Many of us in family medicine practice full-scope including obstetrics. It is one of the most challenging yet rewarding aspects of primary care with unpredictable hours and significant medical-legal risk. Many primary care providers perform outpatient prenatal care which can be equally rewarding. Regardless of what scope of obstetrics care you provide, pregnant patients are always looking for reliable information about their health and that of the fetus from the time of conception through those first few postpartum visits.
One common topic that must be discussed with all pregnant patients early in pregnancy is the topic of prenatal testing. This can take many forms and can include traditional blood tests such as the quad screen, cystic fibrosis testing, nuchal translucency US testing, and the newer non-invasive prenatal testing (NIPT).
Although all of the frequently cited reference apps such as UpToDate, Dynamed, and Essential Evidence Plus have abundant information on the topic as well as Practice Bulletins from ACOG, none of them are geared to the patient. Providers may not have the time to explain prenatal testing during a “new OB” visit or even feel qualified to answer every question about the tests. Roche changed the landscape of prenatal testing with the arrival of their cell-free DNA test/NIPT called Harmony. This test detects fetal DNA released from the placenta into the maternal bloodstream. This test can evaluate for trisomies, microdeletions, and fetal sex. Studies have shown the test’s superiority to standard testing; although it is significantly more expensive in most cases. Many facilities offer this testing in combination with nuchal translucency testing for trisomy testing. Other facilities have maintained the cheaper but less sensitive and specific triple/quad screen tests.
iPrenatal attempts to explain the basics of chromosomes, common prenatal conditions (Trisomy 21, 18, 13, etc), and the options for screening. The app uses a conversational/choose your own adventure approach to revealing the content to the patient. The app has embedded definitions, graphics, and short cartoon-like videos to explain some information in more detail. The app does not go into great detail in any of these areas so providers will need to supplement the app content with some additional counseling or other materials. Providers may want the patient to review the app prior to the patient’s visit with the provider to enable enough time to discuss other topics.
Evidence-based medicine
iPrenatal by Roche presents patient-friendly evidence about common prenatal conditions and prenatal screening including their Harmony NIPT. The app is mostly free of any obvious bias and seems to present the information at a level that most patients will be able to easily understand. The app does include numerous references including ACOG bulletins, NEJM articles, etc.
What patients/providers would benefit from this App?
Any pregnant patient, providers caring for pregnant patients including students, NPs, PAs, midwives, family medicine, and OB/GYN providers.
Price
o Free
Likes
- Mostly complete educational content for patients on prenatal testing.
- Includes information on the basics of chromosomes and common prenatal conditions.
- Available for both iOS and Android
Dislikes
- Some may not like the conversational style of the UI.
- Lacks some details on common screening blood tests and diagnostic procedures.
- No back button (restart hidden away in a menu), home button, or hyperlinks for references.
Overall
A useful app to prescribe to patients to assist with the challenging topic of prenatal testing. Although the app is definitely geared towards the Harmony NIPT by Roche, it takes a very patient-friendly turn at explaining the basics of prenatal testing, chromosomes 101, and common prenatal/chromosome related conditions. The app uses a novel interface that mostly works. I still think the app could go into more detail across each of its 3 main areas or include additional reading/links for additional information.
Overall Score
o 4.0 stars
User Interface
o 4.0 stars
App is divided into 3 primary sections with numerous subsections all “discovered” via a conversational style the user has with the app! Works pretty well, but would still benefit from an overall table of contents and home/back button. Ability to control speed of the conversation and text to speech is nice to have.
Multimedia Usage
o 4.0 stars
Interesting use of a “conversational style” for the UI with ability for text to speech, some mini-videos, and graphics embedded in the app. No links to references, websites, etc.
Price
o 5 stars
App is free!
Real-World Applicability
o 4 stars
If you provide prenatal care, then you should consider prescribing this app to your patients especially if non-invasive prenatal testing (NIPT) is part of your practice. Although sponsored by Roche, there is no real evidence of Pharma bias in the app.
Device Used For Review
o iPhone 11 Pro running iOS 13.6.
Available for Download for iPhone, iPad, and Android.
Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.
