Hans van den Heuvel

1 INTRODUCTION Telemonitoring is a more advanced type of monitoring with self-recorded physiologic data and/or symptom scores transferred from the patients’ home to the health care professional with help of telephone or internet connection. After reviewing the uploaded data in the clinic, the health care professional can decide to contact the patient for more information or to ask her to visit the hospital for further management. In general, digital health has the potential to improve access to health care and support a shift from hospital-based to home-based care. It may help improvement of satisfaction of care while at the same time reduce clinic visits and admissions. Evidence from randomized clinical trials and systematic reviews demonstrate favourable outcomes for a diversity of (chronic) conditions, such as COPD, heart failure, diabetes, hypertension and cancer. 16 Improvements are seen in quality of life, all-cause mortality, disease-related hospitalizations and patient autonomy. By changing the use of health care resources and medical staff, digital health also has the potential to create a reduction of costs. Despite the positive results in several domains, there is a paucity of data on digital technology in pregnancy and childbirth care. To play a key role in the transformation of health care for both patients and caregivers in pregnancy care, unaddressed questions must be answered. Can it enhance antenatal care to deliver the quality that is required to result in equal or even better health outcomes? In this thesis we explore the questions and expectations that arise when digital technology meets healthcare for pregnant women. DIGITAL HEALTH IN PREGNANCY CARE At the start of our studies in 2016, we gathered all available evidence regarding use of eHealth in obstetric care in a literature search. We learned that eHealth was used in different domains of perinatal care; for information purpose, lifestyle improvement, diabetes care, mental health, telemonitoring and improvement of care in low- andmiddle-income countries (Figure 1). Fifteen studies described the characteristics of users of eHealth in their reproductive years. Around 88% of pregnant women owned a smartphone and 50-98% uses websites and apps for information on pregnancy. Women’s attitude towardsmedical information on the Internet is favourable, irrespective of age, education or social support. They value web-based medical information as moderately reliable and as helpful in the conversation with their caregiver on pregnancy subjects. Using this exploration of eHealth users, we concluded that eHealth may be helpful to address questions and assist in decision support for complicated pregnancies. 11