Lindsey Carr

This article is from one of the many presentations from the American College of Obstetrics and Gynecology’s (ACOG) Annual Clinical and Scientific Meeting, which was held April 30 through May 2.

For more information and to explore recorded sessions, check out 

With nearly 2,000 pregnancy and fertility apps available, app overload and inaccuracy are major problems for ob/gyns and their patients. That is why Kathryn Marko, MD, NCMP, Katherine T. Chen, MD, MPH, and Tamika Auguste, MD, led presentations on apps and remote monitoring and their roles in patient care.

Marko led the presentation with her focus on the good, bad, ugly, and future vision for mobile apps and remote monitoring. Marko is the residency program director and assistant professor at the George Washington University in Washington, D.C. In her work with mobile apps and remote monitoring, she saw positives in smoking cessation and breastfeeding.

Moderate quality randomized control trials (RCTs, said Marko, pointed to improved smoking cessation with text message intervention (4 RCTs). The text messages included information on the harms of smoking, both to the mother and to the fetus. Telehealth interventions with text and web-based interventions showed significant improvement in exclusive breastfeeding and breastfeeding continuation rates (3 RCTs). Vaccination rates, however, were not affected by telehealth interventions. No significant clinical or behavioral outcome related to pregnancy wellness—including healthy eating, physical activity, and maternal weight gain—was significantly changed by telehealth intervention with smartphone app and text messaging, Marko said. “We can use this information to help patients more concretely connect with providers,” she said. “We can utilize this information to push out changes.”

Chen followed Marko’s presentation, and highlighted the idea of app overload. There aren’t many standards to ranking on the app store, she said, comparing it to a crowded flea market. “No one is telling you to seek out the yellow tent as the most accurate app. You don’t know to avoid the red tents,” Chen pointed out. From November 2013 to March 2021, there has been a major influx of apps available. For example, Chen said, PubMed papers citing mobile apps went from 275 to 15,456 citations. Google went from 3.7 million to 1.63 billion results. Apps available on Apple’s app store and the Google Play store went from 65,000 to 325,000.“A systematic process to identify and evaluate apps may help with the issues,” Chen concluded.

Auguste wrapped up the presentation with a focus on the gaps in mobile medical apps—namely, fertility awareness and fetal heart rate monitoring. Her first analysis was of the app Clue, which is marketed as a period tracker, cycle, and ovulation calendar. On its website, it reads, “The United States Food and Drug Administration (FDA) has classified Clue Birth Control as a software application that can be used as a contraception to prevent pregnancy.” However, the app was approved as a software application, not contraception. It does, however, have a disclaimer, “Note: Clue Period Tracker & Ovulation App should not be used as a contraceptive.” Auguste emphasized the importance of communicating this to patients. It is crucial for providers to “know what’s out there and know the data. Patients are going to use these apps,” Auguste said. The importance is to communicate the fact that these are not forms of contraception.

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Some mobile health apps and remote monitoring may not be as perfect as patients may think. 

The truth about mobile health apps and remote monitoring from ACOG 2021

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 for coverage during the conference, which was held from April 30 through May 2.

“We have among the highest maternal mortality rate of any industrialized nation,” said Susan Mann, MD, at this year’s meeting.

On July 1, 2020, the Joint Commission released standards to improve the quality and safety of care during pregnancy and postpartum. They also determined the highest impact areas including early recognition and timely treatment of postpartum hemorrhage and severe hypertension. There is no uniform approach for all hospitals regarding implementation of the recommendations.

On Sunday, May 2, Susan Mann, MD, and Kimberlee McKay, MD, led a presentation on what hospitals can and should do to prevent maternal mortality. Mann is an ob/gyn specialist, assistant professor and a fellow of ACOG based in Brookline, Massachusetts. McKay is an ob/gyn in Sioux Falls, South Dakota. In 2015, she became the vice president of the Avera OB/GYN Service Line, which serves 14 hospitals over 72,000 miles throughout eastern South Dakota, Minnesota, Iowa, and Nebraska. Avera uses the Maternal Level of Care (MLoC) framework to create MLoC-specific bundles and care pathways that work within the confines of local hospital resources.

Mann spoke first during the presentation, explaining that Non-Hispanic Black women experienced the highest rate of pregnancy-related mortality by race/ethnicity based upon data from 2014 to 2017. She explained the new Joint Commission Standards and their expectations, highlighting the most important issues. “Hospitals are going to be expected to execute timely treatment of maternal hemorrhage and severe hypertension/preeclampsia,” Mann explained.

To reduce the likelihood of harm related to maternal severe hypertension and preeclampsia, hospitals should provide role-specific education to all staff and providers who treat pregnant and postpartum patients about the hospital’s evidence-based severe hypertension and preeclampsia procedures. At minimum, education should occur at orientation, when changes to the procedure occur, or every 2 years. They should also conduct drills at least annually to determine system issues as part of ongoing quality improvement efforts, Mann noted.

Team training in rural hospitals must be adapted but should include a discussion of all patients in-house and ED volume. “Rural hospitals are very limited by blood bank,” McKay said. “You have to look at your hospital and say, ‘Is this the right hospital for the patient?’ and make the decision from there.”

