Telehealth interventions including text messaging and remote monitoring may improve obstetric and gynecologic outcomes, according to a review published in Obstetrics & Gynecology. These interventions appear to reduce perinatal smoking, increase breastfeeding rates, and improve early access to medical abortion services.
The review included 19 primary studies in English that had a comparison group, were performed in developed countries, and assessed obstetric and gynecologic health outcomes. All studies evaluated the use of virtual care delivery in a reproductive setting. This included mobile media, remote monitoring and care-delivery, patient-generated data, and virtual visits. Researchers who performed the literature review sought to determine whether telehealth interventions like these improve outcomes or were adjunct or alternative to standard of care in low- and high-risk obstetrics, family planning, and gynecology.
Studies that met the inclusion criteria for the review included 17 randomized controlled trials, 1 retrospective study, and 1 case-control study. There was a total of 6827 patients in all included studies. Telehealth was associated with improvements in overall obstetric outcomes associated with smoking cessation and breastfeeding. Vaccine uptake was low in these studies and the receipt of text messages that encouraged influenza vaccination did not improve vaccination rates. Despite the lack of benefit in improving vaccination, text messages were associated with improvements in the continuation of breastfeeding in a separate study.
In addition, telehealth interventions were associated with reductions in the need for high-risk obstetric monitoring office visits. Remote monitoring was associated with less frequent progression to preeclampsia in women with gestational hypertension. The use of telehealth was also associated with improvements in the continuation of oral and injectable contraception, with 1 study showing increased oral contraception rates 6 months after 6 months of telehealth use. In addition, telehealth improved access to early abortion.
Review limitations of the review were the exclusion of articles not published in English and the inclusion of only studies performed in developed nations.
While this review shows promising findings for the use of telehealth in improving obstetric and gynecologic health outcomes, the investigators suggest additional “evidence is needed to help clinicians determine how they might integrate telehealth into practice in ways that clearly improve patient care.”
DeNicola N, Grossman D, Marko K, et al. Telehealth interventions to improve obstetric and gynecologic health outcomes: a systematic review. Obstet Gynecol. 2020;135(2):371-382.