By: Erin Davis, MS, RDN, CDCES

A high-risk pregnancy requires increased screening, monitoring, and follow-up appointments. Add in a full-time job and/or a child or more at home, and it’s challenging for patients to make it to everything. How can you better support your busy patients while providing top-notch care? 

One option may be meeting the patient where they are. Since COVID-19, telehealth has become an increasingly available option to provide medical care to many different populations. The pandemic necessitated the use of technology for providers to connect with patients. In its wake, we’ve found that telemedicine is here to stay. 

Patients can access specialists and allied health professionals who might not be available locally. Just as important is the time savings for the patients. There is no need to take half a day off work for an appointment when you can log in on your lunch break. This is especially appealing to pregnant patients who are juggling multiple commitments.

Telehealth may offer patients convenience and support throughout their pregnancy, but what about the outcomes? Are you wondering how the addition of telehealth and remote patient monitoring in pregnancy can complement the in-person care you provide? We’ve scoured the recent literature on the benefits of telehealth and remote patient monitoring in pregnancy to share the perks. 

Nothing Beats Face-to-Face Care

First, let’s start by emphasizing the value of in-person visits for prenatal care. You’re establishing a relationship built on trust and dependability, and every in-person contact adds to the experience. Especially during pregnancy. 

Furthermore, prenatal care requires physical examination. You’re performing fundal height measurements, pelvic exams, and evaluating fetal heart rates. But telehealth or remote services may be a complement to these essential face-to-face visits to provide thorough and superior prenatal care and education.

Prenatal Telehealth Services

Of course, in-person contact with a patient is necessary in pregnancy. Digital health companies like Maven Clinic and Babyscripts have done an incredible amount of fundraising and have made telehealth more accessible to pregnant patients. So where does telehealth fit in the prenatal care equation?

Clinics are starting to embrace the flexibility and increased touchpoints that telehealth can provide. For example, The University of Michigan has implemented a prenatal care model of 4 in-person visits, 1 ultrasound, and 4 telehealth visits.¹  

Prenatal telehealth visits can take the place of real-time contacts that are recommended at regular intervals throughout pregnancy. Here are the recommended cadence and frequency of visits during pregnancy:

• ACOG (American College of Obstetricians and Gynecologists): The total number of visits is individualized based on patient needs. The initial visit should be in the first trimester, ideally before 13 6/7 weeks. Then visits should occur every 4 weeks until 28 weeks, transitioning to every 2 weeks until 36 weeks, and ending with weekly until delivery. 

• WHO (World Health Organization): Recommends 8 total contacts with healthcare providers with the first visit up to 12 weeks. 

High-risk pregnancies, such as ones complicated by hypertension or gestational diabetes (GDM) can require increased visits and deserve heightened medical attention. Telehealth can conveniently meet the needs of the patient. The bonus is that the research seems favorable.

Benefits of Telehealth in Pregnancy

Advances in telehealth have created opportunities for providers to see patients in the comfort of their own homes. What other benefits does telehealth have in pregnancy? 

Better Gestational Diabetes Outcomes

Closer follow-up and novel modes of education may provide an edge in gestational diabetes management. This meta-analysis of 32 different clinical trials evaluated the effectiveness of telemedicine for patients with GDM.² The interventions included the use of health apps and diabetes telehealth visits in conjunction with in-person care. They found that the addition of telemedicine reduced c-section rates, premature rupture of membranes, pregnancy-induced hypertension or preeclampsia, preterm birth, neonatal asphyxia, and polyhydramnios compared with standard in-person care alone.

Prevention of Preterm Birth

Preterm delivery comes with a whole host of concerns, and additional healthcare costs. A 2024 review indicated that telehealth interventions may improve psychosocial health along with blood sugar management, thereby improving the risk of preterm birth.³ Preterm labor prevention was also a benefit discovered by the researchers evaluating the use of a digital health platform during pregnancy in a 2024 retrospective cohort study.⁴

We can safely assume that these benefits, paired with the convenience of prenatal telehealth services make telehealth well-liked by participants. But let’s review the research on patient satisfaction.

