Approximately one out of every 10 children born in the United States is born pre-term—prior to 37 weeks of gestation.
 
A team of Carnegie Mellon University decision scientists has partnered with maternal-fetal medicine specialists at Magee-Womens Hospital of UPMC to develop and test an app to help reduce that number.
 
Pre-term birth is the leading cause of neonatal death, and can lead to long-lasting health problems, from low birth weight, to apnea, to increased risk of infection and more. These risks are particularly high among specific socioeconomic groups, including African-Americans and families living in poverty.
 
"Mobile phone apps are a great way to engage a vulnerable population in their health care, because approximately 86 percent of American adults own a mobile phone, regardless of racial and ethnic groups," said lead researcher Tamar Krishnamurti, an assistant professor in the Department of Engineering and Public Policy. "Although hundreds of pregnancy-related apps exist, few have been developed through a scientific process that is patient-centered and grounded in behavioral decision research."
 
The app is designed to address some of the key risk factors that lead to poor neonatal health and pre-term birth: maternal weight gain, smoking, alcohol consumption, depression, intimate partner violence, poor attendance at prenatal appointments and more.
 
Researchers recruited study participants from Magee's outpatient clinic. Over three months, the app asked participants a series of questions once a day about their risk factors, then using computer algorithms, delivered patient-specific risk feedback and recommendations for the user. If it detected high-risk events such as intimate partner violence or thoughts of suicide, it sent real-time alerts to medical professionals, who would contact the women to connect them to appropriate services.
 
Additionally, the app provides services such as basic pregnancy education, appointment reminders, fetal health monitoring aids, quitting resources for drug and alcohol addiction and free transportation to and from prenatal appointments through Uber.
 
"Our goal with this app is to support women through their pregnancy," Krishnamurti said. "We hope that the app can both detect risks in a timely fashion and also reassure women that their pregnancy is progressing healthily when they are at low-risk for adverse events."
 
From here, the team will ramp up testing of the app, with plans for a randomized controlled trial over participants' entire pregnancy and evaluating the app's effects on behavioral and clinical outcomes.
 
"While we do not understand why certain socioeconomic groups are at a higher-risk for preterm birth, we do know that prenatal care that starts early in pregnancy is critical for a healthy baby and mother," said Dr. Hyagriv Simhan, professor and chief of the Division of Maternal-Fetal Medicine at UPMC and part of the research team. "This pilot shows that smartphone apps are a promising and potentially cost-saving way to provide personalized care for the highest-risk patients."
 
"We are excited about the possibility of being able to roll our app out on a larger scale, making it more widely available to patients on a national and even international scale, and using it to better understand patients' needs," she said.
 
The research team also included EPP Assistant Professor Alex Davis, EPP Assistant Research Professor Gabrielle Wong-Parodi, and the Howard Heinz University Professor in the Dietrich College of Humanities and Social Sciences Baruch Fischhoff. The clinical team consisted of Simhan and Director of the Magee-Womens Research Institute Dr. Yoel Sadovsky.