%0 Journal Article
        
%@ 2817-1705
%I JMIR Publications
%V 4
%N 
%P e58454
%T A Conversational Agent Using Natural Language Processing for Postpartum Care for New Mothers: Development and Engagement Analysis
%A Leitner,Kirstin
%A Cutri-French,Clare
%A Mandel,Abigail
%A Christ,Lori
%A Koelper,Nathaneal
%A McCabe,Meaghan
%A Seltzer,Emily
%A Scalise,Laura
%A Colbert,James A
%A Dokras,Anuja
%A Rosin,Roy
%A Levine,Lisa
%K conversational agent
%K postpartum care
%K text messaging
%K postpartum
%K natural language processing
%K pregnancy
%K parents
%K newborns
%K development
%K patient engagement
%K physical recovery
%K infant
%K infant care
%K survey
%K breastfeeding
%K support
%K patient support
%K patient satisfaction
%D 2025

%7 22.4.2025
%9 
%J JMIR AI
%G English
                
%X Background: The “fourth trimester,” or postpartum time period, remains a critical phase of pregnancy that significantly impacts parents and newborns. Care poses challenges due to complex individual needs as well as low attendance rates at routine appointments. A comprehensive technological solution could provide a holistic and equitable solution to meet care goals. Objective: This paper describes the development of patient engagement data with a novel postpartum conversational agent that uses natural language processing to support patients post partum. Methods: We report on the development of a postpartum conversational agent from concept to usable product as well as the patient engagement with this technology. Content for the program was developed using patient- and provider-based input and clinical algorithms. Our program offered 2-way communication to patients and details on physical recovery, lactation support, infant care, and warning signs for problems. This was iterated upon by our core clinical team and an external expert clinical panel before being tested on patients. Patients eligible for discharge around 24 hours after delivery who had delivered a singleton full-term infant vaginally were offered use of the program. Patient demographics, accuracy, and patient engagement were collected over the first 6 months of use. Results: A total of 290 patients used our conversational agent over the first 6 months, of which 112 (38.6%) were first time parents and 162 (56%) were Black. In total, 286 (98.6%) patients interacted with the platform at least once, 271 patients (93.4%) completed at least one survey, and 151 (52%) patients asked a question. First time parents and those breastfeeding their infants had higher rates of engagement overall. Black patients were more likely to promote the program than White patients (P=.047). The overall accuracy of the conversational agent during the first 6 months was 77%. Conclusions: It is possible to develop a comprehensive, automated postpartum conversational agent. The use of such a technology to support patients postdischarge appears to be acceptable with very high engagement and patient satisfaction. 
%R 10.2196/58454
%U https://ai.jmir.org/2025/1/e58454
%U https://doi.org/10.2196/58454

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 14
%N 
%P e60417
%T The Impact of Long-Chain Omega-3 Polyunsaturated Fatty Acid Supplementation in Pregnant Women Toward the Intelligence Status of Early Childhood: Protocol for a Systematic Review and Meta-Analysis
%A Lim,Han Yin
%A Mohammad Fadzil,Mohammad Adi
%A Mustar,Suraiami
%A Abdul Shukor,Imanul Hassan
%A Mohamed,Wan Ahmad Syazani
%+ Nutrition, Metabolic and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, No 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, Shah Alam, 40170, Malaysia, 60 333628863, ahmad.syazani@moh.gov.my
%K antenatal
%K long-chain omega-3 polyunsaturated fatty acids supplementation
%K pregnant women
%K systematic reviews
%K pregnant
%K pregnancy
%K maternal
%K maternity
%K infant
%K babies
%K nutrition
%K fish oil
%K docosahexaenoic acid
%K eicosapentaenoic acid
%K supplements
%K cognition
%K attention
%K motor skills
%K languages
%K behaviors
%K vision
%K neurodevelopment
%D 2025

%7 17.4.2025
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Long-chain omega-3 polyunsaturated fatty acids (LCPUFAs) are essential fatty acids that protect cellular structures and provide energy, particularly for fetal growth and development. The maternal supplementations of omega-3 LCPUFA may affect the rate of intelligence in early childhood development. Objective: This systematic review aims to synthesize available evidence on the impact of omega-3 LCPUFA supplementation during pregnancy toward intelligence in early childhood development by analyzing the outcomes specifying the aspects of intelligence such as neurodevelopment, social-emotional, language, attention, behavior, cognition, vision, hearing, and motor skills. Methods: We will only include randomized controlled trials on pregnant women supplemented with omega-3 LCPUFA interventions and the outcome measured is the children’s intelligence. Based on the World Health Organization's definition of early childhood, we will include children aged 8 years or younger. Children’s intelligence can be indicated using several tools measuring their intelligence index, such as neurodevelopment, social-emotional, language, attention, behavior, cognition, vision, hearing, and motor skills. Irrelevant and unavailable studies will be excluded. A systematic search will be conducted in 3 electronic databases, namely PubMed, Scopus, and Cochrane using relevant and synonymous terms. Study screening and selection will be conducted by the authors based on eligibility criteria. Upon encountering conflicting decisions, a discussion will be held to reach a consensus. The screening and selection process will be recorded using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. The included studies will be subjected to bias and quality assessment in accordance with the Critical Appraisal Skills Programme (CASP) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment tool for randomized controlled trials. Results: An initial search was conducted on November 1, 2023, which returned 1998 studies for screening. The extracted data will be classified into groups and subgroups according to the indicator of intelligence measured in the study. Next, the extracted data will be summarized using tables of evidence. Whenever possible, a meta-analysis of homogeneous groups of studies will be conducted using statistical software such as RevMan (version 5.4; Cochrane Collaboration). Studies with significant heterogeneity will be discussed narratively. The systematic review is estimated to be published in November 2025. Conclusions: This systematic review will systematically pool the evidence on the potential use of omega-3 LCPUFA supplementation to improve children’s intelligence status. This review is also important in addressing any existing knowledge gaps on this topic. Finally, a deeper understanding of the association between the consumption of omega-3 LCPUFA supplementation during pregnancy and children’s intelligence will aid policy makers, health care practitioners, and mothers with more informed evidence-based decisions. Trial Registration: PROSPERO CRD42023463910; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023463910 International Registered Report Identifier (IRRID): DERR1-10.2196/60417 
%M 40245394
%R 10.2196/60417
%U https://www.researchprotocols.org/2025/1/e60417
%U https://doi.org/10.2196/60417
%U http://www.ncbi.nlm.nih.gov/pubmed/40245394

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 14
%N 
%P e72542
%T Maternal Metabolic Health and Mother and Baby Health Outcomes (MAMBO): Protocol of a Prospective Observational Study
%A Price,Sarah A L
%A Koye,Digsu N
%A Lewin,Alice
%A Nankervis,Alison
%A Kane,Stefan C
%+ Department of Medicine, University of Melbourne, Grattan St, Parkville, Melbourne, 3010, Australia, 61 3 8345 3749, sarah.price@unimelb.edu.au
%K preconception
%K large for gestational age
%K small for gestational age
%K pregnancy outcomes
%K metabolic disease
%K diabetes
%K obesity
%K hypertension
%D 2025

%7 11.4.2025
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Metabolic disease is increasingly impacting women of reproductive age. In pregnancy, uncontrolled metabolic disease can result in offspring with major congenital anomalies, preterm birth, and abnormal fetal growth. Pregnancy also accelerates the complications of metabolic diseases in mothers resulting in an increased risk of premature cardiovascular events. Despite the convincing evidence that preconception care can largely mitigate the risks of metabolic disease in pregnancy, there are few data about how to identify the highest-risk women so that they can be connected with appropriate preconception care services. Objective: The aim of the study is to determine the maternal phenotype that represents the highest risk of having adverse neonatal and maternal pregnancy outcomes. Methods: This will be a prospective cohort study of 500 women recruited in early pregnancy. The primary outcome is a composite of offspring born small for gestational age (SGA) or large for gestational age (LGA) (customized birthweight ≤10th and ≥90th centile for gestational age). Secondary outcomes are (1) composite of adverse neonatal birth outcomes (SGA, LGA, major congenital abnormalities, preterm birth [<37 weeks’ gestation]) and (2) composite of new maternal metabolic outcomes (gestational diabetes, diabetes in pregnancy, type 2 diabetes [T2D] or prediabetes; gestational hypertension, preeclampsia, eclampsia or new essential hypertension after pregnancy; and gestational weight gain ≥20kg or new overweight/obesity at the 12-18 months postpartum visit). A multivariable logistic regression analysis will be conducted to identify candidate predictors of poor pregnancy outcomes due to metabolic disease. From this model, model coefficients and the associated 95% CIs will be extracted to derive the risk score for predicting the delivery of LGA/SGA offspring (primary outcome) and composites of adverse neonatal outcomes and maternal outcomes (secondary outcomes). Results: Seed funding for the project was acquired in November 2022 and subsequent funding was acquired in May 2024. The first participant was recruited on March 23, 2023. At the time of manuscript submission, 402 participants have been recruited. Data analysis has not yet been performed. Results are expected to be published in the first half of 2027. Conclusions: This is a prospective observational cohort study that intends to identify the metabolic disease risk factors, or combination of factors, that are most likely to cause adverse maternal and fetal health outcomes. These characteristics will be used to develop a risk calculator which will assist in identifying the highest risk women and in triaging them to appropriate services. The study has been approved by the institutional Human Research Ethics Committee (HREC/90080/MH-2022). Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000037606; https://tinyurl.com/yeytsxtp International Registered Report Identifier (IRRID): DERR1-10.2196/72542 
%M 40215105
%R 10.2196/72542
%U https://www.researchprotocols.org/2025/1/e72542
%U https://doi.org/10.2196/72542
%U http://www.ncbi.nlm.nih.gov/pubmed/40215105

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 14
%N 
%P e66439
%T Effects of Using a Smart Bassinet on the Mental Health of Military-Affiliated Pregnant Women: Protocol for a Randomized Controlled Sleep Health and Mood in Newly Expectant Military Mothers (SHINE) Trial
%A Okun,Michele L
%A Payne,Jennifer L
%A Osborne,Lauren M
%A Feliciano,Leilani
%A Lac,Andrew
%+ University of Colorado Colorado Springs, 1420 Austin Bluffs Parkway, Osborne A408, Colorado Springs, CO, 80918, United States, 1 4123028030, mokun@uccs.edu
%K maternal health
%K postpartum
%K pregnancy
%K sleep
%K infant
%K depression
%K anxiety
%K smart bassinet
%K intervention
%K prevention
%K military
%D 2025

%7 10.4.2025
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Postpartum mood and anxiety disorders (PMADs) are higher among pregnant military service women (26%) and military spouses (12.2%) compared to the civilian population (10%-15%). This is partly due to military-specific factors, including deployment, which are known to increase risk. Important risk factors for PMADs include sleep disturbances, defined as sleep deprivation, insomnia, or poor sleep quality, which are more are common among military-affiliated pregnant women. Objective: This study describes a protocol for a new randomized controlled trial that aims to ameliorate the risk for PMADs through improving infant sleep or maternal sleep during the first 6 postdelivery months in a sample of military-affiliated women. Methods: This study is a 6-month, parallel-arm, randomized controlled trial. Pregnant women (N=342) in the third trimester will be randomized at 1:1 ratio to use a smart bassinet (SB) or a standard commercially available bassinet (HALO BassiNest Swivel Sleeper 3.0; traditional bassinet [TB]) for up to 6 months after delivery. Participants will have their infants sleep in the bassinet, complete monthly web-based questionnaires, and record sleep data with diary and actigraphy for both the participants and their infants for 1 week each postpartum month. Blood samples will also be collected at baseline (late pregnancy) and at 3 months and 6 months post partum to assess immune functioning. The primary outcomes for this study will be postpartum mood (depressive and anxiety symptoms) and infant and maternal sleep. In addition, we are evaluating whether SB has a significant impact on immune functioning—a marker that physiologically connects sleep and mood symptoms. Results: Recruitment for this study began in January 2025. Six separate mixed 2 (treatment vs control) × 6 (assessment period) multivariate analysis of variance and analysis of variance models will be conducted to test the hypotheses that SB will have a greater impact on infant and maternal sleep than TB, SB will be associated with a greater reduction in postpartum mood symptoms than TB, and immune system function will be less dysregulated in birthing individuals using SB compared to those using TB. Lastly, we will evaluate whether the elevated risk demonstrated by previously identified postpartum depression epigenetic biomarkers in the TTC9B and HP1BP3 genes can be modified with an SB. We hypothesize that the elevated risk will be reduced in SB compared to that in TB. Conclusions: At the conclusion of this project, we will have gained a thorough understanding of the capability of SB to positively affect infant and maternal sleep compared to the traditional sleep arrangement and its impact on maternal mood through 6 months post partum in military-affiliated women. The promotion of sleep health in both mothers and infants may be an accessible and amenable method to prevent PMADs. Trial Registration: ClinicalTrials.gov NCT06544941; https://clinicaltrials.gov/study/NCT06544941 International Registered Report Identifier (IRRID): PRR1-10.2196/66439 
%M 40209215
%R 10.2196/66439
%U https://www.researchprotocols.org/2025/1/e66439
%U https://doi.org/10.2196/66439
%U http://www.ncbi.nlm.nih.gov/pubmed/40209215

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e67166
%T Efficacy of a Personalized mHealth App in Improving Micronutrient Supplement Use Among Pregnant Women in Karachi, Pakistan: Parallel-Group Randomized Controlled Trial
%A Vadsaria,Khadija
%A Nuruddin,Rozina
%A Mohammed,Nuruddin
%A Azam,Iqbal
%A Sayani,Saleem
%+ Department of Community Health Sciences, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan, 92 34930051 ext 4833, rozina.nuruddin@aku.edu
%K calcium
%K folic acid
%K iron
%K mobile health intervention
%K micronutrient deficiencies
%K Pakistan
%K pregnancy
%K supplement use
%K vitamin D
%K artificial intelligence
%D 2025

