Pregnancy monitoring, there is an app for that (but should it be recommended?)

‘Home-based’ monitoring tools, like pregnancy apps and wearable devices to keep track of fetal development, have become an integral part of the pregnancy experience of many expectant mothers. These tools come in various forms, ranging from virtual factsheets about maternal and fetal health, over personalized gestation-specific information and 3D sample images of developing fetuses, to devices to perform do-it-yourself ultrasound scanning at home.

There is moral reason to investigate digital tools aimed at pregnancy tracking

Some of these pregnancy related mHealth (PRmHealth) instruments are directed at users with a pre-existing medical condition, though a large part is aimed at appeasing curiosity about what purportedly happens in utero. By providing information about fetal development, however, also the subset of PRmHealth tools aimed at ‘non-therapeutic’ usage raises expectations about improving newborn health.

It is, admittedly, important that pregnant persons have the means to go through a healthy pregnancy. Yet, from an ethical point of view, there is moral reason to investigate the balance between, on the one hand, maternal duties of caution and, on the other, evidence that these digital means actually lead to improved pregnancy outcomes. In this blog post, which is based on a recent agenda-setting article authored by members of the UGent Metamedica platform, we call attention to this matter.

The need for evidence-based studies

While many pregnant women use PRmHealth applications in anticipation of an improved fetal development, the existing bioethics literature has, up till now, mostly remained silent on questions about whether these technologies live up to the enthusiasm about better newborn health. This is remarkable, especially because there are worries about increasing pressures and growing responsibilities ascribed to pregnant women, which may, notably, be reinforced by PRmHealth applications.

While these for-profit digital tools are promoted by corporate actors with economic interests, there is at present hardly any empirical basis that supports the idea that PRmHealth improves fetal health or pregnancy outcomes. Likewise, data about whether PRmHealth has a favorable or unfavorable impact on the wellbeing of pregnant women is ambiguous. Without such knowledge, it is as difficult to defend PRmHealth as it is to refute it.

The confines of prenatal responsibilities

From an ethical perspective, the issue essentially hinges on questions about proportionality. Morally speaking, proportionality requires that the expected benefits outweigh the possible burdens that may come with the recommended behavior. In the context of ‘parental’ responsibilities, there is relatively broad consensus that, if a pregnancy is set to lead to the birth of a child parents-to-be already have, prior to birth, certain moral duties to the future child.

There is, however, much less consensus on the confines of these responsibilities. Part of the discussion centers on the role of technology. With its increasing ability to gather information about the in utero sphere and the expanding possibilities to act upon that information, technology can have an inflationary impact on that set of responsibilities.

We need evidence-based research to judge whether benefits of PRmHealth are proportionate to potential burdens

The arrival of PRmHealth is a case in point as it offers instantly accessible fetal information and facilitates domestic prenatal monitoring ‘at the touch of a button’. It thus seems to make the fetus less of an abstraction, draws continual attention to its development, and reminds pregnant women of their respective responsibilities. Given social expectations about responsible pregnancy, it may not be evident to say ‘no’ to PRmHealth usage especially when these tools are marketed as “pregnancy care done right”. This may be reinforced by social media modules that invite women to interact with other expectant mothers and share experiences and (nonmedical) knowledge during pregnancy

Taking an informed ethical stance

Is this morally laudable or questionable? Critics of what some would call the ‘high demands’ on pregnant women to keep a close watch on fetal and newborn health may think that PRmHealth too heavily impacts pregnant women’s personal life. Enthusiasts may, on their part, rather look at these developments as a run-up to a desirable “revolution” in perinatal health services.

What is crucial here, is that evidence to support either stance is lacking. It is largely unknown whether PRmHealth provides sufficient information to improve prenatal care and improve obstetric outcomes. Likewise, we need more research about the impact on the pregnant woman to formulate an informed opinion on whether PRmHealth problematically inflates prenatal responsibilities of expectant mothers.

While such empirical evidence alone cannot settle such normative debates, there is nonetheless an ethical point in stating that we need more such research to take an informed ethical stance on whether the expected benefits are proportionate to the presumed burdens.

Author: Dr. Seppe Segers (Bioethics Institute Ghent & METAMEDICA-platform, Ghent University)

The need for evidence-based studies

The confines of prenatal responsibilities

Taking an informed ethical stance

Further reading