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

Abstract

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.

Conclusion: 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: fetal growth restriction; gestational hypertension; intrauterine growth restriction; placental health; pre-eclampsia; pregnancy-induced hypertension; salivary uric acid.