%7 9.4.2025
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Micronutrient deficiencies in folate, ferritin, calcium, and vitamin D are common during pregnancy in low- and middle-income countries, often due to inadequate diets. Micronutrient supplementation can address this need, whereas innovative awareness strategies in antenatal practices could enhance supplement use compliance. Objective: We evaluated the efficacy of a personalized mobile health (mHealth) intervention, hypothesizing a 30% improvement in supplement use in the intervention group compared to a conventional face-to-face counseling group. Methods: In an unblinded randomized controlled trial, we enrolled 306 first-trimester pregnant women from Aga Khan University Hospital between January 2020 and September 2021 who owned smartphones with internet connection. Women on regular medications or with dietary restrictions or critical illnesses were excluded. The intervention group received personalized micronutrient supplement use coaching through an mHealth app (PurUmeed Aaghaz) as thrice-a-week push messages and tailored recommendations over a 24-week period. The comparison group received standard face-to-face counseling at 6, 12, 18, and 24 weeks after enrollment. Baseline sociodemographic, obstetrics, anthropometric, dietary, and lifestyle data were collected through face-to-face interviews. At each follow-up, participants reported their weekly use of folic acid, iron, calcium, and vitamin D supplements, scored as 0 (daily), 1.5 (4-6 times weekly), and 3 (≤3 times weekly). Scores were summed to calculate the cumulative supplement use score (CSUS; 0-12), with higher scores indicating greater inadequacy. Every fourth woman was invited for biochemical micronutrient assessment. Data were analyzed using Stata (version 14), with random-effects linear and logistic panel regression to compare CSUS and supplement use between the 2 groups from baseline to endline. Results: Of 153 participants per group, 107 (69.9%) in the intervention and 125 (81.7%) in the nonintervention group completed the study. After 24 weeks, the intervention group showed a greater but insignificant reduction in mean CSUS compared to the nonintervention group (β=–.27, 95% CI −0.65 to 0.12; P=.17). Daily supplement use improved by 20% versus 22.4% for folic acid, 11.2 times versus 2.1 times for iron, 1.2 times versus 14.2 times for calcium, and 3 times versus 1.3 times for vitamin D in the intervention versus nonintervention group, respectively. Multivariable analysis showed higher, though insignificant, odds of sufficient folic acid (adjusted odds ratio [aOR] 1.26, 95% CI 0.68-2.36; P=.46) and iron (aOR 1.31, 95% CI 0.95-1.81; P=.10) use in the intervention group, whereas vitamin D use was significantly higher (aOR 1.88, 95% CI 1.43-2.47; P<.001). Calcium intake improved in the nonintervention group (aOR 0.59, 95% CI 0.44-0.79; P<.001). Anemia decreased in the intervention group, whereas ferritin, calcium, and vitamin D deficiencies persisted or worsened, particularly in the nonintervention group. Conclusions: An appropriately implemented mHealth intervention can improve antenatal vitamin D supplementation. Affordable, accessible, and personalized counseling through mHealth could ameliorate micronutrient status during pregnancy. Trial Registration: ClinicalTrials.gov NCT04216446; https://clinicaltrials.gov/study/NCT04216446 
%M 40203301
%R 10.2196/67166
%U https://www.jmir.org/2025/1/e67166
%U https://doi.org/10.2196/67166
%U http://www.ncbi.nlm.nih.gov/pubmed/40203301

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 9
%N 
%P e72469
%T Chatbot to Support the Mental Health Needs of Pregnant and Postpartum Women (Moment for Parents): Design and Pilot Study
%A McAlister,Kelsey
%A Baez,Lara
%A Huberty,Jennifer
%A Kerppola,Marianna
%K perinatal support
%K human-centered design
%K digital health
%K maternal health
%K chatbot
%K digital tool
%D 2025

%7 8.4.2025
%9 
%J JMIR Form Res
%G English
                
%X Background: Maternal mental health disorders are prevalent, yet many individuals do not receive adequate support due to stigma, financial constraints, and limited access to care. Digital interventions, particularly chatbots, have the potential to provide scalable, low-cost support, but few are tailored specifically to the needs of perinatal individuals. Objective: This study aimed to (1) design and develop Moment for Parents, a tailored chatbot for perinatal mental health education and support, and (2) assess usability through engagement, usage patterns, and user experience. Methods: This study used a human-centered design to develop Moment for Parents, a rules-based chatbot to support pregnant and postpartum individuals. In phase 1, ethnographic interviews (n=43) explored user needs to inform chatbot development. In phase 2, a total of 108 pregnant and postpartum individuals were recruited to participate in a pilot test and had unrestricted access to the chatbot. Engagement was tracked over 8 months to assess usage patterns and re-engagement rates. After 1 month, participants completed a usability, relevance, and satisfaction survey, providing key insights for refining the chatbot. Results: Key themes that came from the ethnographic interviews in phase 1 included the need for trusted resources, emotional support, and better mental health guidance. These insights informed chatbot content, including mood-based exercises and coping strategies. Re-engagement was high (69/108, 63.9%), meaning users who had stopped interacting for at least 1 week returned to the chatbot at least once. A large proportion (28/69, 40.6%) re-engaged 3 or more times. Overall, 28/30 (93.3%) found the chatbot relevant for them, though some noted repetitive content and limited response options. Conclusions: The Moment for Parents chatbot successfully engaged pregnant and postpartum individuals with higher-than-typical retention and re-engagement patterns. The findings underscore the importance of flexible, mood-based digital support tailored to perinatal needs. Future research should examine how intermittent chatbot use influences mental health outcomes and refine content delivery to enhance long-term engagement and effectiveness. 
%R 10.2196/72469
%U https://formative.jmir.org/2025/1/e72469
%U https://doi.org/10.2196/72469

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 12
%N 
%P e64131
%T User-Centered Design of an Electronic Dashboard for Monitoring Facility-Level Basic Emergency Obstetric Care Readiness in Amhara, Ethiopia: Mixed Methods Study
%A Dougherty,Kylie
%A Tesfaye,Yihenew
%A Biza,Heran
%A Belew,Mulusew
%A Benda,Natalie
%A Gebremariam Gobezayehu,Abebe
%A Cranmer,John
%A Bakken,Suzanne
%+ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 633 N St Clair St, Chicago, IL, 60611, United States, 1 (312) 503 1725, kylie.dougherty@northwestern.edu
%K health information technology
%K design and evaluation
%K Ethiopia
%K usability
%K nursing informatics
%K user-centered design
%K basic emergency obstetric care
%K obstetric
%K nurse
%K user-centered
%K design
%K maternal mortality
%K maternal
%K develop
%K sub-Saharan Africa
%K Africa
%K dashboard
%K tracking
%K emergency care
%D 2025

%7 3.4.2025
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: Maternal mortality remains a persistent public health concern in sub-Saharan African countries such as Ethiopia. Health information technology solutions are a flexible and low-cost method for improving health outcomes with proven benefits in low- to middle-income countries’ health systems. Objective: This study aimed to develop and assess the usability of an electronic dashboard to monitor facility-level readiness to manage basic emergency obstetric care (BEmOC) in Amhara, Ethiopia. Methods: The study used three methods to iteratively refine the dashboard: (1) user-centered design sessions with individuals who interact with the BEmOC supply chain, (2) review and feedback from domain and information visualization subject matter experts (SMEs) to refine the dashboard, and (3) usability heuristic evaluation with human-computer interaction (HCI) SMEs. Results: User-centered design sessions resulted in a preliminary version of the dashboard informed by end-user preferences and perceptions, with recommendations focusing on aesthetic design, filtering and sorting, and matching with the real world. An example of an end-user recommendation included increasing font sizes on the dashboard and using a red, yellow, and green color-coding scheme. Next, domain and visualization SMEs continued the dashboard’s iterative refinement, focusing on aesthetic design and navigation, by confirming design choices incorporated from the user-centered design sessions and recommending changes to enhance user experience moving through the dashboard, such as adding more filtering options. HCI SMEs rated the dashboard as highly usable (0.82 on a scale of 0-4, with 0 being no usability concern and 4 being a catastrophic usability concern). The principle with the highest usability severity scores was a match between the system and the real world with a score of 1.4. The HCI SMEs also rated the information visualization aspects of the dashboard favorably with 2 usability principles, spatial organization and information coding, scoring 0. Conclusions: Dashboards are a novel method for promoting and tracking facility capacity to manage BEmOC. By including targeted end users and SMEs in the design process, the team was able to tailor the dashboard to meet user needs, fit it into the existing government health systems, and ensure that the dashboard follows design best practices. Collectively, the novel, customized BEmOC dashboard can be used to track and improve facility-level readiness in Amhara, Ethiopia, and similar global BEmOC facilities. 
%M 40179370
%R 10.2196/64131
%U https://humanfactors.jmir.org/2025/1/e64131
%U https://doi.org/10.2196/64131
%U http://www.ncbi.nlm.nih.gov/pubmed/40179370

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 8
%N 
%P e62841
%T Impact of a 6-Week Postpartum Text Messaging Program (Essential Coaching for Every Mother) at 6 Months: Follow-Up Study to a Randomized Controlled Trial
%A Dol,Justine
%A Campbell-Yeo,Marsha
%A Aston,Megan
%A McMillan,Douglas
%A Grant,Amy K
%K mHealth
%K mobile health
%K SMS text message
%K text messages
%K messaging
%K self-efficacy
%K postpartum depression
%K postpartum anxiety
%K social support
%K intervention
%K postpartum
%K postnatal
%K mental health
%K parenting
%K mother
%K depression
%K anxiety
%K RCT
%K randomized controlled trial
%D 2025

%7 2.4.2025
%9 
%J JMIR Pediatr Parent
%G English
                
%X Background: Essential Coaching for Every Mother is an SMS text messaging program that positively improved parenting self-efficacy and reduced postpartum anxiety when measured immediately after intervention at 6 weeks postpartum. However, the impact of a short-term postpartum intervention over time is unknown. Objective: This study aims to compare parenting self-efficacy, postpartum anxiety symptoms, postpartum depression symptoms, and perceived social support at 6 months postpartum for mothers in the Essential Coaching for Every Mother trial. Methods: Participants (n=150) were randomized to Essential Coaching for Every Mother or control (usual care). Data were collected on parenting self-efficacy (primary outcome, Karitane Parenting Confidence Scale), postpartum anxiety symptoms (Postpartum Specific Anxiety Scale), postpartum depressive symptoms (Edinburgh Postnatal Depression Scale), and perceived social support (Multidimensional Scale of Perceived Social Support) at enrollment and 6-months postpartum. Data were analyzed using analyses of covariance and chi-square analysis. Results: A total of 139 women completed the primary outcome at 6 months and 136 completed secondary outcomes. At 6 months, there were no statistically significant differences between mothers in the intervention group and mothers in the control group on any of the outcomes. More mothers in the intervention group had higher postpartum anxiety scores (31/68, 45.6%) than mothers in the control group (16/68, 23.5%; P=.007). Conclusions: At 6 months postpartum, all mothers had similar scores on parenting self-efficacy, postpartum anxiety symptoms, postpartum depression symptoms, and social support. Thus, Essential Coaching for Every Mother improved parenting self-efficacy and reduced postpartum anxiety at 6 weeks, with all mothers having similar scores at 6 months postpartum. Trial Registration: ClincialTrials.gov NCT04730570; https://clinicaltrials.gov/study/NCT04730570 International Registered Report Identifier (IRRID): RR2-10.2196/27138 
%R 10.2196/62841
%U https://pediatrics.jmir.org/2025/1/e62841
%U https://doi.org/10.2196/62841

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 14
%N 
%P e58410
%T Centering Birthing Experiences of Women of Color: Protocol for a Qualitative Maternal Near Miss Study
%A Hernandez-Spalding,Kaitlyn
%A Farinu,Oluyemi
%A Clarke,Lasha
%A Lewis,Tamiah
%A Suarez,Angie
%A Bugg,Kimarie
%A Strickland,Kieauna
%A Molleti,Ashley
%A Maxy,Sherry
%A Hernandez-Green,Natalie
%+ Center for Maternal Health Equity, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310, United States, 1 4047521523, nhernandez@msm.edu
%K maternal health disparities
%K maternal near miss
%K minority health
%K mental health
%K narrative-based medicine
%K experiences
%K birthing experience
%K women
%K Black women
%K United States
%K maternal morbidity
%K patient-centered
%K racial
%K ethnic
%K disparities
%K socioeconomically
%K pregnancy
%K childbirth
%K postpartum
%K antenatal
%D 2025

%7 27.3.2025
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: In the United States, Black women are 3-4 times more likely to experience maternal near miss (MNM) or severe maternal morbidity (SMM) than non-Hispanic White women. However, there is a limited narrative-based investigation into Black and other marginalized women’s MNM experiences. Additionally, limited extant research on the impact of MNM and SMM on birthing women’s families or support persons and health care providers precludes the development of multilevel, patient-centered methods to eliminate these racial or ethnic disparities. Objective: This paper presents the protocol for a study that aims to draw insights from the experiences of racially and socioeconomically diverse mothers with MNM and SMM, their family or support persons (eg, partners), and health care providers to inform legislation, clinical practice, and infrastructure for optimal social support using PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) guidelines. Using a storytelling approach to assess participants’ risk factors, document underlying causes, and research clinical causes of MNM, researchers hypothesize these data will inform policies to improve maternal conditions and provide safe and effective prevention and treatment options for birthing persons. Methods: Morehouse School of Medicine (MSM) will partner with health services and community-based organizations to promote inclusive participant recruitment for this multiphase study. In phase 1, qualitative interviews were conducted with birthing women (n≤87) who have experienced MNM and SMM. In phase 2, we will conduct qualitative interviews with the following groups: birthing women’s partners or support persons (n≤50), health care providers serving birthing women (n≤50), and adults who lost their mothers to pregnancy-related complications (n≤50). In each phase, the total number of participants interviewed will be based on theoretical saturation, that is, the point in iterative data collection and analysis when all important insights have been exhausted from the data already available. Results: Recruitment for phase 1 started in July 2021. As of March 2024, we have recruited 87 racially and socioeconomically diverse birthing women. Of those, 74% (64/87) self-identified as Black or African American, 20% (17/87) as Hispanic or Latina, and 9% (8/87) as Native American or Alaska Native. Severe preeclampsia accounted for 46% (40/87) of participants’ pregnancy-related adverse experiences. Qualitative interviews grounded in narrative-based medicine are ongoing. Recruitment for phase 2 will occur between July 2023 and December 2024. Study results will be published in peer-reviewed scientific journals. Conclusions: The findings from this research will deepen the understanding of how severe obstetric complications (1) are experienced by birthing women; (2) are perceived by their partners, support persons, and health providers; and (3) impact the lives of bereaved family and community members. 
%M 40146199
%R 10.2196/58410
%U https://www.researchprotocols.org/2025/1/e58410
%U https://doi.org/10.2196/58410
%U http://www.ncbi.nlm.nih.gov/pubmed/40146199

%0 Journal Article
        
%@ 1929-073X
%I JMIR Publications
%V 14
%N 
%P e64826
%T Informatics Interventions for Maternal Morbidity: Scoping Review
%A Inderstrodt,Jill
%A Stumpff,Julia C
%A Smollen,Rebecca C
%A Sridhar,Shreya
%A El-Azab,Sarah A
%A Ojo,Opeyemi
%A Bowns,Brendan
%A Haggstrom,David A
%+ Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd., Indianapolis, IN, 46202, United States, 1 3176903316, ji3@iu.edu
%K scoping review
%K maternal morbidity
%K medical informatics
%K clinical informatics
%K mother
%K pregnant
%K perinatal
%K GDM
%K preeclampsia
%K maternity
%K gestational diabetes mellitus
%D 2025

