JMIR Publications

ABSTRACT

Background:

Premature birth rates have slightly increased globally, making its prevention critical for both short-term and long-term health outcomes. In response to the multifaceted risk factors for premature birth, various interventions have been developed, including internet-based programs. These offer accessibility and enhanced engagement, yet their overall efficacy in preventing premature births remains to be thoroughly evaluated.

Objective:

This systematic review aimed to identify study designs and assess the effectiveness of internet-based interventions in preventing premature birth among pregnant women.

Methods:

A comprehensive search of MEDLINE, Embase, CINAHL, and the Cochrane Library was conducted to identify randomized trials and quasi-experimental studies evaluating internet-based interventions for premature birth prevention in pregnant women. The search was inclusive, with no restrictions based on language or geographical location, allowing for a comprehensive global perspective. The time frame for the inclusion of studies extended until February 2023. The risk of bias in each study was independently assessed by 3 authors forming pairs, using the revised Cochrane risk of bias tool for randomized trials, RoB 2.0, as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Due to heterogeneity in populations, measurements, and interventions, a meta-analysis was not conducted.

Results:

The review included 26 articles, comprising 12 intention-to-treat (ITT) and 14 per-protocol (PP) studies. The overall risk of bias was high in most ITT studies and of some concern in most PP studies. The target populations varied, including non-specific pregnant women, those with gestational diabetes mellitus (GDM) or at risk of GDM, individuals with anxiety/depression, and those experiencing preterm labor. Psychosocial, physiological, and wellness health outcomes were evaluated. Internet-based interventions effectively reduced stress/distress in non-specific pregnant women but not in those experiencing preterm labor. Their effectiveness in reducing anxiety and depression varied, with inconsistent results among different groups. In women with GDM or those at risk of GDM, interventions successfully controlled fasting plasma glucose and 2-hour postprandial plasma glucose but did not consistently manage HbA1c. The interventions did not reduce the incidence of premature birth across the various populations studied. The effectiveness in addressing substance or alcohol abuse and insomnia also varied.

Conclusions:

This review underscores the effectiveness of internet-based interventions in psychosocial health, and to some extent, blood sugar management, for preventing premature birth, while also noting variability in measurements and effects for other risk factors. The importance of further research, including clinical trials, is highlighted for the development, evaluation, and dissemination of effective and safe internet-based interventions. The establishment of standardized measurement tools and rigorous evaluation processes is essential to improve these interventions' effectiveness and reliability in clinical practice. These efforts are crucial to ensure that such digital health solutions effectively contribute to preventing premature births and enhancing maternal health outcomes more broadly.