mHealth Interventions for Pregnant Women in Low and Middle Income Countries in Asia: A Systematic Review

Investigator: Eri Yoshimura, MS
Sponsor: Global Health Sciences Education

Location(s): Indonesia


Healthy behavior during women’s pregnancies is an important factor inpreventing maternal and infant morbidity and mortality. As in the rest of the world, mobile phone applications and text messaging are widely used in low- and middle-income countries (LMIC) in Asia that have a major burden of maternal deaths and preterm births. This type of communication has also been explored in interventions to improve health outcomes for a variety of
conditions, and it seems plausible that it could help to increase healthy behavior in pregnant women. Little is known about the effectiveness of text messaging and mobile applications (commonly described as “mHealth” interventions) in improving pregnant women’s healthy behavior, as measured through changes in the rates of important health outcomes in mothers and their newborn babies.
Research Questions
Do mHealth interventions (compared to standard care, or a control condition not designed to improve pregnancy outcomes) influence women’s healthy behavior during pregnancy to prevent maternal mortality, maternal morbidity, still birth, premature birth and low birth weight in LMIC in Asia?
I conducted a systematic review of the effectiveness of mHealth interventions in improving pregnant women’s healthy behaviors during pregnancy, and thus improving maternal and birth outcomes. Primary outcomes of interest were maternal mortality, maternal morbidity, stillbirth, premature birth, low birth weight and diabetes. Randomized controlled trials (RCTs) conducted in Asian LMIC were eligible for inclusion. Eligible study populations were pregnant women in these settings. A comprehensive search strategy was developed to identify eligible RCTs. Databases searched included PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Embase, IndMED (Indian scientific literature), and China National Knowledge Infrastructure (Chinese scientific literature). Gray literature was also searched. I used the Cochrane Collaboration instrument to assess bias risk in the included trial. I report study characteristics and results in summary tables and provide a narrative synthesis of my findings. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance was used in reporting my review.
Searchers found 539 records, of which one RCT conducted in Thailand met inclusion criteria. This trial of 68 women in Bangkok, conducted between May 2007 and October 2007, examined a short message service (SMS) text-messaging intervention. during pregnancy. Outcomes included gestational age at delivery, fetal birth weight, preterm delivery and route of delivery (vaginal or cesarean). Results were inconclusive for all primary outcomes, with no statistically significant differences between intervention and control groups. Risk of bias in this study was assessed as moderate. Although primary outcomes were inconclusive, participants reported that they had a higher confidence level and lower anxiety level in the antenatal period.
The only trial that met inclusion criteria did not show the effectiveness of SMS messaging for pregnant women on pregnancy and birth outcomes. Systematic reviews of similar interventions conducted in African and other LMIC settings have shown mixed results, but risk of bias was often high in primary studies of these reviews. Given the risk of adverse pregnancy outcomes for many women, especially poor women, and the potential of mHealth interventions to reduce this risk, there is a pressing need for rigorous RCTs of mHealth interventions in Asian LMIC settings.