%7 25.3.2025
%9 Review
%J Interact J Med Res
%G English
                
%X Background: Women have been entering pregnancy less healthy than previous generations, placing them at increased risk for pregnancy complications. One approach to ensuring effective monitoring and treatment of at-risk women is designing technology-based interventions that prevent maternal morbidities and treat perinatal conditions. Objective: This scoping review evaluates what informatics interventions have been designed and tested to prevent and treat maternal morbidity. Methods: MEDLINE, Embase, and Cochrane Library were searched to identify relevant studies. The inclusion criteria were studies that tested a medical or clinical informatics intervention; enrolled adult women; and addressed preeclampsia, gestational diabetes mellitus (GDM), preterm birth, Centers for Disease Control and Prevention–defined severe maternal morbidity, or perinatal mental health conditions. Demographic, population, and intervention data were extracted to characterize the technologies, conditions, and populations addressed. Results: A total of 80 studies were identified that met the inclusion criteria. Many of the studies tested for multiple conditions. Of these, 73% (60/82) of the technologies were tested for either GDM or perinatal mental health conditions, and 15% (12/82) were tested for preeclampsia. For technologies, 32% (28/87) of the technologies tested were smartphone or tablet applications, 26% (23/87) were telehealth interventions, and 14% (12/87) were remote monitoring technologies. Of the many outcomes measured by the studies, almost half (69/140, 49%) were patient physical or mental health outcomes. Conclusions: Per this scoping review, most informatics interventions address three conditions: GDM, preeclampsia, and mental health. There may be opportunities to treat other potentially lethal conditions like postpartum hemorrhage using proven technologies such as mobile apps. Ample gaps in the literature exist concerning the use of informatics technologies aimed at maternal morbidity. There may be opportunities to use informatics for lesser-targeted conditions and populations. 
%M 40132184
%R 10.2196/64826
%U https://www.i-jmr.org/2025/1/e64826
%U https://doi.org/10.2196/64826
%U http://www.ncbi.nlm.nih.gov/pubmed/40132184

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 9
%N 
%P e67284
%T Designing a Digital Intervention to Increase Human Milk Feeding Among Black Mothers: Qualitative Study of Acceptability and Preferences
%A Patchen,Loral
%A Tsuei,Jeannette
%A Sherard,Donna
%A Moriarty,Patricia
%A Mungai-Barris,Zoe
%A Ma,Tony
%A Bajracharya,Elina
%A Chang,Katie
%A Evans,William Douglas
%+ Healthcare Delivery Research, MedStar Health Research Institute, 10980 Grantchester Way, 7th Floor, Columbia, MD, 21044, United States, 1 7205845076, loral.patchen@medstar.net
%K health equity
%K breastfeeding
%K qualitative
%K mobile health
%K black mothers
%K preferences
%K cultural tailoring
%K mobile phone
%D 2025

%7 19.3.2025
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Breastfeeding rates among US mothers, particularly Black or African American mothers, fall short of recommended guidelines. Despite the benefits of human milk, only 24.9% of all infants receive human milk exclusively at 6 months. Objective: Our team previously explored the key content areas a mobile health intervention should address and the usability of an initial prototype of the Knowledge and Usage of Lactation using Education and Advice from Support Network (KULEA-NET), an evidence-based mobile breastfeeding app guided by preferences of Black or African American parents. This study aimed to identify the preferences and acceptability of additional features, content, and delivery methods for an expanded KULEA-NET app. Key social branding elements were defined to guide app development as a trusted adviser. The study also aimed to validate previous findings regarding approaches to supporting breastfeeding goals and cultural tailoring. Methods: We conducted a qualitative study using in-depth interviews and focus groups with potential KULEA-NET users. A health branding approach provided a theoretical framework. We recruited 24 participants across 12 interviews and 2 focus groups, each with 6 participants. The Data methods aligned with qualitative research principles and concluded once saturation was reached. Given the focus on cultural tailoring, team members who shared social identities with study participants completed data collection and coding. Two additional team members, 1 with expertise in social branding and 1 certified in lactation, participated in the thematic analysis. Results: All participants identified as Black or African American mothers, and most interview participants (7/12, 58%) engaged in exclusive breastfeeding. In total, 4 themes were recognized. First, participants identified desired content, specifying peer support, facilitated access to experts, geolocation to identify resources, and tracking functions. Second, delivery of content differentiated platforms and messaging modality. Third, functionality and features were identified as key factors, highlighting content diversity, ease of use, credibility, and interactivity. Finally, appealing aspects of messaging to shape a social brand highlighted support and affirmation, inclusivity and body positivity, maternal inspiration, maternal identity, social norms, and barriers to alignment with aspirational maternal behaviors as essential qualities. Crosscutting elements of themes included a desire to communicate with other mothers in web-based forums and internet-based or in-person support groups to help balance the ideal medical recommendations for infant feeding with the contextual realities and motivations of mothers. Participants assigned high value to personalization and emphasized a need to achieve both social and factual credibility. Conclusions: This formative research suggested additional elements for an expanded KULEA-NET app that would be beneficial and desired. The health branding approach to establish KULEA-NET as a trusted adviser is appealing and acceptable to users. Next steps include developing full app functionality that reflects these findings and then testing the updated KULEA-NET edition in a randomized controlled trial. 
%M 40106802
%R 10.2196/67284
%U https://formative.jmir.org/2025/1/e67284
%U https://doi.org/10.2196/67284
%U http://www.ncbi.nlm.nih.gov/pubmed/40106802

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 14
%N 
%P e67049
%T Integration of a Patient-Centered mHealth Intervention (Support-Moms) Into Routine Antenatal Care to Improve Maternal Health Among Pregnant Women in Southwestern Uganda: Protocol for a Randomized Controlled Trial
%A Atukunda,Esther Cathyln
%A Mugyenyi,Godfrey Rwambuka
%A Haberer,Jessica E
%A Siedner,Mark J
%A Musiimenta,Angella
%A Najjuma,Josephine N
%A Obua,Celestino
%A Matthews,Lynn T
%+ Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda, 256 702949832, eatukunda@must.ac.ug
%K social support
%K intervention development
%K maternal health
%K antenatal care attendance
%K skilled births
%K Uganda
%D 2025

%7 19.3.2025
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Mobile health (mHealth) interventions that leverage social support (SS) can improve partner involvement and pregnancy experiences and promote antenatal care (ANC) attendance and skilled births. In our previous studies, we used behavioral frameworks to develop a user-centered mHealth-based, audio SMS text messaging app to support pregnant individuals to use maternity care services in rural Uganda (Support-Moms app). In our pilot study, we observed high intervention uptake, acceptability, and feasibility, as well as increased ANC attendance and skilled births. Objective: With the promising pilot data, we propose a type 1 hybrid implementation-effectiveness trial to test if this novel patient-centered automated and customized mHealth-based SS intervention is effective and cost-effective enough to warrant future large-scale implementation into Uganda’s routine maternity care. Methods: We will physically recruit 824 pregnant women at <20 weeks of gestation living in Mbarara and Mitooma districts, southwestern Uganda, and randomize them (1:1) to receive standard of care or the Support-Moms app, with at least 2 of their identified social supporters. Our primary outcome will be the proportion of skilled births. Secondary outcomes will include number of ANC visits<strong>,</strong> institution-based delivery, mode of infant delivery, preterm birth, birth weight, SS, obstetric complications, and deaths (maternal, fetal, and newborn). We will assess other implementation, service, and client outcomes through study records, the mHealth platform, and questionnaires with all women in the intervention, their social supporters, health care providers (HCPs), and managers from participating facilities. We will conduct face-to-face in-depth exit interviews with 30 purposively selected intervention participants and 15 facility HCPs and managers to explore implementation strategies for scale-up. Annual maternity resource allocations, costs, number of ANC visits, and deliveries will be assessed from facility records up to 36 months after implementation. We will estimate incremental cost-effectiveness ratios concerning cost per additional HCP-led delivery, per death averted, and per quality-adjusted life year gained as cost-effectiveness measures. Results: This study was funded in September 2023. Ethics approval was obtained in February 2024, and actual data collection started in March 2024. As of January 2025, 75% (618/824) of all projected study participants provided consent and were recruited into the study. Participants are expected to be followed up until delivery, and 15% (124/824) have so far exited. Data analysis for the trial is expected to start as soon as the last participant exits from the study. The qualitative interviews will start in April 2025, and data will be analyzed and published as soon as data collection is done, which is expected in March 2027. Conclusions: We are testing the feasibility, acceptability, and cost-effectiveness of implementing Support-Moms into routine maternity care from individual and facility perspectives. We hypothesize that Support-Moms will be an effective and cost-effective strategy to improve maternity service use for women in rural Uganda and similar settings. Trial Registration: ClinicalTrials.gov NCT05940831; https://clinicaltrials.gov/study/NCT05940831 International Registered Report Identifier (IRRID): DERR1-10.2196/67049 
%M 40105879
%R 10.2196/67049
%U https://www.researchprotocols.org/2025/1/e67049
%U https://doi.org/10.2196/67049
%U http://www.ncbi.nlm.nih.gov/pubmed/40105879

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e66580
%T Association of Digital Health Interventions With Maternal and Neonatal Outcomes: Systematic Review and Meta-Analysis
%A Wang,Jianing
%A Tang,Nu
%A Jin,Congcong
%A Yang,Jianxue
%A Zheng,Xiangpeng
%A Jiang,Qiujing
%A Li,Shengping
%A Xiao,Nian
%A Zhou,Xiaojun
%+ Department of Maternal and Child Information Management, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chonqing, 401147, China, 86 23 6723 2442, 1186440689@qq.com
%K digital health
%K telemedicine
%K telehealth
%K mobile health
%K mHealth
%K mobile phone
%K intervention
%K meta-analysis
%K pregnant women
%K systematic review
%D 2025

%7 14.3.2025
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Gestational weight gain (GWG) is crucial to maternal and neonatal health, yet many women fail to meet recommended guidelines, increasing the risk of complications. Digital health interventions offer promising solutions, but their effectiveness remains uncertain. This study evaluates the impact of such interventions on GWG and other maternal and neonatal outcomes. Objective: This study aimed to investigate the effect of digital health interventions among pregnant women and newborns. Methods: A total of 2 independent researchers performed electronic literature searches in the PubMed, Embase, Web of Science, and Cochrane Library databases to identify eligible studies published from their inception until February 2024; an updated search was conducted in August 2024. The studies included randomized controlled trials (RCTs) related to maternal and neonatal clinical outcomes. The Revised Cochrane risk-of-bias tool for randomized trials was used to examine the risk of publication bias. Stata (version 15.1; StataCorp) was used to analyze the data. Results: We incorporated 42 pertinent RCTs involving 148,866 participants. In comparison to the routine care group, GWG was markedly reduced in the intervention group (standardized mean difference–0.19, 95% CI –0.25 to –0.13; P<.001). A significant reduction was observed in the proportion of women with excessive weight gain (odds ratio [OR] 0.79, 95% CI 0.69-0.91; P=.001), along with an increase in the proportion of women with adequate weight gain (OR 1.33, 95% CI 1.10-1.64; P=.003). Although no significant difference was reported for the proportion of individuals below standardized weight gain, there is a significant reduction in the risk of miscarriage (OR 0.66, 95% CI 0.46-0.95; P=.03), preterm birth (OR 0.8, 95% CI 0.75-0.86; P<.001), as well as complex neonatal outcomes (OR 0.93, 95% CI 0.87-0.99; P=.02). Other maternal and fetal outcomes were not significantly different between the 2 groups (all P>.05). Conclusions: The findings corroborate our hypothesis that digitally facilitated health care can enhance certain facets of maternal and neonatal outcomes, particularly by mitigating excessive weight and maintaining individuals within a reasonable weight gain range. Therefore, encouraging women to join the digital health team sounds feasible and helpful. Trial Registration: PROSPERO CRD42024564331; https://tinyurl.com/5n6bshjt 
%M 40085842
%R 10.2196/66580
%U https://www.jmir.org/2025/1/e66580
%U https://doi.org/10.2196/66580
%U http://www.ncbi.nlm.nih.gov/pubmed/40085842

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 14
%N 
%P e66637
%T Healthy Mom Zone Adaptive Intervention With a Novel Control System and Digital Platform to Manage Gestational Weight Gain in Pregnant Women With Overweight or Obesity: Study Design and Protocol for a Randomized Controlled Trial
%A Downs,Danielle Symons
%A Pauley,Abigail M
%A Rivera,Daniel E
%A Savage,Jennifer S
%A Moore,Amy M
%A Shao,Danying
%A Chow,Sy-Miin
%A Lagoa,Constantino
%A Pauli,Jaimey M
%A Khan,Owais
%A Kunselman,Allen
%+ Department of Kinesiology, Pennsylvania State University, 378 N Burrowes, 266 Recreation Building, University Park, PA, 16802, United States, 1 814 863 0456, dsd11@psu.edu
%K pregnancy
%K gestational weight gain
%K physical activity
%K healthy eating
%K overweight
%K obesity
%K intervention
%D 2025

%7 13.3.2025
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Regulating gestational weight gain (GWG) in pregnant women with overweight or obesity is difficult, particularly because of the narrow range of recommended GWG for optimal health outcomes. Given that many pregnant women show excessive GWG and considering the lack of a “gold standard” intervention to manage GWG, there is a timely need for effective and efficient approaches to regulate GWG. We have enhanced the Healthy Mom Zone (HMZ) 2.0 intervention with a novel digital platform, automated dosage changes, and personalized strategies to regulate GWG, and our pilot study demonstrated successful recruitment, compliance, and utility of our new control system and digital platform. Objective: The goal of this paper is to describe the study protocol for a randomized controlled optimization trial to examine the efficacy of the enhanced HMZ 2.0 intervention with the new automated control system and digital platform to regulate GWG and influence secondary maternal and infant outcomes while collecting implementation data to inform future scalability. Methods: This is an efficacy study using a randomized controlled trial design. HMZ 2.0 is a multidosage, theoretically based, and individually tailored adaptive intervention that is delivered through a novel digital platform with an automated link of participant data to a new model-based predictive control algorithm to predict GWG. Our new control system computes individual dosage changes and produces personalized physical activity (PA) and energy intake (EI) strategies to deliver just-in-time dosage change recommendations to regulate GWG. Participants are 144 pregnant women with overweight or obesity randomized to an intervention (n=72) or attention control (n=72) group, stratified by prepregnancy BMI (<29.9 vs ≥30 kg/m2), and they will participate from approximately 8 to 36 weeks of gestation. The sample size is based on GWG (primary outcome) and informed by our feasibility trial showing a 21% reduction in GWG in the intervention group compared to the control group, with 3% dropout. Secondary outcomes include PA, EI, sedentary and sleep behaviors, social cognitive determinants, adverse pregnancy and delivery outcomes, infant birth weight, and implementation outcomes. Analyses will include descriptive statistics, time series and fixed effects meta-analytic approaches, and mixed effects models. Results: Recruitment started in April 2024, and enrollment will continue through May 2027. The primary (GWG) and secondary (eg, maternal and infant health) outcome results will be analyzed, posted on ClinicalTrials.gov, and published after January 2028. Conclusions: Examining the efficacy of the novel HMZ 2.0 intervention in terms of GWG and secondary outcomes expands the boundaries of current GWG interventions and has high clinical and public health impact. There is excellent potential to further refine HMZ 2.0 to scale-up use of the novel digital platform by clinicians as an adjunct treatment in prenatal care to regulate GWG in all pregnant women. International Registered Report Identifier (IRRID): DERR1-10.2196/66637 
%M 40080809
%R 10.2196/66637
%U https://www.researchprotocols.org/2025/1/e66637
%U https://doi.org/10.2196/66637
%U http://www.ncbi.nlm.nih.gov/pubmed/40080809

