Adherence to digital pregnancy care - lessons learned from the SMART start feasibility study

Area of Science:

• Digital health
• Maternal health
• Healthcare technology adoption

Background:

• The World Health Organization advocates for digital health in prenatal care.
• Real-world implementation of digital prenatal care is limited, even in high-income countries.
• Existing analog systems present challenges for integrating new digital solutions.

Purpose of the Study:

• To evaluate the adherence and clinical/technical lessons learned from the SMART Start digital pregnancy care framework.
• To assess the feasibility of home-based, multimodal self-monitoring in pregnant individuals.
• To identify factors influencing engagement with digital prenatal care technologies.

Main Methods:

• A prospective study involving 528 pregnant individuals in Germany using the SMART Start framework.
• Participants utilized a mobile app for questionnaires, records, and content, alongside self-examination kits.
• Kits included standard measurements (weight, blood pressure, urinalysis) and novel sensors (smartwatch, sleep analyzer).

Main Results:

• 49% of participants engaged with at least one digital package; weekly weight tracking adherence reached 67% initially.
• Adherence for blood pressure (20%) and urinalysis (28%) was lower but stable; questionnaire completion varied.
• 31% disengaged at registration; while overall retention was similar across groups, engagement with specific self-monitoring varied.

Conclusions:

• Pregnant individuals are capable of home-based self-monitoring, but consistent engagement requires adaptive scheduling and patient-centered feedback.
• The SMART Start framework demonstrates potential for data-driven, personalized pregnancy care.
• Future digital health studies must prioritize adaptive design, patient feedback, and interdisciplinary collaboration for successful implementation.