Randomized comparison of a reduced-visit prenatal care model enhanced with remote monitoring
Abstract
Background Standard prenatal care, consisting of 12-14 visits per pregnancy, is expensive and resource intensive, with limited evidence supporting the structure, rhythm, or components of care. Some studies suggest a reduced-frequency prenatal care model is as safe as the standard model of care for low-risk pregnant women, but evidence is limited. We developed and evaluated an innovative, technology-enhanced, reduced prenatal visit model (OB Nest).Objective To evaluate the acceptability and effectiveness of OB Nest, a reduced-frequency prenatal care model enhanced with remote home monitoring devices and nursing support.Study design A single-center randomized controlled trial, composed of pregnant women, aged 18-36 years, recruited from an outpatient obstetric tertiary academic center in the Midwest United States. OB Nest care consisted of 8 onsite appointments with an obstetric provider; 6 virtual visits consisting of phone or online communication with an assigned nurse, supplemented with fetal Doppler and sphygmomanometer home monitoring devices; and access to an online community of pregnant women. Usual care consisted of 12 prescheduled prenatal clinic appointments with obstetric providers. Acceptability of OB Nest was measured by validated surveys of patient satisfaction with care at 36 weeks; perception of stress at 14, 24, and 36 weeks; and perceived quality of care at 36 weeks of gestation. Effectiveness was analyzed by comparing adherence to the American College of Obstetricians and Gynecologists recommended routine prenatal and ancillary services, maternal and fetal safety outcomes, and healthcare utilization.Results Three hundred pregnant women at <13 weeks of gestation were recruited and randomized to OB Nest or usual care (150 in each arm) using a minimization algorithm. Demographic characteristics were similar between groups. Compared to usual care, patients in OB Nest had higher satisfaction on a 100-point validated modified Littlefield and Adams Satisfaction scale (OB Nest = 93.9% vs usual care = 78.9%, P < .01). Pregnancy-related stress, measured, on a 0-2 point PreNatal Maternal Stress validated scale, with higher scores indicating higher levels of stress, was lower among OB Nest participants at 14 weeks (OB Nest = 0.32 vs usual care = 0.41, P < .01) and at 36 weeks of gestation (OB Nest = 0.34 vs usual care = 0.40, P < .03). There was no statistical difference in perceived quality of care. Adherence to the provision of American College of Obstetricians and Gynecologists prenatal services was similar in both arms. Maternal and fetal clinical outcomes were similar between groups. Total reported nursing time was higher in OB Nest (OB Nest = 171.2 minutes vs usual care = 108.2 minutes, 95% confidence interval, 48.7-77.4).Conclusion OB Nest is an innovative, acceptable, and effective reduced-frequency prenatal care model. Compared to routine prenatal care, OB Nest resulted in higher patient satisfaction and lower prenatal stress, while reducing the number of appointments with clinicians and maintaining care standards for pregnant women. This program is a step toward evidence-driven prenatal care that improves patient satisfaction.
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Twelve articles reported levels of stress as a mental health-related outcome.
“Twelve articles reported levels of stress as a mental health-related outcome [36, 39, 40, 44, 45, 52, 55, 60, 64, 70–72]”
From Mental health-related telemedicine interventions for pregnant women and new mothers: a systematic literature review (2023) · cites this paper as [45]
The majority of articles (n = 24) did not deal with the feasibility of the interventions.
“However, the majority of the articles (n = 24) did not deal with the feasibility of the interventions [20, 35, 36, 38, 40, 43–45, 47, 48, 50, 51, 56, 62, 64, 66, 67, 69, 72–77].”
From Mental health-related telemedicine interventions for pregnant women and new mothers: a systematic literature review (2023) · cites this paper as [45]
Participants were mostly positive in terms of their acceptance of or satisfaction with the intervention (n = 23).
“The participants were mostly positive in terms of their acceptance of or satisfaction with the intervention (n = 23 [20, 38, 39, 41–43, 45, 46, 48, 51, 52, 54, 55, 58, 59, 61, 62, 64, 65, 68, 70–72])”
From Mental health-related telemedicine interventions for pregnant women and new mothers: a systematic literature review (2023) · cites this paper as [45]
The other studies (n = 38) did not report anything about implementation barriers.
“the other studies (n = 38 [20, 35–37, 39–42, 44, 45, 47, 48, 50–57, 59, 61–77]) did not report anything about this aspect.”
From Mental health-related telemedicine interventions for pregnant women and new mothers: a systematic literature review (2023) · cites this paper as [45]
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Telemedicine For Prenatal Care: A Systematic ReviewPreprint
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- Authors
- Butler Tobah, Y. S., LeBlanc, A., Branda, M. E., Inselman, J. W., Morris, M. A., Ridgeway, J. L., Finnie, D. M., Theiler, R., Torbenson, V. E., Brodrick, E. M., Meylor de Mooij, M., Gostout, B., & Famuyide, A.
- Affiliations
- Mayo Clinic (US)
- ORCID
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2019-12
- Volume
- 221
- Issue
- 6
- Pages
- 638.e1-638.e8
- ISSN
- 0002-9378 (ISSN-L)
- OpenAlex
- W2952303999
- Cited by
- 212
- References
- 20
- Citations by year
- 2026: 18 · 2025: 14 · 2024: 32 · 2023: 45 · 2022: 41 · 2021: 40 · 2020: 22
- FWCI
- 35.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Mayo Clinic (NCT02082275)
- Topics
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- remote fetal monitoring, patient satisfaction, pregnancy-related stress, perceived quality of care, health care utilization, low-risk pregnancy, maternal and fetal safety
- MeSH terms
- Adult, Blood Pressure Determination, Delivery of Health Care, Female, Heart Rate, Fetal, Humans, Obstetric Nursing, Obstetrics, Patient Acceptance of Health Care, Pregnancy, Prenatal Care, Quality of Health Care, Self Care, Stress, Psychological, Patient Satisfaction, Telemedicine, Ultrasonography, Doppler, Sphygmomanometers
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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