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 8
%N 
%P e59377
%T Fetal Birth Weight Prediction in the Third Trimester: Retrospective Cohort Study and Development of an Ensemble Model
%A Gao,Jing
%A Jie,Xu
%A Yao,Yujun
%A Xue,Jingdong
%A Chen,Lei
%A Chen,Ruiyao
%A Chen,Jiayuan
%A Cheng,Weiwei
%K fetal birthweight
%K ensemble learning model
%K machine learning
%K prediction model
%K ultrasonography
%K macrosomia
%K low birth weight
%K birth weight
%K fetal
%K AI
%K artificial intelligence
%K prenatal
%K prenatal care
%K Shanghai
%K neonatal
%K maternal
%K parental
%D 2025

%7 10.3.2025
%9 
%J JMIR Pediatr Parent
%G English
                
%X Background: Accurate third-trimester birth weight prediction is vital for reducing adverse outcomes, and machine learning (ML) offers superior precision over traditional ultrasound methods. Objective: This study aims to develop an ML model on the basis of clinical big data for accurate prediction of birth weight in the third trimester of pregnancy, which can help reduce adverse maternal and fetal outcomes. Methods: From January 1, 2018 to December 31, 2019, a retrospective cohort study involving 16,655 singleton live births without congenital anomalies (>28 weeks of gestation) was conducted in a tertiary first-class hospital in Shanghai. The initial set of data was divided into a train set for algorithm development and a test set on which the algorithm was divided in a ratio of 4:1. We extracted maternal and neonatal delivery outcomes, as well as parental demographics, obstetric clinical data, and sonographic fetal biometry, from electronic medical records. A total of 5 basic ML algorithms, including Ridge, SVM, Random Forest, extreme gradient boosting (XGBoost), and Multi-Layer Perceptron, were used to develop the prediction model, which was then averaged into an ensemble learning model. The models were compared using accuracy, mean squared error, root mean squared error, and mean absolute error. International Peace Maternity and Child Health Hospital's Research Ethics Committee granted ethical approval for the usage of patient information (GKLW2021-20). Results: Train and test sets contained a total of 13,324 and 3331 cases, respectively. From a total of 59 variables, we selected 17 variables that were readily available for the “few feature model,” which achieved high predictive power with an accuracy of 81% and significantly exceeded ultrasound formula methods. In addition, our model maintained superior performance for low birth weight and macrosomic fetal populations. Conclusions: Our research investigated an innovative artificial intelligence model for predicting fetal birth weight and maximizing health care resource use. In the era of big data, our model improves maternal and fetal outcomes and promotes precision medicine. 
%R 10.2196/59377
%U https://pediatrics.jmir.org/2025/1/e59377
%U https://doi.org/10.2196/59377

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e55844
%T Effects of a Mobile Health Intervention Based on Behavioral Integrated Model on Cognitive and Behavioral Changes in Gestational Weight Management: Randomized Controlled Trial
%A Zhou,Meng
%A Wang,Li
%A Deng,Ying
%A Ge,Jinjin
%A Zhao,Shiqi
%A You,Hua
%+ Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, China, 86 13382772548, youhua98@163.com
%K cognition
%K health behavior
%K information-motivation-behavioral skills model
%K mobile health
%K psychological models
%K pregnant woman
%K randomized controlled trial
%K mobile phone
%D 2025

%7 10.3.2025
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: The key to gestational weight management intervention involves health-related behaviors, including dietary and exercise management. Behavioral theory-based interventions are effective in improving health-related behaviors. However, evidence for mobile health interventions based on specific behavioral theories is insufficient and their effects have not been fully elucidated. Objective: This study aimed to examine the effects of a gestational mobile health intervention on psychological cognition and behavior for gestational weight management, using an integrated behavioral model as the theoretical framework. Methods: This study was conducted in a tertiary maternity hospital and conducted as a single-blind randomized controlled trial (RCT) in Changzhou, Jiangsu Province, China. Using the behavioral model, integrated with the protection motivation theory and information–motivation–behavioral skills model (PMT-IMB model), the intervention group received a mobile health intervention using a self-developed app from 14 to 37 gestational weeks, whereas the control group received routine guidance through the application. Psychological cognition and behaviors related to weight management during pregnancy were the main outcomes, which were measured at baseline, and at the second and third trimesters of pregnancy using a self-designed questionnaire. Generalized estimation and regression equations were used to compare the outcome differences between the intervention and control groups. Results: In total, 302 (302/360, 83.9%) participants underwent all measurements at 3 time points (intervention group: n=150; control group: n=152). Compared with the control group, the intervention group had significantly higher scores for information, perceived vulnerability, response cost, and exercise management in the second trimester, while their scores for perceived vulnerability, response cost, and diet management were significantly higher in the third trimester. The results of repeated measures analysis revealed that, in psychological cognition, the information dimension exhibited both the time effects (T3 β=3.235, 95% CI 2.859-3.611; P<.001) and the group effects (β=0.597, 95% CI 0.035-1.158; P=.04). Similarly, response costs demonstrated both the time effects (T3 β=0.745, 95% CI 0.199-1.291; P=.008) and the group effects (β=1.034, 95% CI 0.367-1.700; P=.002). In contrast, perceived vulnerability solely exhibited the group effects (β=0.669, 95% CI 0.050-1.288; P=.03). Regarding weight management behaviors, both time (T3 β=6, 95% CI 4.527-7.473; P<.001) and group (β=2.685, 95% CI 0.323-5.047; P=.03) had statistically significant impacts on the total points. Furthermore, the exercise management dimension also demonstrated both the time effects (T3 β=3.791, 95% CI 2.999-4.584; P<.001) and the group effects (β=1.501, 95% CI 0.232-2.771; P=.02). Conclusions: The intervention program was effective in increasing psychological cognitions in terms of information, perceived vulnerability, and response costs, as well as promoting healthy behaviors among Chinese pregnant women. This study provides new evidence supporting the effectiveness of mobile intervention based on behavioral science theory in gestational weight management. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100043231; https://www.chictr.org.cn/showproj.html?proj=121736 
%M 40063942
%R 10.2196/55844
%U https://www.jmir.org/2025/1/e55844
%U https://doi.org/10.2196/55844
%U http://www.ncbi.nlm.nih.gov/pubmed/40063942

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 9
%N 
%P e64239
%T Evaluation of the MyFertiCoach Lifestyle App for Subfertile Couples: Single-Center Evaluation of Augmented Standard Care
%A Smeenk,Jesper
%A Smit,Ellen
%A Jacobs,Marc
%A van Rooij,Ilse
%+ Elisabeth TweeSteden Ziekenhuis, Doctor Deelenlaan 5, Tilburg, 5042 AD, The Netherlands, 31 (013) 221 00 00, j.smeenk@etz.nl
%K fertility
%K mHealth
%K pregnancy
%K lifestyle
%K app
%K smartphone
%D 2025

%7 10.3.2025
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Many couples undergoing fertility treatment face multiple lifestyle risk factors that lower their chances of achieving pregnancy. The MyFertiCoach (MFC) app was designed as an integrated lifestyle program featuring modules on healthy weight management, nutrition, exercise, quitting smoking, reducing alcohol and drug use, and managing stress. We hypothesized that supplementing standard care with the MFC app would improve lifestyle outcomes. Objective: This study aims to assess the impact of the MFC app on changing multiple lifestyle habits in women seeking fertility treatment. The primary outcome is the change in the total risk score (TRS) at 3- and six-month follow-ups. The TRS is calculated for each individual as the sum of all risk scores per behavior (eg, vegetable/fruit/folic acid intake, smoking, and alcohol use) at 3 and 6 months. A higher TRS indicates unhealthier nutrition and lifestyle habits and a lower likelihood of achieving pregnancy. The secondary endpoints include changes in BMI, activity score, preconception dietary risk score, distress score (eg, perceived burden), smoking habits, alcohol intake, and program adherence. Methods: This retrospective, observational, single-center evaluation included patients between January 1, 2022, and December 31, 2023. Subfertile female patients aged 18-43 years and their partners, who were referred to a gynecologist, were invited to participate in online lifestyle coaching via the MFC app. The gynecologist selected relevant lifestyle modules based on the results of integrated screening questionnaires. We used (hierarchical) linear mixed models (LMMs) to estimate changes in outcomes. For missing data patterns deemed missing not at random, joint modeling was applied. Statistical significance was set at P≤.05, with methods in place to maintain the same false-positive rate. Results: A total of 1805 patients were invited to participate in the evaluation, with an average of 737 (40.83%) completing the screening questionnaire at baseline. For the TRS, 798 (44.21%) patients were included at baseline, of whom 517 (64.8%) involved their partner. On average, 282 of 744 (37.9%) patients submitted at least one follow-up questionnaire. Patients rated the app above average (n=137, median score of 7 on a 1-10 scale) on days 7 and 14. The TRS decreased by an average of 1.5 points (P<.001) at T3 and T6 compared with baseline, a clinically meaningful improvement. All secondary outcomes showed statistically significant positive changes for patients who used a relevant lifestyle module (P<.001). Most improvements were achieved by 3 months and remained significant at 6 months (P<.001), except for alcohol intake (P<.53). These findings were consistent across both LMMs and joint models. Conclusions: Our evaluation of a mobile health app integrated into standard care demonstrates immediate and clinically meaningful improvements in key lifestyle parameters among women seeking to become pregnant. Additional scientific research is needed to identify the causal pathways leading to sustained effectiveness. To maintain and enhance these outcomes, further tailoring of patient-specific programs is essential. 
%M 40063944
%R 10.2196/64239
%U https://formative.jmir.org/2025/1/e64239
%U https://doi.org/10.2196/64239
%U http://www.ncbi.nlm.nih.gov/pubmed/40063944

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e51517
%T Exploration of Reproductive Health Apps’ Data Privacy Policies and the Risks Posed to Users: Qualitative Content Analysis
%A Zadushlivy,Nina
%A Biviji,Rizwana
%A Williams,Karmen S
%+ Department of Health Policy and Management, Graduate School of Public Health and Health Policy, City University of New York, 55 W. 125th Street, New York, NY, 10027, United States, 1 918 816 0915, Karmen.Williams@sph.cuny.edu
%K data privacy policy
%K reproductive health apps
%K Transparency, Health Content, Excellent Technical Content, Security/Privacy, Usability, Subjective
%K THESIS
%K THESIS evaluation
%K women’s health
%K menstrual health
%K mobile health
%K mHealth
%K menstruating persons’ health
%K mobile phone
%D 2025

%7 5.3.2025
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Mobile health apps often require the collection of identifiable information. Subsequently, this places users at significant risk of privacy breaches when the data are misused or not adequately stored and secured. These issues are especially concerning for users of reproductive health apps in the United States as protection of sensitive user information is affected by shifting governmental regulations such as the overruling of Roe v Wade and varying state-level abortion laws. Limited studies have analyzed the data privacy policies of these apps and considered the safety issues associated with a lack of user transparency and protection. Objective: This study aimed to evaluate popular reproductive health apps, assess their individual privacy policies, analyze federal and state data privacy laws governing these apps in the United States and the European Union (EU), and recommend best practices for users and app developers to ensure user data safety. Methods: In total, 4 popular reproductive health apps—Clue, Flo, Period Tracker by GP Apps, and Stardust—as identified from multiple web sources were selected through convenience sampling. This selection ensured equal representation of apps based in the United States and the EU, facilitating a comparative analysis of data safety practices under differing privacy laws. A qualitative content analysis of the apps and a review of the literature on data use policies, governmental data privacy regulations, and best practices for mobile app data privacy were conducted between January 2023 and July 2023. The apps were downloaded and systematically evaluated using the Transparency, Health Content, Excellent Technical Content, Security/Privacy, Usability, Subjective (THESIS) evaluation tool to assess their privacy and security practices. Results: The overall privacy and security scores for the EU-based apps, Clue and Flo, were both 3.5 of 5. In contrast, the US-based apps, Period Tracker by GP Apps and Stardust, received scores of 2 and 4.5, respectively. Major concerns regarding privacy and data security primarily involved the apps’ use of IP address tracking and the involvement of third parties for advertising and marketing purposes, as well as the potential misuse of data. Conclusions: Currently, user expectations for data privacy in reproductive health apps are not being met. Despite stricter privacy policies, particularly with state-specific adaptations, apps must be transparent about data storage and third-party sharing even if just for marketing or analytical purposes. Given the sensitivity of reproductive health data and recent state restrictions on abortion, apps should minimize data collection, exceed encryption and anonymization standards, and reduce IP address tracking to better protect users. 
%M 40053713
%R 10.2196/51517
%U https://www.jmir.org/2025/1/e51517
%U https://doi.org/10.2196/51517
%U http://www.ncbi.nlm.nih.gov/pubmed/40053713

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e67386
%T Internet-Based Cognitive Behavioral Therapy for Preventing Postpartum Depressive Symptoms Among Pregnant Individuals With Depression: Multicenter Randomized Controlled Trial in China
%A Duan,Chen-Chi
%A Zhang,Chen
%A Xu,Hua-Lin
%A Tao,Jing
%A Yu,Jia-Le
%A Zhang,Dan
%A Wu,Shan
%A Zeng,Xiu
%A Zeng,Wan-Ting
%A Zhang,Zhi-Yin
%A Dennis,Cindy-Lee
%A Liu,Han
%A Wu,Jia-Ying
%A Mol,Ben Willem J
%A Huang,He-Feng
%A Wu,Yan-Ting
%+ Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, No.419, Fangxie Rd, Shanghai, 200000, China, 86 17321218018, yanting_wu@163.com
%K antenatal depression
%K postpartum depression
%K internet-based cognitive behavioral therapy
%K randomized controlled trial
%D 2025