Patient Satisfaction and Convenience

In the end, we want to provide patients with optimal outcomes…and a user-friendly experience. Offering remote care, whether it's education via an app or remote patient monitoring of blood pressure, is convenient for busy pregnant participants.⁵ A 2024 review found that in the 66 obstetric care studies they evaluated, the majority had positive patient satisfaction scores.⁶ 

So what do patients like about virtual medicine? According to a review measuring qualitative data for patient satisfaction of virtual care, patients have attributed the following reasons for liking telehealth options⁷: 

• Reduced uncertainty
• Enhanced human connection
• Increased empathy
• Boosted confidence
• Increased self-management skills
• Reduction in absences from work and travel time. 

Remote Patient Monitoring in Pregnancy: What Can You Monitor?

Remote patient monitoring, or RPM, sounds nice. The patient goes about their business and is monitored by a provider in a different location. So what exactly can you measure or monitor in pregnant patients?

The most prominent RPM service in pregnancy is blood pressure monitoring. Unmanaged hypertension can be dangerous and disproportionately impacts women in rural areas. RPM provides an avenue for real-time blood pressure tracking via Bluetooth-enabled blood pressure devices.

Weight is another measure that has been tracked remotely, and has been found to improve adherence to the Institutes of Medicine's recommended weight gain targets for pregnancy.⁸  

Additionally, continuous glucose monitoring (CGM) is becoming more common, allowing easy access to real-time blood glucose metrics. Wearable fitness and health trackers have paved the way for the acceptability of RPM devices. And the literature reveals some desirable results.

Benefits of Remote Patient Monitoring in Pregnancy

Anecdotally, we know RPM can be a valuable part of care, particularly in patients with high blood pressure and blood glucose. Below are some of the benefits of RPM in pregnancy from recent research. 

Reduce Costs with RPM

Increased patient contact at a lower cost? Sounds almost too good to be true. However, this recently published analysis shows that blood pressure RPM in postpartum hypertension saves costs and improves outcomes compared to standard care.⁹ When contrasting the cost of RPM staff and RPM devices vs. hospital readmission, RPM services were significantly less.

This cost savings can apply to those who have to travel long distances to see specialists, which is another advantage for RPM.

Enhance Access to Care

For those in rural areas, specialists are few and far between. Plus, lack of transportation can be a major barrier to receiving adequate prenatal care. Of course, the access to high-speed internet is a potential barrier for telehealth. Fortunately, research has shown that cellular-enabled RPM is an option for those lacking both access to the internet and community-based providers.¹⁰ 

Providing supplementary services and monitoring via cell phone enhances access to care and can also improve clinical outcomes.

Improved Clinical Outcomes

This is the reason you do what you do—improved clinical outcomes. Healthy patient and healthy baby is the ultimate goal. A large retrospective cohort study published this September highlighted the outcomes for those participating in a postpartum blood pressure RPM program¹¹:

• Fewer hospital readmissions
• Better postpartum visit attendance
• Improved adherence to guidelines
• Better rates of medication use

Between cost-savings, convenience, and better outcomes, remote patient monitoring and telehealth are mutually supportive of a thriving OB practice.

Takeaways

Technology is enabling more robust care for pregnancy. Complementary care methods such as prenatal telehealth visits, educational apps, and RPM are enhancing patient experience and outcomes.

• Prenatal telehealth is a valid option for busy patients who are balancing life’s demands and the increased medical visits, screenings, and monitoring that accompany a high-risk pregnancy.
• The benefits of telehealth are improved clinical outcomes in both those with gestational diabetes and hypertension in pregnancy, including decreased rates of preterm birth.
• Prenatal telehealth is well-liked by patients and is inclusive—addressing social determinants of health like access to healthcare services and quality care.
• RPM tracks metrics like blood pressure, blood glucose, and weight and has been successfully implemented in the pregnant population.
• Outcomes of RPM include reduced costs, increased access to care, and clinical benefits, like fewer hospital readmissions, better attendance for postpartum visits, and increased medication and guideline adherence.

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Do you want to help your patients by increasing contact, but don’t have the in-house resources to take on telehealth visits or RPM? 

LilyLink has you covered. We can partner with your practice to provide expert diabetes education via telehealth. Our state-of-the-art RPM platform and patient-facing gestational diabetes app streamline the process of gestational diabetes monitoring and education. 

