Telehealth in pregnancy
Authors: Rebecca M Reynolds
Journal: The Lancet Diabetes & Endocrinology (2020)

Telehealth lifestyle interventions are gaining increasing popularity for use in pregnancy for management of complications such as gestational diabetes1Xie W Dai P Qin Y Wu M Yang B Yu X Effectiveness of telemedicine for pregnant women with gestational diabetes mellitus: an updated meta-analysis of 32 randomized controlled trials with trial sequential analysis.BMC Pregnancy Childbirth. 2020; 20: 198Crossref PubMed Scopus (81) Google Scholar and for monitoring of blood pressure.2Kalafat E Benlioglu C Thilaganathan B Khalil A Home blood pressure monitoring in the antenatal and postpartum period: a systematic review meta-analysis.Pregnancy Hypertens. 2020; 19: 44-51Crossref PubMed Scopus (54) Google Scholar Telehealth has also been used in trials in low-income and middle-income countries, particularly in rural communities where access to antenatal care is challenging.3Modi D Dholakia N Gopalan R et al.mHealth intervention "ImTeCHO" to improve delivery of maternal, neonatal, and child care services-A cluster-randomized trial in tribal areas of Gujarat, India.PLoS Med. 2019; 16e1002939Crossref PubMed Scopus (52) Google Scholar The option of using telehealth in antenatal care has been brought sharply into focus with the coronavirus disease 2019 (COVID-19) pandemic. Pregnant women are considered a vulnerable group and are therefore advised to be stringent with public health measures such as social distancing and self-isolation to lower their risk of exposure to the virus. This advice has led to recommendations to limit face-to-face consultations and for rapid implementation of remote access to antenatal care throughout the UK.4Royal College of Obstetricians and GynaecologistsCoronavirus (COVID 19) infection in pregnancy guidelines version 5.https://www.rcog.org.uk/globalassets/documents/guidelines/2020-03-28-covid19-pregnancy-guidance.pdfDate accessed: April 21, 2020Google Scholar The methods and outcomes of the GLOW randomised controlled trial done by Assiamira Ferrara and colleagues5Ferrara A Hedderson MM Brown SD et al.A telehealth lifestyle intervention to reduce excess gestational weight gain in pregnant women with overweight or obesity (GLOW): a randomised, parallel-group, controlled trial.Lancet Diabetes Endocrinol. 2020; 8: 490-500Summary Full Text Full Text PDF PubMed Scopus (76) Google Scholar and published in The Lancet Diabetes and Endocrinology are therefore are therefore of interest and are particularly relevant during the current COVID-19 pandemic. GLOW was a randomised trial of a weight management intervention delivered by telephone during a pregnancy with an aim of reducing gestational weight gain in women with overweight or obesity (BMI 25·0–40·0 kg/m2). Eligible women were at 8–15 weeks' gestation and received two face-to-face consultations and 11 telephone sessions using behavioural strategies to improve weight, diet, and physical activity. Women in the intervention group had less gestational weight gain (GWG) and improved lifestyle and metabolic parameters than did those in the usual care group. 96 (48%) of 199 women in the lifestyle intervention group and 134 (69%) of 195 women in the usual care group exceeded Institute of Medicine guidelines for rate of GWG per week (relative risk 0·70, 95% CI 0·59–0·83). Compared to usual care, women in the intervention group also had reduced calorie intake, reduced proportion of calories they obtained from saturated fat, and less sedentary behaviour. Metabolic markers including insulin, homoeostatic model assessment of insulin resistance, and leptin were also lower in the intervention group than in the usual care group. Lifestyle interventions in pregnancy are difficult to undertake and often labour intensive.6Dalrymple KV Flynn AC Relph SA O'Keeffe M Poston L Lifestyle interventions in overweight and obese pregnant or postpartum women for postpartum weight management: a systematic review of the literature.Nutrients. 2018; 10e1704Crossref Scopus (53) Google Scholar Use of telehealth has been increasingly adopted in management of obesity in the general population.7Shannon HH Joseph R Puro N Darrell E Use of technology in the management of obesity: a literature review.Perspect Health Inf Manag. 2019; 16: 1cPubMed Google Scholar The GLOW trial reports a robust approach of delivering a telehealth weight management intervention in pregnancy with success at reducing GWG. Detailed descriptions of the intervention, including the lengths of consultations and an estimate of the costs are included, which are helpful for considering implementation of the intervention in health services. Of note, the trial was not powered to look at perinatal outcomes and no differences in perinatal complications were observed. Indeed, a previous individual patient data meta-analysis, including data from 36 randomised trials (12 526 women), showed that interventions that reduce GWG do not have an effect on key maternal and fetal outcomes, except caesarean section rates.8International Weight Management in Pregnancy (i-WIP) Collaborative GroupEffect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials.BMJ. 2017; 358j3119Google Scholar Much debate remains about why these lifestyle interventions have had no effect on clinical outcomes and whether there are wider implications for the long-term health of the mother and her family. In the rapid implementation of delivery of remote antenatal care in response to COVID-19 there remain many uncertainties. There is limited knowledge about women's views of use of telehealth for monitoring pregnancy complications although available data suggests that women find this to be a positive experience.9van den Heuvel JFM Teunis CJ Franx A Crombag NMTH Bekker MN Home-based telemonitoring versus hospital admission in high risk pregnancies: a qualitative study on women's experiences.BMC Pregnancy Childbirth. 2020; 20: 77Crossref PubMed Scopus (29) Google Scholar There is concern that most of the trials of telehealth technologies have been done in highly selected groups and so the findings might not be applicable to the wider population. Notably, the GLOW trial also had very strict eligibility criteria, and in particular excluded women with mental health problems and other medical comorbidities, which will likely limit its generalisability. Concerns about usability of technology, reliability of data, and ability to inform clinical decision making have also been raised10Alves DS Times VC da Silva ÉMA Melo PSA Novaes MA Advances in obstetric telemonitoring: a systematic review.Int J Med Inform. 2020; 134104004Crossref PubMed Scopus (30) Google Scholar and critical evaluation of the changes in practice will be needed. The GLOW trial suggests that an appropriate and effective telehealth intervention, when delivered by skilled researchers, offers promise to reduce excess GWG in overweight and obese pregnancy. With continuing development and refinement of technologies, such studies provide important lessons that can be applied and used more widely. I declare no competing interests. A telehealth lifestyle intervention to reduce excess gestational weight gain in pregnant women with overweight or obesity (GLOW): a randomised, parallel-group, controlled trialOur evidence-based programme showed that health-care delivery systems could further adapt to meet the needs of their clinical settings to prevent excess GWG and improve healthy behaviours and markers of insulin resistance among women with overweight or obesity by using telehealth lifestyle interventions. Full-Text PDF