Monitoring postpartum patients with hypertensive disorders of pregnancy for follow-up care and service linkages using a smartphone application (MOMitor): a cohort study.

BACKGROUND

Hypertensive disorders of pregnancy (HDP) have continued to increase in prevalence among US women of reproductive age and are a leading cause of maternal morbidity and mortality. Digital health technologies may offer a novel approach in the detection and management of HDP.

OBJECTIVE

The purpose of this study is to report on the follow-up care and service linkages provided through a smartphone application (MOMitor) developed to monitor postpartum participants with HDP.

STUDY

DESIGN

This was a cohort study involving 861 pregnancies from a quaternary care institution in the southeastern United States. Postpartum participants with HDP were asked to complete hypertension assessments through the MOMitor app for a 6-week period. Participants were evaluated through the app for the need of follow-up care and service linkages. Primary outcomes were defined as counts of follow-up (nurse contacts following app triggers) and counts of service linkages by type.

RESULTS

A total of 5378 hypertension-related assessments were completed by 572 respondents. Follow-up calls by nurses were triggered 496 times, with the majority resulting in continued remote monitoring. Findings include: 2.3% (20/861) of participants were admitted to the hospital, 3.1% (27/861) were referred to labor and delivery or the emergency department, and 2.3% (20/861) were referred to clinic. Medication changes and nurse call requests each occurred in 0.2% (2/861) of cases. Continued monitoring was recommended for 18.5% (159/861) of participants, while 3.1% (27/861) could not be reached. Analysis of the 289 nonresponders to the app assessments demonstrated that nonresponders were more likely unmarried, Black, and had lower levels of education than responders.

CONCLUSION

Our findings demonstrate the feasibility of app-based monitoring and how such programs can function within the existing postpartum care model. Real-time monitoring of participants with HDP through MOMitor can assist clinical practice and reduce care burdens by providing increased follow-up and service care linkages to those at risk of maternal morbidity and mortality. Nonresponders did not generate app triggers, and therefore their clinical outcomes could not be ascertained through this protocol. As this group showed characteristics associated with increased morbidity and mortality, additional support, "nudges," incentives, and interventions may be needed.