To reduce disparities in pregnancy-related mortality, the speakers concluded, hospitals and health care systems can:

Implement standardized protocols in quality improvement initiatives, especially among facilities that serve disproportionately affected communities.

Identify and address implicit bias in health care that would likely improve patient-provider interactions, health communication, and health outcomes.

ACOG’s conference proceedings concluded on Sunday, May 2. For information on how to access recorded sessions, visit 

This article is from one of the presentations from the American College of Obstetrics and Gynecology’s (ACOG) Annual Clinical and Scientific Meeting, which started on April 30.

Maternal Mortality in Pregnancy

. To register and for more information, check out 

 for coverage during the conference, which extends through Sunday, May 2.

On Saturday, May 1, ACOG’s coronavirus 19 (COVID-19) in pregnancy task force joined together to provide updates and answer frequently asked questions. The panel discussion began with a brief overview of ACOG’s response and concluded with a Q&A session for the task force.

ACOG’s COVID-19 response has evolved from the start of the pandemic until now. Beginning in December 2019, the Centers for Disease Control and Prevention (CDC) released the first Health Alert Network correspondence about a novel coronavirus detected in China. January 2020 brought increasing concerns about the novel coronavirus as the impacts to the U.S. remained unknown. In February 2020, ACOG released its first Practice Advisory on the Novel Coronavirus 2019 on February 26, 2020. March 2020 brought a flood of inquiries on COVID-19—most of them relating to pregnancy—and the first round of FAQs was drafted by ACOG staff and SMEs.

Four COVID-19 Expert Work Groups were formed in March and April of 2020 to address questions and develop guidance for practitioners that focused on ethics, gynecology, obstetrics and telehealth. From April 2020 to present, the obstetrics-focused work group continues to meet weekly to review, revise, and develop FAQs as needed.

Due to the rapidly developing nature of COVID-19 information, ACOG has developed the Practice Advisory and over 100 clinician and patient FAQs, plus a vaccination Practice Advisory.

The panel discussion mainly focused on the Q&A session, with the most frequently asked question revolving around COVID-19 in pregnancy and prophylactic anticoagulation. The panel summarized with the guidance as follows: If a pregnant woman has received the vaccine, there is no indication for prophylaxis. Patients with moderate to severe disease that are hospitalized should get prophylaxis. Patients who are outpatient, whether they were ill or only had mild or asymptomatic disease, do not get prophylaxis in the outpatient setting. In the postpartum setting, multiple risk factor indication may be used as per the institution’s standards.

ACOG’s COVID-19 Task Force Updates

This article includes information presented at the 2021 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting (ACSM), being held from April 30 to May 2.

Chalas’ discussion points on preventive care include cardiovascular disease, pre-pregnancy counseling, diabetes, obesity, modified cancer risk factors, and genetic cancer risk factors. “Our encounter with women across their lifespan helps identify risk for future illness,” Chalas said. Her presentation included the roadmap to a new practice, which included 2011 Institute of Medicine recommendations that annual visits should serve as a focus on evidence-based, age-appropriate preventive care. Additional visits should be conducted based on patient’s health status and risk factors. She added that every encounter should serve as a focus on preventive care and mitigation of personal risk factors for disease.

Chalas then handed over the presentation to 2 experts in the field of preventive medicine, each of whom gave their own 20-minute presentation.

Janine A. Clayton, MD, National Institutes of Health (NIH) Associate Director for Research on Women’s Health, and Director of the Office of Research on Women’s Health, spoke about keeping women healthy across their lifespan. She focused on America’s health disparities and high maternal mortality rates. “This audience is aware that this country is the most dangerous place in the world to deliver a baby,” Clayton said, “and the Office of Research on Women’s Health issued a call to action in 2019 among our research community to focus on these areas. America’s health disparities and maternal mortality rates are unacceptable.” Visit the 

NIH Maternal Morbidity and Mortality Web Portal

The other speaker was Douglas R. Lowy, MD, the Principal Deputy Director of the National Cancer Institute (NCI). His 2 main research areas focus on human papillomavirus (HPV) infection and cancer genes. His joint research with John Schiller, MD, has developed technology underlying FDA-approved HPV vaccines and mechanisms for high efficacy of the vaccines. Lowy also has received the National Medal of Honor for basic research from the American Cancer Society and is a fellow of the American Association for Cancer Research academy. Lowy’s presentation focused on reducing HPV-associated cancer by vaccinations and screening. “Patient care is really at the heart of everything that we are trying to do at the NIH,” Lowy said.

For more ACOG coverage, stay tuned to Contemporary OB/GYN®. To explore conference proceedings and to register, visit 

Eva Chalas, MD, kicked off the Annual Clinical and Scientific Meeting as ACOG’s 71st president. Her keynote speech focused on her presidential initiative of personalized care. The goal was to provide guidance and tools to assist ob/gyns in enhancing access to comprehensive preventive care. 

Lindsey Carr

Articles

The truth about mobile health apps and remote monitoring from ACOG 2021

Maternal Mortality in Pregnancy

ACOG’s COVID-19 Task Force Updates

ACOG President Eva Chalas kicks off Annual Clinical and Scientific Meeting