Shristi Rawal Awarded NIH Grant to Continue Work on Remote Monitoring for High-Risk Pregnancies
Shristi Rawal, associate professor in the Department of Clinical and Preventive Nutrition Sciences, has received a five-year, $3.3 million grant from the National Institutes of Health (NIH), building on two prior NIH-funded projects focused on developing and evaluating digital health interventions to improve outcomes in pregnancy.
The new, R01 funded-study will evaluate the effectiveness and implementation of MOM-HD, a mobile app-based remote monitoring program for Nepalese women with hypertensive disorders of pregnancy and gestational diabetes. The app was developed during a prior study that was disrupted by the COVID-19 pandemic, and the current project capitalizes on this existing infrastructure by studying the same population.
Women with these pregnancy complications require more intensive monitoring through frequent clinic visits than a normal pregnancy because they are at high risk for adverse outcomes. However, Rawal observed that instead, many women were not coming to the clinic at all, due to concerns related to COVID-19. Telemonitoring seemed to be the perfect approach to help maintain continuity of care for these at-risk women in the face of these disruptions.
“I myself had gestational hypertension during my pregnancy and was part of an early remote monitoring program in Philadelphia,” said Rawal. “These programs have become increasingly common in the United States, but we still know relatively little about their impact on health outcomes and whether they can be effectively implemented in resource-constrained settings like Nepal.”
The MOM-HD platform allows women to record their blood pressure and/or glucose levels through a mobile app, enabling clinicians to monitor data remotely and intervene earlier if complications arise. The app sends reminders to take measurements and provides immediate, automated feedback when readings fall outside clinically recommended ranges. Trained nurse research assistants review out-of-range values daily and follow up with patients or escalate concerns to clinicians when needed.
These additional points of contact aim increase patient satisfaction with their level of care and encourage visit follow-through. The continuous stream of patient-generated data also gives providers additional insight between visits, supporting more timely and informed clinical decision-making.
In addition to evaluating the program’s effects on maternal and neonatal outcomes, the study will also examine how well the program can be implemented in real-world clinical settings and its cost-effectiveness. This includes assessing implementation outcomes such as adoption, feasibility, and sustainability, as well as costs related to training, devices, telemonitoring workload, and health system utilization.
Rawal and her collaborators are working closely with clinical partners in Nepal as well as government and national-level stakeholders to ensure the intervention can be integrated into routine maternal healthcare if proven effective, with particular attention being paid to expanding internet connectivity to resource-scarce areas.
“If successful, these partnerships offer a really exciting opportunity to create a scalable model for remote monitoring of high-risk pregnancies that could be implemented nationally in Nepal and adapted for use in other resource-limited settings,” she concluded.