%7 4.3.2025
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Women are particularly vulnerable to depression during pregnancy, which is one of the strongest risk factors for developing postpartum depression (PPD). Addressing antenatal depressive symptoms in these women is crucial for preventing PPD. However, little is known about the effectiveness of internet-based cognitive behavioral therapy (ICBT) in preventing PPD in this high-risk group. Objective: This study aims to evaluate the short- and long-term effects of ICBT in preventing PPD among women with antenatal depressive symptoms. Methods: Participants were screened for antenatal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) and randomly allocated (1:1) to either the ICBT group (receiving weekly online modules starting antenatally and continuing into early postpartum) or the control group (observed without treatment). Follow-up assessments were conducted up to 12 months postpartum, and data were analyzed using generalized estimating equations. The primary outcome was the prevalence of depressive symptoms at 6 weeks postpartum. A subgroup analysis based on the severity of antenatal depressive symptoms was also performed. The secondary outcomes included the long-term effects of ICBT on maternal depression, as well as its impact on anxiety, sleep quality, social support, parenting stress, co-parenting relationships, and infant development. Results: Between August 2020 and September 2021, 300 pregnant individuals were recruited from 5 centers across China. No significant differences were observed in depressive symptoms at 6 weeks postpartum (P=.18) or at any longer-term follow-up time points (P=.18). However, a post hoc subgroup analysis showed that participants with antenatal EPDS scores of 10-12 in the ICBT group had a lower risk of developing depression during the first year postpartum (odds ratio 0.534, 95% CI 0.313-0.912; P=.02), but this was not observed for participants with more severe depression. Additionally, this subgroup demonstrated higher levels of co-parenting relationships (P=.02). Conclusions: Among individuals with antenatal depression, ICBT did not prevent the development of PPD. However, ICBT may be a preferable option for those with mild to moderate antenatal depressive symptoms. Future research is needed to explore modifications to ICBT to address more severe depressive symptoms. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000033433; https://www.chictr.org.cn/showproj.html?proj=54482 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06728-5 
%M 40053801
%R 10.2196/67386
%U https://www.jmir.org/2025/1/e67386
%U https://doi.org/10.2196/67386
%U http://www.ncbi.nlm.nih.gov/pubmed/40053801

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 12
%N 
%P e63570
%T Evaluation of Satisfaction With a Secure, Connected Mobile App for Women in Assisted Reproductive Technology Programs: Prospective Observational Study
%A Plouvier,Pauline
%A Marcilly,Romaric
%A Robin,Geoffroy
%A Benamar,Chaymae
%A Robin,Camille
%A Simon,Virginie
%A Piau,Anne Sophie
%A Cambay,Isabelle
%A Schiro,Jessica
%A Decanter,Christine
%+ Departments of Assisted Reproductive Technologies and Fertility Preservation, Jeanne de Flandre Hospital, Avenue Eugène Avinée, Lille, F-59000, France, 33 0626394791, pauline.plouvier@chu-lille.fr
%K mobile apps
%K mHealth
%K mobile health
%K assisted reproductive technologies
%K evaluation
%K satisfaction
%K reproduction
%K fertility
%K ovarian stimulation
%K ease of use
%K usability
%K midwives
%K obstetrics
%K gynecology
%D 2025

%7 24.2.2025
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: Telemedicine has emerged rapidly as a novel and secure tool to deliver medical information and prescriptions. A secure, connected health care app (WiStim) has been developed in order to facilitate dialogue between patients and the medical team during an ovarian stimulation cycle for medically assisted reproduction (MAR). Objective: This study aimed to evaluate the patients’ and midwives’ levels of satisfaction with the connected mobile app. Methods: We conducted a prospective, observational, single-center study at Lille University Hospital, France. From May 1 to July 31, 2021, all women undergoing ovarian stimulation started to receive their treatment advice through the mobile app. A total of 184 women were included and they filled out the 30-item Usefulness Satisfaction and Ease-of-Use (USE) questionnaire, which examines the users’ opinions in 4 dimensions: usefulness, ease of use, ease of learning, and satisfaction. The women also answered a series of closed and open questions. The 5 midwives in our assisted reproductive technology center filled out the French version of the 10-item System Usability Scale (SUS) when the app was implemented and then after 3 and 6 months of use. We also performed semistructured interviews with the midwives. Results: Overall, 183 women using the app completed the questionnaire. None refused to use the app, and 1 withdrew from the study. The mean scores for the four USE dimensions were all significantly greater than 4, that is, the middle of the response scale. The women liked the app’s ease of use, the access to tutorial videos, and the reminders about appointments and treatments. In particular, the women liked to be able to (re)read the information; this reassured them, might have reduced the number of missed appointments and treatments, and made them more independent during the day, especially when they were working. Some of the women regretted the loss of direct contact with the midwife. The mean SUS score was 76 (SD 13.54) at the start of the study, 75 (SD 17.16) after 3 months, and 84 (11.21) after 6 months. According to the adjective rating scale, these scores corresponded to good usability for the app. After the requisite training and a familiarization period, the midwives reported that using the app saved them 2 hours a day. The mobile app enabled better transmission of information and thus probably helped to decrease treatment errors. Conclusions: The WiStim connected mobile app is one of the first reliable, secure apps in the field of MAR. The app reassured the patients during the ovarian stimulation. Women and the medical team considered that the app was easy and intuitive to use. Given the growth in demand for MAR programs and the medical team’s workload, the time savings provided by the app constitute a nonnegligible advantage. 
%M 39993725
%R 10.2196/63570
%U https://humanfactors.jmir.org/2025/1/e63570
%U https://doi.org/10.2196/63570
%U http://www.ncbi.nlm.nih.gov/pubmed/39993725

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e56230
%T Improving Maternal Mental Health and Weight Control With a Mindfulness Blended Care Approach: Insights From a Randomized Controlled Trial
%A Hassdenteufel,Kathrin
%A Müller,Mitho
%A Abele,Harald
%A Brucker,Sara Yvonne
%A Graf,Johanna
%A Zipfel,Stephan
%A Bauer,Armin
%A Jakubowski,Peter
%A Pauluschke-Fröhlich,Jan
%A Wallwiener,Markus
%A Wallwiener,Stephanie
%+ Department of Obstetrics and Gynecology, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Heidelberg, 69120, Germany, 49 15238492062, Kathrin.hassdenteufel@med.uni-heidelberg.de
%K peripartum mental health
%K digital intervention
%K depression
%K anxiety
%K personal coaching
%K ehealth
%K pregnancy
%K maternal mental health
%K weight gain
%K mindfulness-based intervention
%K coaching
%K randomized controlled clinical trial
%K postpartum
%K treatment
%K electronic
%K effectiveness
%K women
%K digital intervention
%D 2025

%7 24.2.2025
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Perinatal maternal mental health problems, such as depression and anxiety, are highly prevalent during pregnancy and post partum. Electronic mindfulness-based interventions (eMBIs) are a promising treatment option, which can be provided in a low-threshold, cost-effective manner. However, research underscores the fact that face-to-face coaching sessions are more effective than solely digital methods. A blended care approach (eMBI with direct face-to-face coaching) could amplify the therapeutic impact on maternal mental health and weight gain during the perinatal period. Objective: We investigated whether combining an eMBI intervention with face-to-face personal support significantly improves maternal mental health, and whether the intervention can influence weight gain in affected women during pregnancy. Methods: A community-based sample of 460 pregnant women with a singleton pregnancy who screened positive for depression was enrolled in a multicenter randomized controlled trial (RCT) including the University Hospitals of Heidelberg and Tübingen as well as more than 200 gynecological practices within the state of Baden-Württemberg in Germany between February 2019 and October 2020. Participating women were randomized 1:1 to the control group (CG) or intervention group (IG) that received access to an 8-week pregnancy-adapted eMBI between the 29th and 36th gestational week. In a subanalysis, we grouped participants in those receiving only the initial face-to-face coaching session at recruitment (no personal coaching) and those with ≥2 personal coaching sessions. Primary outcome measures were severity of depressive symptoms using the Edinburgh Postnatal Depression Scale, anxiety using the State-Trait Anxiety Inventory, the Pregnancy-Related Anxiety Questionnaire, the Freiburg Mindfulness Inventory, and the Patient Health Questionnaire; secondary outcome measure, BMI. Results: In the final sample, 137 CG women and 102 IG women received only one coaching session, whereas 37 CG women and 40 IG women received at least 2 (mean 2.3, SD 0.7) coaching sessions. The analyses were adjusted for significant confounders. The IG’s mindfulness scores increased significantly (F1.873,344.619=4.560, P=.01, η²=0.024, ω²=0.012) regardless of coaching frequency. Both general anxiety (F12,129=2.361, P=.01, η²=0.0180, ω²=0.100) and depression symptoms (F4.758, 699.423=3.033, P=.01, η²=0.020, ω²=0.009) were significantly lower in the group that received ≥2 coaching sessions than in the no-personal-coaching group. In the group receiving ≥2 coaching sessions, BMI generally was lower in the IG than in the CG (F3.555,444.416=4.732, P=.002, η²=0.036, ω²=0.013). Conclusions: Adding a minimal amount of PC to the digital eMBI increased mindfulness and decreased birth-related anxiety, symptoms of depression, and anxiety in at-risk pregnant women. Favorable effects on gestational weight gain were found in the respective IGs, the strongest effect being within the PC group. This blended digital health approach amplifies the effectiveness of the digital intervention. Trial Registration: German Clinical Trials Register DRKS00017210; https://www.drks.de/search/de/trial/DRKS00017210 
%M 39992700
%R 10.2196/56230
%U https://www.jmir.org/2025/1/e56230
%U https://doi.org/10.2196/56230
%U http://www.ncbi.nlm.nih.gov/pubmed/39992700

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 8
%N 
%P e60315
%T Simulation of Contraceptive Access for Adolescents and Young Adults Using a Pharmacist-Staffed e-Platform: Development, Usability, and Pilot Testing Study
%A Knowles,Kayla
%A Lee,Susan
%A Yapalater,Sophia
%A Taylor,Maria
%A Akers,Aletha Y
%A Wood,Sarah
%A Dowshen,Nadia
%+ PolicyLab, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, United States, 1 267 425 1449, knowlesk1@chop.edu
%K adolescent
%K contraception
%K telemedicine
%K user-centered design
%K young adult
%K reproductive
%K design
%K usability
%K experience
%K mHealth
%K mobile health
%K app
%K youth
%K teenager
%K drug
%K pharmacology
%K pharmacotherapy
%K pharmaceutics
%K medication
%K pharmacy
%K digital health
%K platform
%K access
%D 2025

%7 19.2.2025
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Offering contraceptive methods at pharmacies without a prescription is an innovative solution to reduce the incidence of unintended pregnancies among adolescents and young adults (AYA). Pharmacy-prescribed contraception may increase the convenience, simplicity, and affordability of contraceptives. Objective: The aim of this study was to develop, pilot test, and evaluate the acceptability and feasibility of a telemedicine electronic platform app simulating pharmacist prescribing of contraceptives to AYA as well as assess agreement between pharmacist-simulated contraceptive approvals and contraception as prescribed in routine clinic visits. Methods: This study was conducted in two phases: (1) development and usability testing of a prototype app to simulate pharmacists prescribing contraceptives to AYA and (2) pilot testing the app in a simulation for AYA requesting contraception from a pharmacist with pharmacist review and request approval or rejection. Eligibility criteria in both phases included the following: assigned female sex at birth, age 15-21 years, seeking contraceptive services at an academic adolescent medicine clinic, prior history of or intention to have penile-vaginal intercourse in the next 12 months, smartphone ownership, and English language proficiency. Phase 1 (usability) involved a video-recorded “think aloud” interview to share feedback and technical issues while using the app prototype on a smartphone and the completion of sociodemographic, sexual history, and perception of the prototype surveys to further develop the app. Phase 2 (pilot) participants completed phase 1 surveys, tested the updated app in a simulation, and shared their experiences in an audio-recorded interview. Descriptive analyses were conducted for quantitative survey data, and thematic analyses were used for interview transcripts. Results: Of the 22 participants, 10 completed usability testing, with a mean age of 16.9 (SD 1.97) years, and 12 completed pilot testing, with a mean age of 18.25 (SD 1.48) years. Three issues with the prototype were identified during “think aloud” interviews: challenges in comprehension of medical language, prototype glitches, and graphic design suggestions for engagement. Usability testing guided the frontend and backend creation of the platform. Overall, participants agreed or strongly agreed that using an app to receive contraceptives would make it easier for teens to access (n=19, 86%) and make contraceptive use less stigmatizing (n=19, 86%). In addition, participants agreed that receiving contraception prescriptions from a pharmacist without a clinic visit would be safe (n=18, 82%), convenient (n=19, 86%), acceptable (n=18, 82%), and easy (n=18, 82%). Pharmacists and medical providers had 100% agreement on the prescribed contraceptive method for pilot participants. Conclusions: AYA found contraceptive prescription by a pharmacist via an app to be highly acceptable and provided critical feedback to improve the design and delivery of the app. Additionally, pharmacist contraceptive approvals and contraception as prescribed in routine clinic visits were identical. 
%M 39970429
%R 10.2196/60315
%U https://pediatrics.jmir.org/2025/1/e60315
%U https://doi.org/10.2196/60315
%U http://www.ncbi.nlm.nih.gov/pubmed/39970429

%0 Journal Article
        
%@ 2373-6658
%I JMIR Publications
%V 9
%N 
%P e66852
%T Evaluating the Quality, Content Accuracy, and User Suitability of mHealth Prenatal Care Apps for Expectant Mothers: Critical Assessment Study
%A Asadollahi,Fateme
%A Ebrahimzadeh Zagami,Samira
%A Eslami,Saeid
%A Latifnejad Roudsari,Robab
%+ Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Qarashi Building, Central Office of the University, Daneshgah Street, Mashhad, 91388-13944, Iran, 98 9370400607, rlatifnejad@yahoo.com
%K pregnancy
%K prenatal care
%K mobile health apps
%K mHealth
%K women’s health
%K health care providers
%K quality assessment
%K content evaluation
%K suitability assessment
%K digital health
%K smartphones
%K eHealth
%K telehealth
%K telemedicine
%K health promotion
%K technology
%K functionality
%K systematic search
%D 2025

