the incidence of meconium-stained amniotic fluid (RR = 0.45, 95 % CI 0.27-0.75, p = 0.002), and improved the non-stress test abnormality detection rate (RR = 1.95, 95 % CI 1.19-3.18, p = 0.008). No statistically significant effect was observed on caesarean section rates (RR = 0.88, 95 % CI 0.76-1.03, p=0.110). The reduction in preterm birth (RR = 0.53, 95 % CI 0.36-0.76, p < 0.001) lost significance after adjusting for publication bias using the trim-and-fill method (RR = 0.85, 95 % CI 0.59-1.24, p = 0.401).

CONCLUSIONS

Remote foetal health monitoring effectively enhances foetal surveillance and reduces specific neonatal complications among high-risk pregnancies. However, the predominance of evidence from China may limit immediate generalisability to other settings. Future multinational studies are needed to confirm global applicability and assess cost-effectiveness.

REGISTRATION: PROSPERO CRD 42024606744, registered 29/11/2024.