Hans van den Heuvel

ABSTRACT Background Unrestricted by time and place, e-health applications provide solutions for patient empowerment and value based health care. Women in the reproductive age are particularly frequent users of Internet, social media and smartphone applications. Therefore, the pregnant patient seems to be a prime candidate for e-health supported health care with telemedicine for fetal and maternal conditions. Objective This study aims to review the current literature on e-health developments in pregnancy in order to assess this new generation of perinatal care. Methods We conducted a systematic literature search of studies on e-health technology in perinatal care in PubMed and EMBASE in June 2017. Studies reporting the use of e-health during prenatal, perinatal and postnatal care were included. Given the heterogeneity in study methods, used technologies and outcome measurements, results were analysed and presented in a narrative overview of the literature. Results The literature search provided 71 studies of interest. These studies were categorized in six domains: Information and e-health use, Lifestyle (gestational weight gain, exercise and smoking cessation), Gestational diabetes, Mental health, Low- and middle income countries and Telemonitoring/teleconsulting. Most studies in gestational diabetes and mental health show that e-health 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 behavioural therapy. Applications and exercise programs show a direction towards 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. Conclusions This review showed that e-health 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 CHAPTER 2 18