van den Heuvel Josephus Fm, Groenhof T Katrien, Veerbeek Jan Hw, van Solinge Wouter W, Lely A Titia, Franx Arie, Bekker Mireille N
Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
J Med Internet Res. 2018 Jun 5;20(6):e202. doi: 10.2196/jmir.9262.
Unrestricted by time and place, electronic health (eHealth) provides solutions for patient empowerment and value-based health care. Women in the reproductive age are particularly frequent users of internet, social media, and smartphone apps. Therefore, the pregnant patient seems to be a prime candidate for eHealth-supported health care with telemedicine for fetal and maternal conditions.
This study aims to review the current literature on eHealth developments in pregnancy to assess this new generation of perinatal care.
We conducted a systematic literature search of studies on eHealth technology in perinatal care in PubMed and EMBASE in June 2017. Studies reporting the use of eHealth during prenatal, perinatal, and postnatal care were included. Given the heterogeneity in study methods, used technologies, and outcome measurements, results were analyzed and presented in a narrative overview of the literature.
The literature search provided 71 studies of interest. These studies were categorized in 6 domains: information and eHealth use, lifestyle (gestational weight gain, exercise, and smoking cessation), gestational diabetes, mental health, low- and middle-income countries, and telemonitoring and teleconsulting. Most studies in gestational diabetes and mental health show that eHealth applications are good alternatives to standard practice. Examples are interactive blood glucose management with remote care using smartphones, telephone screening for postnatal depression, and Web-based cognitive behavioral therapy. Apps and exercise programs show a direction toward less gestational weight gain, increase in step count, and increase in smoking abstinence. Multiple studies describe novel systems to enable home fetal monitoring with cardiotocography and uterine activity. However, only few studies assess outcomes in terms of fetal monitoring safety and efficacy in high-risk pregnancy. Patients and clinicians report good overall satisfaction with new strategies that enable the shift from hospital-centered to patient-centered care.
This review showed that eHealth interventions have a very broad, multilevel field of application focused on perinatal care in all its aspects. Most of the reviewed 71 articles were published after 2013, suggesting this novel type of care is an important topic of clinical and scientific relevance. Despite the promising preliminary results as presented, we accentuate the need for evidence for health outcomes, patient satisfaction, and the impact on costs of the possibilities of eHealth interventions in perinatal care. In general, the combination of increased patient empowerment and home pregnancy care could lead to more satisfaction and efficiency. Despite the challenges of privacy, liability, and costs, eHealth is very likely to disperse globally in the next decade, and it has the potential to deliver a revolution in perinatal care.
电子健康（eHealth）不受时间和地点限制，为患者赋权和基于价值的医疗保健提供了解决方案。育龄女性是互联网、社交媒体和智能手机应用程序的特别频繁使用者。因此，怀孕患者似乎是接受电子健康支持的医疗保健以及针对胎儿和产妇状况的远程医疗的主要候选人群。
本研究旨在回顾当前关于孕期电子健康发展的文献，以评估这一新一代围产期保健方式。
2017年6月，我们在PubMed和EMBASE中对围产期保健中电子健康技术的研究进行了系统的文献检索。纳入了报告在产前、围产期和产后保健中使用电子健康的研究。鉴于研究方法、所使用技术和结果测量方面的异质性，对结果进行了分析，并以文献叙述性综述的形式呈现。
文献检索得到71项相关研究。这些研究分为6个领域：信息与电子健康使用、生活方式（孕期体重增加、运动和戒烟）、妊娠期糖尿病、心理健康、低收入和中等收入国家以及远程监测和远程咨询。大多数关于妊娠期糖尿病和心理健康的研究表明，电子健康应用是标准做法的良好替代方案。例如，使用智能手机进行远程护理的交互式血糖管理、产后抑郁症的电话筛查以及基于网络的认知行为疗法。应用程序和运动项目显示出有助于减少孕期体重增加、增加步数和提高戒烟率的趋势。多项研究描述了通过胎心监护和子宫活动实现家庭胎儿监测的新系统。然而，只有少数研究评估了高危妊娠中胎儿监测安全性和有效性方面的结果。患者和临床医生对能够实现从以医院为中心向以患者为中心的护理转变的新策略总体满意度较高。
本综述表明，电子健康干预措施具有非常广泛的、多层次的应用领域，涵盖围产期保健的各个方面。所审查的71篇文章中，大多数是2013年以后发表的，这表明这种新型护理是一个具有临床和科学相关性的重要主题。尽管呈现出了有前景的初步结果，但我们强调需要有证据证明电子健康干预措施在围产期保健中的健康结果、患者满意度以及对成本的影响。总体而言，增强患者权能与家庭孕期护理相结合可能会带来更高的满意度和效率。尽管存在隐私、责任和成本等挑战，但电子健康很可能在未来十年在全球范围内得到推广，并且有潜力在围产期保健领域引发一场革命。
