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ORIGINAL RESEARCH article

Front. Med.
Sec. Obstetrics and Gynecology
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1385299

The clinical efficacy of a novel smartphone-based salivary self-test for the prediction of preeclampsia, pregnancy-induced hypertension and intrauterine growth restriction: a prospective cohort study

Provisionally accepted
Ida Catharina PĆ¼schl Ida Catharina PĆ¼schl 1*Lisbeth Bonde Lisbeth Bonde 1Thomas Alexander Gerds Thomas Alexander Gerds 2Mia Sato Tackney Mia Sato Tackney 3James Quest James Quest 4Bjarke Lund Sorensen Bjarke Lund Sorensen 5Nicholas Stephen Macklon Nicholas Stephen Macklon 6
  • 1 Department of Obstetrics and Gynecology, Zealand University Hospital, Roskilde, Denmark
  • 2 Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
  • 3 MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, England, United Kingdom
  • 4 Morgan Innovation and Technology (United Kingdom), Petersfield, United Kingdom
  • 5 Department of Obstetrics and Gynecology, Slagelse Hospital, Slagelse, Denmark
  • 6 London Women's Clinic, London, United Kingdom

The final, formatted version of the article will be published soon.

    Introduction This study investigated the efficacy of a digital health solution utilizing smartphone images of colorimetric test-strips for home-based salivary uric acid (sUA) measurement to predict pre-eclampsia (PE), pregnancy-induced hypertension (PIH), and intrauterine growth restriction (IUGR). Methods 495 pregnant women were included prospectively at Zealand University Hospital, Denmark. They performed weekly self-tests from mid-pregnancy until delivery and referred these for analysis by a smartphone-app. Baseline characteristics were obtained at recruitment and pregnancy outcomes from the journals. The mean compliance rate of self-testing was assessed. For the statistical analyses, standard color analyses deduced the images into the red-green-blue (RGB) color model value, to observe the individual, longitudinal pattern throughout the pregnancy for each outcome. Extended color analyses were applied, deducing the images into 72 individual color variables that reflected the four dominant color models. The individual discriminatory ability was assessed by calculating the area under the curve for the outcome of PE, and the outcome of hypertensive pregnancy disorders solely or combined with IUGR at 25 weeks of gestation and for the weekly color change between 20 and 25 weeks of gestation. Results Thirty-four women (6.9%) developed PE, 17 (3.4%) PIH, and 10 (2.0%) IUGR. The overall mean compliance rate was 67%, increasing to 77% after updating the smartphone-app halfway through the study. The longitudinal pattern of the RGB value showed a wide within-person variability, and discrimination was not achieved. However, it was noted that all women with IUGR repeatedly had RGB values below 110, contrasting women with non-IUGR. Significant discriminatory ability was achieved for 8.2% of the analyses of individual color variables, of which 27.4% summarized the Hue color variable. However, the analyses lacked consistency regarding outcome group and gestational age. Conclusions This study is the first proof-of-concept that digital self-tests utilizing colorimetric sUA measurement for the prediction of PE, PIH, and IUGR is acceptable to pregnant women. The discriminatory ability was not found be sufficient to have clinical value. However, being the first study that compares individual color variables of the four dominant color models, this study adds important methodological insights into the expanding field of smartphone-assisted colorimetric test-strips.

    Keywords: Pre-Eclampsia, intrauterine growth restriction, fetal growth restriction, salivary uric acid, Pregnancy-induced hypertension, Gestational hypertension, Placental health

    Received: 12 Feb 2024; Accepted: 21 Nov 2024.

    Copyright: Ā© 2024 PĆ¼schl, Bonde, Gerds, Tackney, Quest, Sorensen and Macklon. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Ida Catharina PĆ¼schl, Department of Obstetrics and Gynecology, Zealand University Hospital, Roskilde, Denmark

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.