This article originally appeared in HIT Consultant: https://hitconsultant.net/2024/10/03/prenatal-monitoring-remote-technology-provision-of-care/

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The Evolution of Prenatal Monitoring: How AI and Remote Monitoring Can Improve the Provision of Care

by Amit Reches, CTO, Nuvo Group 10/03/2024

Prenatal monitoring technology has advanced considerably over the last decade. High-resolution sonograms now offer unprecedented clarity, enabling detailed insights into fetal development. Meanwhile, innovations have transformed previously cumbersome and uncomfortable equipment into more portable and user-friendly devices, enhancing accessibility and patient comfort. However, for essential insights into fetal health and development, clinicians still rely primarily on legacy in-clinic systems and techniques, such as cardiotocography (CTG), which possess inherent challenges.

Current Challenges with Legacy Systems

The non-stress test (NST), measuring maternal-fetal heart rate and uterine activity, remains the cornerstone of prenatal monitoring. This has traditionally entailed the use of CTG, requiring frequent visits to the clinic where monitoring is performed using technology that has changed little since it was first introduced in the 1950s.

It is well-known among clinicians that CTG can require frequent adjustments from the clinical staff to ensure the fetal heart rate trace is maintained. Additionally, NSTs create logistical pressures and burdens regarding patient flow and scheduling. Most significantly, the one-to-two weekly NSTs recommended by the American College of Obstetricians and Gynecologists for the last eight weeks of pregnancy can put additional strain on patients financially, professionally, and personally. This can lead to poor patient compliance, resulting in suboptimal pregnancy management and risk of reduced health outcomes.

Meanwhile, as maternity care deserts continue to expand across the U.S., compounded by a chronic shortage of OB-GYNs and midwives, access to pregnancy care continues to become more challenging.

This situation is beginning to change, with the integration of new technologies that have the potential to enhance the accuracy of maternal-fetal monitoring and increase access to quality prenatal care.

Recent Advancements

The advent of telemedicine and remote patient monitoring over the last four decades has seen increased attention given to prenatal care innovation, with a number of companies attempting to make an impact in the space. Some players are leveraging existing technologies (including CTG), relying on the current standard of care and bringing it into the home. While adding some convenience, such solutions will still suffer from the preexisting requirements and inefficiencies of legacy systems.

Others are looking to employ newer advanced sensing technologies, including electrocardiography (ECG) and electrohysterography (EHG), which can overcome many of the inherent disadvantages associated with CTG. Meanwhile, new concepts of data collection, involving multiple synchronized wearable devices, have emerged to further move the industry forward, enabling providers to scale up monitoring sessions with the same number of clinicians.

Remote pregnancy monitoring thus has the potential to substantially improve the delivery of prenatal care and pregnancy outcomes, by democratizing care and increasing patient compliance.

The Need for Innovation in Cardiac Pregnancy Monitoring

Undetected fetal cardiac abnormalities play a significant role in perinatal outcomes. Moreover, with the maternal mortality crisis, greater attention to maternal cardiac health is also critical to improving outcomes. However, current tools to monitor fetal cardiac function are limited. They can only be performed in-clinic with devices such as echocardiograms and, where applicable, electrocardiography, which must then be interpreted by specialists.

With the general shift to home-based healthcare, there is an obvious need to provide remote access to medical-grade capabilities, enabling expectant mothers to maintain compliance and access essential care beyond the confines of healthcare facilities.

A remote solution based on a combination of technologies, such as non-invasive ECG and phonocardiography (PCG), can provide a detailed analysis of the structure and function of the fetal heart, providing a more complete picture than is currently available. It can also more accurately distinguish between the maternal and fetal heart rates to further improve the management of high-risk pregnancies and enable more timely intervention.

Staying Ahead of the Curve

The wealth of data generated from connected devices can support clinical decision-making and improve efficiency. However, this can also create a new bottleneck, with the same limited number of physicians now being asked to handle a greater workload, with exponentially more data in need of analysis.

Efforts are already underway to develop clinical decision support systems that can enhance efficiency and workflow by automating the review process based on existing guidelines. As technology continues to progress, these systems will leverage machine learning models to further streamline the review process and improve clinical decision-making.

In Steps AI

Already integrated across many healthcare disciplines, artificial intelligence has considerable potential to improve prenatal monitoring. Recently, significant advancements in AI have been made through leveraging foundation models, most notably large language models (LLMs) trained on vast amounts of data. Similar foundation models are now being applied to more diverse types of data, including physiological data such as ECG. Once calibrated to specific datasets, they can be used to perform essential tasks, such as diagnosing and even predicting previously undetectable high-risk cases in pregnancy monitoring.

This approach has the potential to dramatically improve the use of AI in medicine, by transitioning from the current foundation models to a new generation of domain-specific models requiring much smaller datasets. This new era of AI will prioritize the most informative data, enabling more precise and predictive prenatal care.

A Better Future for All

The evolution of prenatal monitoring, from outdated in-clinic systems to advanced remote capabilities, heralds a new era of more accessible and effective patient-centric care. Meanwhile, the introduction of new remote monitoring capabilities, enhanced by next-generation AI models, can address the growing challenges impacting maternity care. Through continued innovation and integration of new technologies, we can look forward to a future of improved outcomes for mothers and babies worldwide.

About Amit Reches

Amit Reches is chief technology officer of Nuvo Group, a company that is closing the gap in health disparities and social determinants of health with advanced pregnancy monitoring technology. Amit is an experienced research and development executive in the field of medical devices, with extensive experience leading multidisciplinary R&D teams. Prior to joining Nuvo Group, he served as VP R&D at Firefly Neuroscience, developer of a brain-mapping technology to improve outcomes associated with mental illnesses, and in various roles as an R&D team leader and researcher prior to that. Amit holds a PhD in Neuroscience from the Technion – Israel Institute of Technology and a BSc in Computer Science from Tel Aviv University.

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