%7 13.2.2025
%9 Original Paper
%J Asian Pac Isl Nurs J
%G English
                
%X Background: The proliferation of health apps in the digital health landscape has created significant opportunities for health promotion, particularly during pregnancy. However, despite the widespread distribution and popularity of pregnancy mobile apps, there are limited data on their quality and content. Objective: This study aimed to evaluate the quality, content accuracy, and suitability of the most popular and freely available Persian mobile health (mHealth) apps for prenatal care in expectant mothers. Methods: Through a systematic search, a total of 199 apps were screened from available app stores using the search term “pregnancy app” until July 2023. Inclusion criteria were apps in the Farsi language, freely available, downloaded more than 10,000 times, and designed for pregnant women. Ultimately, 9 apps met these criteria. These apps were downloaded onto mobile phones and assessed by 2 independent reviewers using the Mobile App Rating Scale (MARS), the Coverage and Depth of Information Checklist, and the Suitability Assessment of Materials (SAM). Statistical analyses explored relationships between app quality metrics and user ratings. Results: The 9 apps evaluated had an average MARS score of 3.55 (SD 0.61) out of 5. Aesthetics (mean 4.02, SD 0.45) and Functionality (mean 4.11, SD 0.36) scored the highest, followed by Engagement (mean 3.29, SD 0.53) and Information (mean 3.09, SD 0.48). User star ratings did not strongly correlate with MARS scores (r=0.38, P>.05). Regarding health information coverage, 6 out of 9 (66.7%) apps were rated as poor, and 3 (33.3%) as adequate. For SAM, 4 (44.4%) apps were rated as superior and 5 (55.6%) as adequate. No app received a poor score. Conclusions: The study underscores the need for improved standards in pregnancy app development to enhance educational efficacy and user satisfaction. Health care providers should recommend high-quality pregnancy apps with appropriate content to ensure effective health promotion. These findings contribute to understanding the current landscape of pregnancy apps and highlight areas for future research and regulatory attention. Trial Registration: PROSPERO CRD42023461605; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=461605 
%M 39946714
%R 10.2196/66852
%U https://apinj.jmir.org/2025/1/e66852
%U https://doi.org/10.2196/66852
%U http://www.ncbi.nlm.nih.gov/pubmed/39946714

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 8
%N 
%P e60038
%T Usability and Acceptability of a Pregnancy App for Substance Use Screening and Education: A Mixed Methods Exploratory Pilot Study
%A Fitzgerald,Haley
%A Frank,Madison
%A Kasula,Katelyn
%A Krans,Elizabeth E
%A Krishnamurti,Tamar
%K substance use disorder
%K substance use screening
%K mHealth
%K mobile health apps
%K pregnancy
%K technology
%D 2025

%7 13.2.2025
%9 
%J JMIR Pediatr Parent
%G English
                
%X Background: Increasing opioid and other substance use has led to a crisis of epidemic proportions, with substance use now recognized as a leading cause of maternal morbidity and mortality in the United States. Interventions will only be effective if those who would benefit are identified early and connected to care. Apps are a ubiquitous source of pregnancy information, but their utility as a platform for evaluating substance use during pregnancy is unknown. Objective: This study aims to explore the usability and acceptability of a pregnancy app for opioid and other substance use screening and education. Methods: This mixed methods, exploratory pilot study examined adult pregnant people with a history of substance use who were recruited from outpatient and inpatient settings at a tertiary care obstetric hospital. After completing a baseline survey collecting demographics, substance use, and technology use, participants accessed an existing pregnancy support app for 4 weeks. Qualitative methods were used to measure the acceptability of embedding substance use screening, education, and information within the tool. App use frequency and access to substance use educational content and treatment referral information were evaluated. Results: The 28 female participants had a mean (SD) age of 31 (0.46) years; most were White (21/28, 75%) and Medicaid insured (26/28, 93%), with an annual household income of <US $30,000 (16/28, 57%). The mean gestational age at enrollment was 22 weeks. Almost half (13/28, 46%) were taking medication for opioid use disorder (methadone or buprenorphine). Other substances used included tobacco (22/28, 79%), marijuana (20/28, 71%), illicit opioids (9/28, 32%), alcohol (6/28, 21%), and stimulants (4/28, 14%), including cocaine, amphetamines, and benzodiazepines (2/28, 7%). Most (19/28, 68%) reported previously using one or more prenatal apps and 11% (3/28) cited prenatal apps as their most frequently used source of pregnancy information. After approximately 4 weeks of app exposure, 71% (20/28) logged in at least weekly, 89% (25/28) were satisfied with the app, and 96% (27/28) reported that the app was a helpful source of support. In cognitive interviews, participants reported that app-based disclosure of substance use could be easier than disclosing in person due to reduced stigma. However, participants expressed concerns about not knowing who would have access to this information. Conclusions: Incorporating substance use supports into a pregnancy app was found to be acceptable among those using substances. Participants reported frequent baseline use of prenatal apps, showed a high level of engagement with the pregnancy app during the study, and demonstrated interest in expanding the substance use support elements of this app. Embedding substance use screening, information, and connection to care into a tool with wide-scale use during pregnancy has the potential to identify at-risk individuals who may otherwise not be identified during routine prenatal care. It also has the potential to connect individuals, who might otherwise be hesitant to disclose their substance use, to recovery or harm reduction resources. 
%R 10.2196/60038
%U https://pediatrics.jmir.org/2025/1/e60038
%U https://doi.org/10.2196/60038

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 9
%N 
%P e60862
%T Privacy Concerns Versus Personalized Health Content—Pregnant Individuals’ Willingness to Share Personal Health Information on Social Media: Survey Study
%A Hao,Haijing
%A Lee,Yang W
%A Sharko,Marianne
%A Li,Qilu
%A Zhang,Yiye
%K privacy concerns
%K trust
%K pregnancy
%K health information seeking
%K pregnant women
%K maternal
%K maternity
%K childbearing
%K web-based information
%K health information
%K mental health
%K internet
%K social support
%K technology
%K mobile health
%K mHealth
%K digital health
%K health informatics
%K social media
%D 2025

%7 10.2.2025
%9 
%J JMIR Form Res
%G English
                
%X Background: Often lacking immediate access to care providers, pregnant individuals frequently turn to web-based sources for information to address their evolving physical and mental health needs. Social media has gained increasing prominence as a source of news and information despite privacy concerns and unique risks posed to the pregnant population. Objectives: This study investigated the extent to which patients may be willing to disclose personal health information to social media companies in exchange for more personalized health content. Methods: We designed and deployed an electronic survey to pregnant individuals worldwide electronically in 2023. We used the classical Internet Users’ Information Privacy Concerns (IUIPC) model to examine how privacy concerns modulate pregnant individuals’ behaviors and beliefs regarding risk and trust when using social media for health purposes. Results were analyzed using partial least squares structural equation modeling. Results: Among 317 respondents who initiated the survey, 84% (265/317) of the respondents remained in the study, providing complete responses. Among them, 54.7% (145/265) indicated willingness to provide their personalized health information for receiving personalized health content via social media, while 26% (69/265) were uncertain and 19.3% (51/265) were opposed. Our estimated IUIPC model results are statistically significant and qualitatively align with the classic IUIPC model for the general population, which was previously found in an e-commerce context. The structural model revealed that privacy concerns (IUIPC) negatively affected trusting beliefs (β=−0.408; P<.001) and positively influenced risk beliefs (β=0.442; P<.001). Trusting beliefs negatively impacted risk beliefs (β=−o.362; P<.001) and positively affected the intention to disclose personal health information (β=o.266; P<.001). Risk beliefs negatively influenced the intention to disclose (β=−0.281; P<.001). The model explained 41.5% of the variance in the intention to disclose personal health information (R²=0.415). In parallel with pregnant individuals’ willingness to share, we find that they have heightened privacy concerns and their use of social media for information seeking is largely impacted by their trust in the platforms. This heightened concern significantly affects both their trusting beliefs, making them less inclined to trust social media companies, and their risk beliefs, leading them to perceive greater risks in sharing personal health information. However, within this population, an increase in trust toward social media companies leads to a more substantial decrease in perceived risks than what has been previously observed in the general population. Conclusions: We find that more than half of the pregnant individuals are open to sharing their personal health information to receive personalized content about health via social media, although they have more privacy concerns than the general population. This study emphasizes the need for policy regarding the protection of health data on social media for the pregnant population and beyond. 
%R 10.2196/60862
%U https://formative.jmir.org/2025/1/e60862
%U https://doi.org/10.2196/60862

%0 Journal Article
        
%@ 1929-073X
%I JMIR Publications
%V 14
%N 
%P e51718
%T Process Evaluations of Interventions for the Prevention of Type 2 Diabetes in Women With Gestational Diabetes Mellitus: Systematic Review
%A Sa'id,Iklil Iman Mohd
%A Hotung,Natasha
%A Benton,Madeleine
%A Nadal,Iliatha Papachristou
%A Baharom,Anisah
%A Prina,Matthew
%A Nisak Mohd Yusof,Barakatun
%A Goldsmith,Kimberley
%A Birts,Samantha
%A Siew Mooi,Ching
%A Forbes,Angus
%A Ismail,Khalida
%A Chew,Boon How
%+ Department of Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, Denmark Hill Campus, King’s College London, 16 De Crespigny Park, London, SE5 8AB, United Kingdom, 44 7905985068, khalida.2.ismail@kcl.ac.uk
%K gestational diabetes mellitus
%K randomized controlled trial
%K process evaluation
%K implementation
%K complex interventions
%D 2025

%7 6.2.2025
%9 Review
%J Interact J Med Res
%G English
                
%X Background: Gestational diabetes mellitus (GDM) is characterized by hyperglycemia in pregnancy and typically resolves after birth. Women with GDM have an increased risk of developing type 2 diabetes mellitus (T2DM) later in life compared to those with normoglycemic pregnancy. While diabetes prevention interventions (DPIs) have been developed to delay or prevent the onset of T2DM, few studies have provided process evaluation (PE) data to assess the mechanisms of impact, quality of implementation, or contextual factors that may influence the effectiveness of the intervention. Objective: This study aims to identify and evaluate PE data and how these link to outcomes of randomized controlled trials (RCTs) of T2DM prevention interventions for women with GDM. Methods: A systematic review was conducted to identify studies published from 2005 to 2020 aiming to capture the most recent DPIs. Five electronic bibliographic databases (Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, Embase, PubMed, and MEDLINE) were searched to identify relevant studies. Inclusion criteria were published (peer-reviewed) RCTs of DPIs in women with a current diagnosis or history of GDM. Exclusion criteria were studies not published in English; studies where the target population was women who had a family history of T2D or women who were menopausal or postmenopausal; and gray literature, including abstracts in conference proceedings. The Medical Research Council’s PE framework of complex interventions was used to identify key PE components. The Mixed Method Appraisal Tool was used to assess the quality of included studies. Results: A total of 24 studies were included; however, only 5 studies explicitly reported a PE theoretical framework. The studies involved 3 methods of intervention delivery, including in person (n=7), digital (n=7), and hybrid (n=9). Two of the studies conducted pilot RCTs assessing the feasibility and acceptability of their interventions, including recruitment, participation, retention, program implementation, adherence, and satisfaction, and 1 study assessed the efficacy of a questionnaire to promote food and vegetable intake. While most studies linked PE data with study outcomes, it was unclear which of the reported PE components were specifically linked to the positive outcomes. Conclusions: While the Medical Research Council’s framework is a valuable source for conducting systematic reviews on PEs, it has been criticized for lacking practical advice on how to conduct them. The lack of information on PE frameworks in our review also made it difficult to categorize individual PE components against the framework. We need clearer guidance and robust frameworks for conducting PEs for the development and reporting of DPIs for women with GDM. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020208212; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=208212 International Registered Report Identifier (IRRID): RR2-https://doi.org/10.1177/16094069211034010 
%M 39913176
%R 10.2196/51718
%U https://www.i-jmr.org/2025/1/e51718
%U https://doi.org/10.2196/51718
%U http://www.ncbi.nlm.nih.gov/pubmed/39913176

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e64634
%T Metaverse Clinic for Pregnant Women With Subclinical Hypothyroidism: Prospective Randomized Study
%A Zheng,Yuanyuan
%A Chen,Yizhen
%A Chen,Yan
%A Lin,Liang
%A Xue,Ting
%A Chen,Chuhui
%A Wen,Junping
%A Lin,Wei
%A Chen,Gang
%+ Department of Endocrinology, Fuzhou University Affiliated Provincial Hospital, No134 East Road, Fuzhou, 350001, China, 86 059188217521, chengangfj@163.com
%K metaverse
%K subclinical hypothyroidism
%K adverse pregnancy outcomes
%K psychological health
%K neurobehavioral development
%D 2025

%7 5.2.2025
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Health care is experiencing new opportunities in the emerging digital landscape. The metaverse, a shared virtual space, integrates technologies such as augmented reality, virtual reality, blockchain, and artificial intelligence. It allows users to interact with immersive digital worlds, connect with others, and explore unknowns. While the metaverse is gaining traction across various medical disciplines, its application in thyroid diseases remains unexplored. Subclinical hypothyroidism (SCH) is the most common thyroid disorder during pregnancy and is frequently associated with adverse pregnancy outcomes. Objective: This study aims to evaluate the safety and effectiveness of a metaverse platform in managing SCH during pregnancy. Methods: A randomized controlled trial was conducted at Fujian Provincial Hospital, China, from July 2022 to December 2023. A total of 60 pregnant women diagnosed with SCH were randomly assigned into two groups: the standard group (n=30) and the metaverse group (n=30). Both groups received levothyroxine sodium tablets. Additionally, participants in the metaverse group had access to the metaverse virtual medical consultations and metaverse-based medical games. The primary outcomes were adverse maternal and offspring outcomes, and the secondary outcomes included the neurobehavioral development of offspring and maternal psychological assessments. Results: Of the 30 participants in each group, adverse maternal outcomes were observed in 43% (n=13) of the standard group and 37% (n=11) of the metaverse group (P=.60). The incidence of adverse offspring outcomes was 33% (n=10) in the standard group, compared to 7% (n=2) in the metaverse group (P=.01). The Gesell Development Scale did not show significant differences between the two groups. Notably, the metaverse group demonstrated significantly improved scores on the Self-Rating Depression Scale and the Self-Rating Anxiety Scale scores compared to the standard group (P<.001 and P=.001, respectively). Conclusions: The use of metaverse technology significantly reduced the incidence of adverse offspring outcomes and positively impacted maternal mental health. Maternal adverse outcomes and offspring neurobehavioral development were comparable between the two groups. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300076803; https://www.chictr.org.cn/showproj.html?proj=205905 
%M 39908543
%R 10.2196/64634
%U https://www.jmir.org/2025/1/e64634
%U https://doi.org/10.2196/64634
%U http://www.ncbi.nlm.nih.gov/pubmed/39908543

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e60667
%T Oura Ring as a Tool for Ovulation Detection: Validation Analysis
%A Thigpen,Nina
%A Patel,Shyamal
%A Zhang,Xi
%+ , Oura Ring, 60 Francisco St, San Francisco, CA, 94133, United States, 1 358 50 4668390, nnt7845@gmail.com
%K ovulation
%K digital medicine
%K physiology
%K body temperature
%K menstrual cycles
%K wearable
%K fertility
%K nonhormonal contraception
%K reproductive health
%K women’s health
%K calendar method
%K mHealth
%K mobile health
%K detection
%D 2025

