NIH-Funded Study Targets Telehealth, Rural Maternal Death Rate

Researchers at the University of Arkansas for Medical Sciences (UAMS) will use a $228,000 federal grant to investigate how telehealth could improve Arkansas’ maternal death rate, which ranks fifth in the nation.

In Arkansas, there are 44.5 maternal deaths per 100,000 live births annually compared to the national average of 29.6 deaths.

The research team, led by UAMS’ Hari Eswaran, PhD, will focus on using remote patient monitoring for pregnant women in rural areas where there are few health providers or resources. The objective is to determine if telehealth can improve rural healthcare for pregnant women with high blood pressure.

“This is a critical health issue for us,” said Eswaran, a professor in the College of Medicine Department of Obstetrics and Gynecology. “No other developed countries have maternal mortality rates as high as Arkansas, and we know that lack of access to care is a significant factor.”

The UAMS research team will recruit 50 pregnant women to test if maternal patient care can be improved using an array of telehealth strategies including telemedicine video calls with UAMS maternal-fetal specialists and remote patient monitoring of blood pressure rates.

The study’s remote patient monitoring system will come as an addition to the Institute’s existing rural telemedicine clinic and call center model for monitoring blood pressure in pregnancy.

Severe maternal illness is on the rise in the United States, affecting about 52,000 women at delivery every year. According to a CDC report that UAMS referenced, the severe maternal illness rate during delivery increased almost 200 percent from 1993 to 2014. The increase in this rate is caused by increased rates of acute renal failure, cardiac disease, blood transfusion, and respiratory distress syndrome.

Researchers expect the rate of severe maternal illness to continue to increase. As women continue to become pregnant later in life, the chances for pre-pregnancy obesity, pre-existing chronic medical conditions, and cesarean deliveries increase, thereby increasing the rate of severe maternal illnesses, said Eswaran.

Women from racial minorities, poorer populations, and rural areas experience much higher rates of severe maternal illness as well as maternal death.

“By identifying these at-risk women early in their pregnancy, we can potentially help provide timely medical care using telehealth technology,” Eswaran said. “This would help prevent illness and death, shorten hospital stays, and reduce health care costs.”

The National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS) will fund the one-year grant. The funding was awarded as a supplement to UAMS’ Clinical and Translational Science Award (CTSA) funded by NCATS. Laura James, M.D., is the principal investigator of the CTSA and director of the UAMS Translational Research Institute.

Other rural states have used telehealth to improve maternal care management. The Montana Obstetric and Maternal Support (MOMS) program helps link OB/GYN experts with rural care providers to share expertise on a variety of topics affecting pregnant women such as medication-assisted treatment (MAT) therapy and substance abuse counseling.

The program is coordinated through the Billings Clinic’s Eastern Montana Telemedicine Network which is made up of 30 health systems and hospitals in the state.

“By bringing more resources to rural Montana, we hope to improve maternal health outcomes by collaborating on high-risk pregnancies, promoting the importance of prenatal care in the first trimester and identifying and consulting on these cases early in the process,” said C.H. “Tersh” McCracken III, MD, FACOG, an OBGYN at the Billings Clinic and the new program’s medical director,  in a press release.