JMIR Publications

ABSTRACT

Background:

Chronic diseases have had an increasing effect on maternal-fetal health in the last several decades, especially in developed countries. However, there remains a lack of discussion regarding obstetric chronic disease management with technological approaches, including smartphone-based mobile health (“mHealth”) interventions.

Objective:

The objective of this study was to systematically evaluate mHealth interventions used in pregnancy in developed countries and their effects on maternal health behaviors and maternal-fetal health outcomes.

Methods:

This systematic review identified studies published between 01/2000 and 11/2018 in MEDLINE/PubMed, Cochrane Library, EMBASE, CINAHL, PsycInfo, Web of Science and grey literature. Studies were eligible for inclusion if they included pregnant women in developed countries and evaluated standalone smartphone interventions intended to promote healthy maternal beliefs, behaviors, and/or maternal-fetal health outcomes. Two researchers independently reviewed and categorized aspects of full-text articles including study design, setting, participant demographics, main outcomes and risk of bias. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed and the study was registered in PROSPERO prior to initiation.

Results:

Of the 2,225 records examined, 28 studies were included and categorized into 4 themes: gestational weight gain, obesity and physical activity (n=9), smoking cessation (n=9), influenza vaccination (n = 2) and general prenatal health, preventive strategies, and miscellaneous topics (n = 8). Reported sample sizes ranged from 16 to 5,243 with a median of 91. All participants in the included studies were pregnant at the time of study initiation. In the gestational weight gain, obesity, and physical activity group, three interventions were associated with less overall gestational weight gain in intervention users over the study period. Notably, all three interventions utilized text messaging or an app in combination with another communication strategy (Facebook or email). Regarding smoking cessation, influenza vaccination, and miscellaneous topics, there was some evidence of positive effects on health behaviors and beliefs, but very limited correlation with improved health outcomes.

Conclusions:

In developed countries, smartphone-based health behavior interventions in pregnancy are usable with moderately good follow-up rates and demonstrate some data exhibiting positive beliefs, behaviors, and health outcomes. More effective interventions are multi-faceted in terms of communication strategies and tend to focus on gestational weight gain, obesity, and physical activity. Clinical Trial: Prior to performance of this search, information about the study proposal was published electronically in the University of York PROSPERO register of systematic reviews at: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42016051055. The ID is CRD42016051055.