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

May 2, 2021
Lindsey Carr

Associate Editor for Contemporary OB/GYN

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

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.

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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.