%7 31.1.2025
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Oura Ring is a wearable device that estimates ovulation dates using physiology data recorded from the finger. Estimating the ovulation date can aid fertility management for conception or nonhormonal contraception and provides insights into follicular and luteal phase lengths. Across the reproductive lifespan, changes in these phase lengths can serve as a biomarker for reproductive health. Objective: We assessed the strengths, weaknesses, and limitations of using physiology from the Oura Ring to estimate the ovulation date. We compared performance across cycle length, cycle variability, and participant age. In each subgroup, we compared the algorithm’s performance with the traditional calendar method, which estimates the ovulation date based on an individual’s last period start date and average menstrual cycle length. Methods: The study sample contained 1155 ovulatory menstrual cycles from 964 participants recruited from the Oura Ring commercial database. Ovulation prediction kits served as a benchmark to evaluate the performance. The Fisher test was used to determine an odds ratio to assess if ovulation detection rate significantly differed between methods or subgroups. The Mann-Whitney U test was used to determine if the accuracy of the estimated ovulation date differed between the estimated and reference ovulation dates. Results: The physiology method detected 1113 (96.4%) of 1155 ovulations with an average error of 1.26 days, which was significantly lower (U=904942.0, P<.001) than the calendar method’s average error of 3.44 days. The physiology method had significantly better accuracy across all cycle lengths, cycle variability groups, and age groups compared with the calendar method (P<.001). The physiology method detected fewer ovulations in short cycles (odds ratio 3.56, 95% CI 1.65-8.06; P=.008) but did not differ between typical and long or abnormally long cycles. Abnormally long cycle lengths were associated with decreased accuracy (U=22,383, P=.03), with a mean absolute error of 1.7 (SEM .09) days compared with 1.18 (SEM .02) days. The physiology method was not associated with differences in accuracy across age or typical cycle variability, while the calendar method performed significantly worse in participants with irregular cycles (U=21,643, P<.001). Conclusions: The physiology method demonstrated superior accuracy over the calendar method, with approximately 3-fold improvement. Calendar-based fertility tracking could be used as a backup in cases of insufficient physiology data but should be used with caution, particularly for individuals with irregular menstrual cycles. Our analyses suggest the physiology method can reliably estimate ovulation dates for adults aged 18-52 years, across a variety of cycle lengths, and in users with regular or irregular cycles. This method may be used as a tool to improve fertile window estimation, which can aid in conceiving or preventing pregnancies. This method also offers a low-effort solution for follicular and luteal phase length tracking, which are key biomarkers for reproductive health. 
%M 39889300
%R 10.2196/60667
%U https://www.jmir.org/2025/1/e60667
%U https://doi.org/10.2196/60667
%U http://www.ncbi.nlm.nih.gov/pubmed/39889300

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 12
%N 
%P e60825
%T The Research Agenda for Perinatal Innovation and Digital Health Project: Human-Centered Approach to Multipartner Research Agenda Codevelopment
%A Amhaz,Haneen
%A Chen,Sally Xuanping
%A Elchehimi,Amanee
%A Han,Kylin Jialin
%A Gil,Jade Morales
%A Yao,Lu
%A Vidler,Marianne
%A Berry-Einarson,Kathryn
%A Dewar,Kathryn
%A Tuason,May
%A Prestley,Nicole
%A Doan,Quynh
%A van Rooij,Tibor
%A Costa,Tina
%A Ogilvie,Gina
%A Payne,Beth A
%+ Women's Health Research Institute, H214-4500 Oak Street, Box 42, Vancouver, BC, V6H3N1, Canada, 1 604 875 3459, bpayne@cw.bc.ca
%K digital health
%K co-design
%K digital strategy
%K human-centered design
%K eHealth
%K cocreation
%K codevelopment
%K perinatal intervention
%K quality of care
%K digital tools
%K pregnancy
%K patient autonomy
%K patient support
%K mobile phone
%D 2025

%7 30.1.2025
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: Digital health innovations provide an opportunity to improve access to care, information, and quality of care during the perinatal period, a critical period of health for mothers and infants. However, research to develop perinatal digital health solutions needs to be informed by actual patient and health system needs in order to optimize implementation, adoption, and sustainability. Objective: Our aim was to co-design a research agenda with defined research priorities that reflected health system realities and patient needs. Methods: Co-design of the research agenda involved a series of activities: (1) review of the provincial Digital Health Strategy and Maternity Services Strategy to identify relevant health system priorities, (2) anonymous survey targeting perinatal care providers to ascertain their current use and perceived need for digital tools, (3) engagement meetings using human-centered design methods with multilingual patients who are currently or recently pregnant to understand their health experiences and needs, and (4) a workshop that brought together patients and other project partners to prioritize identified challenges and opportunities for perinatal digital health in a set of research questions. These questions were grouped into themes using a deductive analysis approach starting with current BC Digital Health Strategy guiding principles. Results: Between September 15, 2022, and August 31, 2023, we engaged with more than 150 perinatal health care providers, researchers, and health system stakeholders and a patient advisory group of women who were recently pregnant to understand the perceived needs and priorities for digital innovation in perinatal care in British Columbia, Canada. As a combined group, partners were able to define 12 priority research questions in 3 themes. The themes prioritized are digital innovation for (1) patient autonomy and support, (2) standardized educational resources for patients and providers, and (3) improved access to health information. Conclusions: Our research agenda highlights the needs for perinatal digital health research to support improvements in the quality of care in British Columbia. By using a human-centered design approach, we were able to co-design research priorities that are meaningful to patients and health system stakeholders. The identified priority research questions are merely a stepping stone in the research process and now need to be actioned by research teams and health systems partners. 
%M 39883935
%R 10.2196/60825
%U https://humanfactors.jmir.org/2025/1/e60825
%U https://doi.org/10.2196/60825
%U http://www.ncbi.nlm.nih.gov/pubmed/39883935

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 14
%N 
%P e56142
%T Scaling Up Kangaroo Mother Care Through a Facility Delivery Model in Rural Districts of Pakistan: Protocol for a Mixed Methods Study
%A Muhammad,Shah
%A Soomro,Asif
%A Ahmed Khan,Samia
%A Najmi,Hina
%A Memon,Zahid
%A Ariff,Shabina
%A Soofi,Sajid
%A Bhutta,Zufiqar Ahmed
%+ Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, 74800, Pakistan, Karachi, P.O. Box 3500, Pakistan, 92 34869826, zulfiqar.bhutta@aku.edu
%K kangaroo mother care
%K scale up intervention
%K health facility
%K community
%K preterm infants
%D 2025

%7 29.1.2025
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The neonatal mortality rate in Pakistan is the third highest in Asia, with 8.6 million preterm babies. These newborns require warmth, nutrition, and infection protection, typically provided by incubators. However, the high maintenance and repair costs of incubators pose a barrier to accessibility for many premature and low birth weight neonates in low- and middle-income countries. This study aims to implement a context-specific kangaroo mother care (KMC) model in Sanghar within secondary health care facilities and catchment communities. Objective: This study aims to achieve at least 80% KMC coverage for premature and low birth weight neonates. Methods: This research uses a mixed methods design grounded in implementation science principles, with the goal of developing adaptive strategies tailored to district and facility managers, as well as health care workers, leveraging previous evidence on the benefits of KMC. The research is conducted in the district of Sanghar, Sindh with an emphasis on promoting KMC for infants weighing between 1200 and 2500 g in three facilities. It includes preimplementation data collection, training of health care providers and lady health workers, and intervention involving mother-baby skin-to-skin contact, breastfeeding initiation, and postdischarge follow-ups. Ethical considerations and data management are prioritized, to improve KMC coverage and neonatal health outcomes. Results: This research will be implemented over a period of 18 months. The primary objective of this research is to achieve an 80% improvement in KMC coverage, with the secondary objective to promote optimal breastfeeding practices among postpartum mothers. Key indicators include the proportion of eligible infants enrolled in KMC, the percentage of mother-baby pairs receiving skin-to-skin care postdischarge, and the duration of KMC during the neonatal period. Additionally, the study will assess exclusive breastfeeding rates, neonatal weight gain, and neonatal deaths within the cohort. The data management team will evaluate the effectiveness of the model in achieving the targeted KMC coverage. Conclusions: The integration of KMC into the health care system will provide valuable insights for policy makers regarding effective implementation and scaling strategies. The study’s findings will highlight facilitators and barriers to KMC adoption, benefiting regions across Pakistan and globally. Additionally, these findings will offer valuable insights for the development of future newborn care programs. International Registered Report Identifier (IRRID): DERR1-10.2196/56142 
%M 39879619
%R 10.2196/56142
%U https://www.researchprotocols.org/2025/1/e56142
%U https://doi.org/10.2196/56142
%U http://www.ncbi.nlm.nih.gov/pubmed/39879619

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 14
%N 
%P e59461
%T Feasibility of a Mobile App–Based Cognitive-Behavioral Perinatal Skills Program: Protocol for Nonrandomized Pilot Trial
%A Temkin-Yu,Andrea B
%A Ayaz,Aliza
%A Blicker,Ella
%A Liu,Michael X
%A Oh,Ace
%A Siegel,Isabelle E
%A Seewald,Meredith J
%A Hermann,Alison D
%A Givrad,Soudebah
%A Baez,Lara M
%A Osborne,Lauren M
%A Green,Cori M
%A Schier,Maddy M
%A Davis,Alexandra M
%A Zhu,Shasha
%A Falk,Avital
%A Bennett,Shannon M
%+ Psychiatry Department, Weill Cornell Medicine, 525 E 68th Street, New York, NY, 10065, United States, 1 6402038301, andreabtemkin@gmail.com
%K perinatal mood and anxiety disorders
%K apps
%K smartphones
%K digital intervention
%K cognitive behavioral therapy
%K feasibility
%K pilot trial
%K mobile phones
%D 2025

%7 28.1.2025
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Mental illness is one of the top causes of preventable pregnancy-related deaths in the United States. There are many barriers that interfere with the ability of perinatal individuals to access traditional mental health care. Digital health interventions, including app-based programs, have the potential to increase access to useful tools for these individuals. Although numerous mental health apps exist, there is little research on developing programs to address the unique needs of perinatal individuals. In an effort to fill this gap, a multidisciplinary team of experts in psychology, psychiatry, obstetrics, and pediatric primary care collaborated to develop the novel Perinatal Skills Program within Maya, a flexible and customizable cognitive-behavioral skills app. Maya-Perinatal Skills Program (M-PSP) uses evidence-based strategies to help individuals manage their mood and anxiety symptoms during pregnancy and post partum. Objective: This pilot study aims to assess the feasibility, acceptability, and usability of M-PSP and explore links between program use and symptoms of anxiety and low mood. Methods: This single-arm trial will recruit 50 pregnant or postpartum individuals with mild-to-moderate anxiety or mood symptoms. Participants will be recruited from a variety of public and private insurance-based psychiatry, obstetrics, and primary care clinics at a large academic medical center located in New York City. Participants will complete all sessions of M-PSP and provide feedback. Outcome measures will include qualitative and quantitative assessments of feasibility, acceptability, and usability, passively collected program usage data, and symptom measures assessing mood, anxiety, and trauma. Planned data analysis includes the use of the grounded theory approach to identify common themes in qualitative feedback, as well as an exploration of possible associations between quantitative data regarding program use and symptoms. Results: The recruitment began on August 2023. As of October 2024, a total of 32 participants have been enrolled. The recruitment will continue until 50 participants have been enrolled. Conclusions: Digital health interventions, like M-PSP, have the potential to create new pathways to reach individuals struggling with their mental health. The results of this study will be the groundwork for future iterations of M-PSP in the hopes of providing an accessible and helpful tool for pregnant and postpartum individuals. Trial Registration: ClinicalTrials.gov NCT05897619; https://classic.clinicaltrials.gov/ct2/show/NCT05897619 International Registered Report Identifier (IRRID): PRR1-10.2196/59461 
%M 39874578
%R 10.2196/59461
%U https://www.researchprotocols.org/2025/1/e59461
%U https://doi.org/10.2196/59461
%U http://www.ncbi.nlm.nih.gov/pubmed/39874578

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 9
%N 
%P e60829
%T Designing the First Pregnancy Guaranteed Income Program in the United States: Qualitative Needs Assessment and Human-Centered Design to Develop the Abundant Birth Project
%A Karasek,Deborah
%A Williams,Jazzmin C
%A Taylor,Michaela A
%A De La Cruz,Monica M
%A Arteaga,Stephanie
%A Bell,Sabra
%A Castillo,Esperanza
%A Chand,Maile A
%A Coats,Anjeanette
%A Hubbard,Erin M
%A Love-Goodlett,Latriece
%A Powell,Breezy
%A Spellen,Solaire
%A Malawa,Zea
%A Gomez,Anu Manchikanti
%+ Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall, MC 7400, Berkeley, CA, 94720-7400, United States, 1 510 6420722, anugomez@berkeley.edu
%K maternal and child health
%K economics
%K public health
%K qualitative research methods
%K programs (evaluation and funding)
%K community-centered
%K pregnancy
%K first pregnancy
%K behavioral interventions
%K racial health
%K financial stress
%K Abundant Birth Project
%K infant health
%K infant
%K Black
%D 2025

%7 27.1.2025
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Racial inequities in pregnancy outcomes persist despite investments in clinical, educational, and behavioral interventions, indicating that a new approach is needed to address the root causes of health disparities. Guaranteed income during pregnancy has the potential to narrow racial health inequities for birthing people and infants by alleviating financial stress. Objective: We describe community-driven formative research to design the first pregnancy-guaranteed income program in the United States—the Abundant Birth Project (ABP). Informed by birth equity and social determinants of health perspectives, ABP targets upstream structural factors to improve racial disparities in maternal and infant health. Methods: The research team included community researchers, community members with lived experience as Black or Pacific Islander pregnant, and parenting people in the San Francisco Bay Area. The team conducted needs assessment interviews and facilitated focus groups with participants using human-centered design methods. Needs assessment participants later served as co-designers of the ABP program and research, sharing their experiences with financial hardships and government benefits programs and providing recommendations on key program elements, including fund disbursement, eligibility, and amount. Results: Housing affordability and the high cost of living in San Francisco emerged as significant sources of stress in pregnancy. Participants reported prohibitively low income eligibility thresholds and burdensome enrollment processes as challenges or barriers to existing social services. These insights guided the design of prototypes of ABP’s program components, which were used in a design sprint to determine the final components. Based on this design process, the ABP program offered US $1000/month for 12 months to pregnant Black and Pacific Islander people, selected through a lottery called an abundance drawing. Conclusions: The formative design process maximized community input and shared decision-making to co-design a guaranteed income program for Black and Pacific Islander women and people. Our upstream approach and community research model can inform the development of public health and social service programs. 
%M 39869889
%R 10.2196/60829
%U https://formative.jmir.org/2025/1/e60829
%U https://doi.org/10.2196/60829
%U http://www.ncbi.nlm.nih.gov/pubmed/39869889

