Hans van den Heuvel

11 GENERAL DISCUSSION In this chapter, we will discuss additional considerations regarding previous described findings and use of digital health in pregnancy and childbirth care, in the context of: • safety, • user experiences, • shift into digital care, • value-based care. Also, implications for future use and research will be addressed. Safety of digital health in obstetric care The development of technological innovations and its implications for digital health may provide solutions for the need to optimize prenatal care. However, patient safety of digital health needs to be researched more extensively. Although there are clear examples of health benefit associated with digital health use, questions remain. 1 Blood pressure telemonitoring; what is known In the SAFE@HOME study, we studied the combination of symptom reporting and blood pressure measurements inwomenwith (increased risk of) hypertension in pregnancy. Given the importance of accurate blood pressure measurements, especially in pregnancy because of changes in maternal hemodynamics, international societies have published several protocols to validate BP monitors. 2 These validation protocols are developed to ensure that the accuracy of new to use BP monitors is comparable to a gold standard measuring device. In a recent systematic review of accuracy of devices for use in pregnancy, 41 articles were identified, assessing 28 devices. In 61% the device was validated using a standard or modified protocol and only 34% of validated devices (11/32 studies), the validation study was performed without a protocol violation of modification. 3 Because of the implications of (in)accurate BP measurements on medical decision making, we validated two BP monitors in a pregnant population using the ESH protocol (Chapter 3). Both the iHealth Track and Omron HEM-9210T, chosen because of their Bluetooth connectivity for use in an adjacent smartphone application, were validated for use in a pregnant population with and without hypertension and preeclampsia. As prenatal care is integrating mobile technology more and more, these validated monitors may contribute to remote monitoring in pregnancy. Moreover, a recent individual patient data meta-analysis compared clinic readings with self- monitored BP measurement of 758 pregnant subjects and found an insignificant difference between those two. This evidence is helpful to determine thresholds of alarms for women who self-monitor BP during pregnancy. 4 Subsequently, we developed a digital health platform for repeated measurements of BP and symptoms. Before its use in our intended population, we needed to assess several questions: SUMMARY AND GENERAL DISCUSSION 181