Hans van den Heuvel

SUMMARY In this thesis, we aimed to explore the use of digital health tools in different pregnancy care paths. Chapter 1 introduces the emergence of digital health and specifically telemonitoring in the obstetric care in the Netherlands. In chapter 2 , we describe the results of the literature research of the present knowledge on eHealth use in perinatal care. It includes users’ characteristics and domains such as diabetes care, mental health and telemonitoring. 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. In part I of the thesis we report the development of a digital telemonitoring platform for women at risk of hypertensive complications. In Chapter 3 , we describe a validation study of two automated blood pressure monitors with Bluetooth for the connection with a smartphone application. Both the iHealth Track and the OMRON HEM-9210T were validated in a group of 33 pregnant women with use of the 2010 protocol of the European Hypertension Society. The group consisted of women with and without hypertension. The Bluetooth functionality of both monitors can link to our telemonitoring platform for use in pregnancy. Chapter 4 shows the feasibility study of our telemonitoring platform, consisting of a smartphone application and connected BP monitor. This platform was tested in a group of low-risk pregnant women, without risk factors for hypertension. The objective was to assess participant compliance, efficacy of the automatic alert system and the usability and user satisfaction of the platform. Use of a digital platform for telemonitoring of blood pressure and preeclampsia symptoms was found feasible with good compliance, 93% and 85% for blood pressure and symptom checklists respectively. The majority of participants were satisfied with the system. In Chapter 5 we assessed the effects of our telemonitoring platform in women at high risk for hypertensive complications in pregnancy. We compared a prospective cohort of pregnant women (n=103) with telemonitoring and a predefined reduced antenatal visit schedule to a retrospective cohort (n=133) of women managed with usual care, without self-monitoring of blood pressure. Outcomes of interest were healthcare consumption, user CHAPTER 11 178