Developed specifically for glucose monitoring in pregnancy, you’ll no longer be flipping through messy paper logs or performing time-consuming data reviews. Instead, the patients’ data is reviewed by our educators so you have time to focus on what you do best—providing top-tier care to your patients. Schedule a demo to learn more.

Frequently Asked Questions

Do prenatal telehealth services prevent no-shows?

While telehealth is convenient, some single-site observations have shown that the no-show rates aren’t necessarily better with telehealth visits.¹²

Can you bill for remote patient monitoring services in pregnancy?

Yes, most insurance, including Medicare, reimburse for RPM. CPT codes 99453, 99454, 99457, and 99458 can be billed to cover the initial patient setup and subsequent monitoring in pregnancy and care management (up to 1 hour per month).

What if your patient doesn’t have high-speed internet access?

As long as your patient has a cellphone— which per Pew Research Center, most Americans do (97% own a cellphone, 90% of those are smartphones)—they should be able to connect to remote patient monitoring and telehealth services. 

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References:

1. Peahl AF, Smith RD, Moniz MH. Prenatal care redesign: creating flexible maternity care models through virtual care. Am J Obstet Gynecol. 2020;223(3):389.e1-389.e10. doi:10.1016/j.ajog.2020.05.029
2. Xie 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(1):198. Published 2020 Apr 6. doi:10.1186/s12884-020-02892-1
3. Kim SH, Park JH, Jung SY, De Gagne JC. Internet-Based Interventions for Preventing Premature Birth Among Pregnant Women: Systematic Review. JMIR Pediatr Parent. 2024;7:e54788. Published 2024 Apr 2. doi:10.2196/54788
4. Brinson AK, Jahnke HR, Henrich N, Karwa S, Moss C, Shah N. Digital health utilization during pregnancy and the likelihood of preterm birth. Digit Health. 2024;10:20552076241277037. Published 2024 Sep 2. doi:10.1177/20552076241277037
5. Tully KP, Tharwani S, Venkatesh KK, et al. Birthing Parent Experiences of Postpartum at-Home Blood Pressure Monitoring Versus Office-Based Follow up After Diagnosis of Hypertensive Disorders of Pregnancy. J Patient Exp. 2024;11:23743735241272217. Published 2024 Aug 8. doi:10.1177/23743735241272217
6. Mara T, Barbara T, Lucia P, et al. Exploring the impact of integrating telehealth in obstetric care: A scoping review. Eur J Obstet Gynecol Reprod Biol. Published online September 23, 2024. doi:10.1016/j.ejogrb.2024.09.031
7. Ghimire S, Martinez S, Hartvigsen G, Gerdes M. Virtual prenatal care: A systematic review of pregnant women's and healthcare professionals' experiences, needs, and preferences for quality care. Int J Med Inform. 2023;170:104964. doi:10.1016/j.ijmedinf.2022.104964
8. Litman EA, Kavathekar T, Amdur R, Sebastian A, Marko K. Remote gestational weight gain monitoring in a large low-risk US population. Obes Sci Pract. 2021;8(2):147-152. Published 2021 Sep 1. doi:10.1002/osp4.554
9. Mei JY, Hauspurg A, Corry-Saavedra K, Nguyen TA, Murphy A, Miller ES. Remote blood pressure management for postpartum hypertension: a cost-effectiveness analysis. Am J Obstet Gynecol MFM. 2024;6(9):101442. doi:10.1016/j.ajogmf.2024.101442
10. Jones RD, Peng C, Jones CD, Long B, Helton V, Eswaran H. Cellular-Enabled Remote Patient Monitoring for Pregnancies Complicated by Hypertension. Cardiovasc Digit Health J. 2024;5(3):156-163. Published 2024 Mar 15. doi:10.1016/j.cvdhj.2024.03.001
11. Lemon LS, Quinn B, Binstock A, Larkin JC, Simhan HN, Hauspurg A. Clinical Outcomes Associated With a Remote Postpartum Hypertension Monitoring Program. Obstet Gynecol. 2024;144(3):377-385. doi:10.1097/AOG.0000000000005665
12. Peahl AF, Powell A, Berlin H, et al. Patient and provider perspectives of a new prenatal care model introduced in response to the coronavirus disease 2019 pandemic. Am J Obstet Gynecol. 2021;224(4):384.e1-384.e11. doi:10.1016/j.ajog.2020.10.008

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