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e54148
%T Effectiveness of a Web-Based Medication Education Course on Pregnant Women’s Medication Information Literacy and Decision Self-Efficacy: Randomized Controlled Trial
%A Li,Suya
%A Chen,Hui-Jun
%A Zhou,Jie
%A Zhouchen,Yi-Bei
%A Wang,Rong
%A Guo,Jinyi
%A Redding,Sharon R
%A Ouyang,Yan-Qiong
%+ Wuhan University, 115 Donghu Road, Wuchang District, Wuhan, 430071, China, 86 02768758747, ouyangyq@whu.edu.cn
%K decision self-efficacy
%K self-efficacy
%K decision efficacy
%K medication information literacy
%K information literacy
%K web-based medication education
%K medication education
%K web-based platforms
%K pregnant women
%K pregnancy
%K RCT
%K randomized controlled trial
%D 2025

%7 22.1.2025
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Medication-related adverse events are common in pregnant women, and most are due to misunderstanding medication information. The identification of appropriate medication information sources requires adequate medical information literacy (MIL). It is important for pregnant women to comprehensively evaluate the risk of medication treatment, self-monitor their medication response, and actively participate in decision-making to reduce medication-related adverse events. Objective: This study aims to examine the effectiveness of a medication education course on a web-based platform in improving pregnant women’s MIL and decision self-efficacy. Methods: A randomized controlled trial was conducted. Pregnant women were recruited from January to June 2021 in the Department of Obstetrics and Gynecology of a large hospital in a major city in central China. A total of 108 participants were randomly divided into a control group (CG), which received routine prenatal care from nurses and physicians, and an intervention group (IG), which received an additional 3-week web-based medication education course based on the theory of planned behavior as part of routine prenatal care. Participants completed a Medication Information Literacy Scale and a decision self-efficacy questionnaire at baseline, upon completion of the intervention, and at a 4-week follow-up. Generalized estimation equations (GEE) were used to analyze the main effect (time and grouping) and interaction effect (grouping×time) of the 2 outcomes. The CONSORT-EHEALTH (V 1.6.1) checklist was used to guide the reporting of this randomized controlled trial. Results: A total of 91 pregnant women (48 in the IG and 43 in the CG) completed the questionnaires at the 3 time points. The results of GEE indicated that there was no statistically significant difference in time×group interactions of MIL between the 2 groups (F2=3.12; P=.21). The results of the main effect analysis showed that there were statistically significant differences in MIL between the 2 groups at T1 and T2 (F1=17.79; P<.001). Moreover, the results of GEE indicated that there was a significant difference in decision self-efficacy regarding the time factor, grouping factor, and time×group interactions (F2=21.98; P<.001). The results of the simple effect analysis indicated a statistically significant difference in decision self-efficacy between the 2 groups at T1 (F1=36.29; P<.001) and T2 (F1=36.27; P<.001) compared to T0. Results showed that MIL and decision self-efficacy in the IG were found to be significantly higher than those in the CG (d=0.81; P<.001 and d=1.26; P<.001, respectively), and they remained significantly improved at the 4-week follow-up (d=0.59; P<.001 and d=1.27; P<.001, respectively). Conclusions: Web-based medication education courses based on the theory of planned behavior can effectively improve pregnant women’s MIL and decision self-efficacy, and they can be used as supplementary education during routine prenatal care. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100041817; https://www.chictr.org.cn/showproj.html?proj=66685 
%M 39841986
%R 10.2196/54148
%U https://www.jmir.org/2025/1/e54148
%U https://doi.org/10.2196/54148
%U http://www.ncbi.nlm.nih.gov/pubmed/39841986

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 9
%N 
%P e58265
%T A Mindfulness-Based App Intervention for Pregnant Women: Qualitative Evaluation of a Prototype Using Multiple Case Studies
%A Rizzi,Silvia
%A Pavesi,Maria Chiara
%A Moser,Alessia
%A Paolazzi,Francesca
%A Marchesoni,Michele
%A Poggianella,Stefania
%A Gadotti,Erik
%A Forti,Stefano
%+ Digital Health Research, Centre for Digital Health & Wellbeing, Fondazione Bruno Kessler, Via Sommarive 18, Trento, 38123, Italy, 39 0461312415, srizzi@fbk.eu
%K mindfulness
%K promoting well-being
%K pregnancy
%K eHealth
%K mHealth
%K mobile apps
%K development
%K usability
%K user-centered design
%K well-being
%K maternal health
%K digital health
%K intervention
%K design
%K preliminary testing
%K technology-based
%K interview
%K multidisciplinary approach
%K mother
%K women
%K WhatsApp
%K email
%K midwife
%D 2025

%7 17.1.2025
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Pregnancy is a complex period characterized by significant transformations. How a woman adapts to these changes can affect her quality of life and psychological well-being. Recently developed digital solutions have assumed a crucial role in supporting the psychological well-being of pregnant women. However, these tools have mainly been developed for women who already present clinically relevant psychological symptoms or mental disorders. Objective: This study aimed to develop a mindfulness-based well-being intervention for all pregnant women that can be delivered electronically and guided by an online assistant with wide reach and dissemination. This paper aimed to describe a prototype technology-based mindfulness intervention’s design and development process for pregnant women, including the exploration phase, intervention content development, and iterative software development (including design, development, and formative evaluation of paper and low-fidelity prototypes). Methods: Design and development processes were iterative and performed in close collaboration with key stakeholders (N=15), domain experts including mindfulness experts (n=2), communication experts (n=2), and psychologists (n=3), and target users including pregnant women (n=2), mothers with young children (n=2), and midwives (n=4). User-centered and service design methods, such as interviews and usability testing, were included to ensure user involvement in each phase. Domain experts evaluated a paper prototype, while target users evaluated a low-fidelity prototype. Intervention content was developed by psychologists and mindfulness experts based on the Mindfulness-Based Childbirth and Parenting program and adjusted to an electronic format through multiple iterations with stakeholders. Results: An 8-session intervention in a prototype electronic format using text, audio, video, and images was designed. In general, the prototypes were evaluated positively by the users involved. The questionnaires showed that domain experts, for instance, positively evaluated chatbot-related aspects such as empathy and comprehensibility of the terms used and rated the mindfulness traces present as supportive and functional. The target users found the content interesting and clear. However, both parties regarded the listening as not fully active. In addition, the interviews made it possible to pick up useful suggestions in order to refine the intervention. Domain experts suggested incorporating auditory components alongside textual content or substituting text entirely with auditory or audiovisual formats. Debate surrounded the inclusion of background music in mindfulness exercises, with opinions divided on its potential to either distract or aid in engagement. The target users proposed to supplement the app with some face-to-face meetings at crucial moments of the course, such as the beginning and the end. Conclusions: This study illustrates how user-centered and service designs can be applied to identify and incorporate essential stakeholder aspects in the design and development process. Combined with evidence-based concepts, this process facilitated the development of a mindfulness intervention designed for the end users, in this case, pregnant women. 
%M 39625414
%R 10.2196/58265
%U https://formative.jmir.org/2025/1/e58265
%U https://doi.org/10.2196/58265
%U http://www.ncbi.nlm.nih.gov/pubmed/39625414

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 8
%N 
%P e65247
%T Integrating Infant Safe Sleep and Breastfeeding Education Into an App in a Novel Approach to Reaching High-Risk Populations: Prospective Observational Study
%A Krishnamurti,Tamar
%A Moon,Rachel
%A Richichi,Rudolph
%A Berger,Rachel
%K SIDS
%K infant death
%K sleep
%K sudden infant death
%K US
%K United States
%K infant
%K infancy
%K baby
%K prenatal
%K safe sleep
%K breastfeeding
%K infant care
%K pregnancy
%K app
%K randomized controlled study
%K TodaysBaby
%K mobile health
%K mHealth
%K smartphone
%D 2025

%7 14.1.2025
%9 
%J JMIR Pediatr Parent
%G English
                
%X Background: Sudden unexpected infant death (SUID) is a leading cause of death for US infants, and nonrecommended sleep practices are reported in most of these deaths. SUID rates have not declined over the past 20 years despite significant educational efforts. Integration of prenatal safe sleep and breastfeeding education into a pregnancy app may be one approach to engaging pregnant individuals in education about infant care practices prior to childbirth. Objective: This study aims to assess whether pregnant individuals would engage with prenatal safe sleep and breastfeeding education provided within a pre-existing pregnancy app. Secondary objectives were to compare engagement among those at high and low risk of losing an infant to SUID and to assess the importance of end user push notifications for engagement. Methods: This prospective observational study was conducted from September 23, 2019 to March, 22 2022; push notifications were removed on October 26, 2021. TodaysBaby (University of Virginia, Boston University, and Washington University), a mobile health program in which safe sleep and breastfeeding video education was originally provided via texts, was embedded into the MyHealthyPregnancy app (Naima Health LLC). Pregnant mothers who received prenatal care within the University of Pittsburgh Medical Center hospital system were randomized to receive either safe sleep or breastfeeding education beginning at the start of the third trimester of pregnancy and ending 6 weeks post partum. Pregnant persons were designated as high risk if they lived in the 5% of zip codes in Allegheny County, Pennsylvania with the highest rates of SUID in the county. The primary outcome was engagement, defined as watching at least 1 video either in response to a push notification or directly from the app’s learning center. Results: A total of 7572 pregnant persons were enrolled in the TodaysBaby Program—3308 with push notifications and 4264 without. The TodaysBaby engagement rate was 18.8% with push notifications and 3.0% without. Engagement was highest in the initial weeks after enrollment, with a steady decline through pregnancy and very little postpartum engagement. There was no difference in engagement between pregnant persons who were low and high risk. The most viewed videos were ones addressing the use of pacifiers, concerns about infant choking, and the response of the body to the start of breastfeeding. Conclusions: Integrating safe sleep and breastfeeding education within a pregnancy app may allow for rapid dissemination of infant care information to pregnant individuals. Birthing parents at high risk of losing an infant to SUID—a leading cause of infant death after 1 month of age—appear to engage with the app at the same rates as birth parents who are at low risk. Our data demonstrate that push notifications increase engagement, overall and for those in high-risk zip codes where the SUID education is likely to have the most impact. 
%R 10.2196/65247
%U https://pediatrics.jmir.org/2025/1/e65247
%U https://doi.org/10.2196/65247

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 9
%N 
%P e65611
%T Postpartum Remote Health Coaching Intervention for Individuals With a Hypertensive Disorder of Pregnancy: Proof-of-Concept Study
%A Borrowman,Jaclyn D
%A Carr,Lucas J
%A Pierce,Gary L
%A Story,William T
%A Gibbs,Bethany Barone
%A Whitaker,Kara M
%K cardiovascular disease
%K postpartum
%K hypertensive disorders of pregnancy
%K intervention
%K physical activity intervention
%K proof-of-concept
%K cardiovascular health
%K CVD risk
%K cardiovascular disease risk
%K feasibility
%K acceptability
%K health coaching
%K women's health
%K postnatal
%D 2025

%7 8.1.2025
%9 
%J JMIR Form Res
%G English
                
%X Background: Cardiovascular disease (CVD) is the leading cause of death among women in America. Hypertensive disorders of pregnancy (HDP) negatively impact acute and long-term cardiovascular health, with approximately 16% of all pregnancies affected. With CVD 2‐4 times more likely after HDP compared to normotensive pregnancies, effective interventions to promote cardiovascular health are imperative. Objective: With postpartum physical activity (PA) interventions after HDP as an underexplored preventative strategy, we aimed in this study to assess (1) the feasibility and acceptability of a remotely delivered PA intervention for individuals with HDP 3‐6 months postpartum and (2) changes in average steps per day, skills related to PA behavior, and postpartum blood pressure (BP). Methods: A remotely delivered 14-week health coaching intervention was designed based on prior formative work. The health coaching intervention called the Hypertensive Disorders of Pregnancy Postpartum Exercise (HyPE) intervention was tested for feasibility and acceptability with a single-arm proof-of-concept study design. A total of 19 women who were 3‐6 months postpartum HDP; currently inactive; 18 years of age or older; resided in Iowa; and without diabetes, kidney disease, and CVD were enrolled. Feasibility was assessed by the number of sessions attended and acceptability by self-reported satisfaction with the program. Changes in steps achieved per day were measured with an activPAL4 micro, PA behavior skills via validated surveys online, and BP was assessed remotely with a research-grade Omron Series 5 (Omron Corporation) BP monitor. Results: Participants at enrollment were on average 30.3 years of age, 4.1 months postpartum, self-identified as non-Hispanic White (14/17, 82%), in a committed relationship (16/17, 94%), and had a bachelor’s degree (9/17, 53%). A total of 140 of 152 possible health coaching sessions were attended by those who started the intervention (n=19, 92%). Intervention completers (n=17) indicated they were satisfied with the program (n=17, 100%) and would recommend it to others (n=17, 100%). No significant changes in activPAL measured steps were observed from pre- to posttesting (mean 138.40, SD 129.40 steps/day; P=.75). Significant improvements were observed in PA behavior skills including planning (mean 5.35, SD 4.97 vs mean 15.06, SD 3.09; P<.001) and monitoring of PA levels (mean 7.29, SD 3.44 vs mean 13.00, SD 2.45; P<.001). No significant decreases were observed for systolic (mean –1.28, SD 3.59 mm Hg; Hedges g=–0.26; P=.16) and diastolic BP (mean –1.80, SD 5.03 mm Hg; Hedges g=–0.44; P=.12). Conclusions: While PA behaviors did not change, the intervention was found to be feasible and acceptable among this sample of at-risk women. After additional refinement, the intervention should be retested among a larger, more diverse, and less physically active sample. Trial Registration: ClinicalTrials.gov NCT06019715; https://clinicaltrials.gov/study/NCT06019715 
%R 10.2196/65611
%U https://formative.jmir.org/2025/1/e65611
%U https://doi.org/10.2196/65611

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 14
%N 
%P e62847
%T Remote Lifestyle Intervention to Reduce Postpartum Weight Retention: Protocol for a Community-Engaged Hybrid Type I Effectiveness-Implementation Randomized Controlled Trial
%A Martin,Lindsay M
%A McKinney,Christine D
%A Escobar Acosta,Lia
%A Coughlin,Janelle W
%A Jeffers,Noelene K
%A Solano-Umaña,Alexandra
%A Carson,Kathryn A
%A Wang,Nae-Yuh
%A Bennett,Wendy L
%A Bower,Kelly M
%+ Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, United States, 1 410 502 0654, kbower1@jhu.edu
%K pregnancy
%K obesity
%K postpartum weight retention
%K remote lifestyle intervention
%K home visiting
%K mobile health
%K mHealth app
%K community-engaged research
%K implementation science
%K health disparities
%K maternal health
%D 2025

%7 7.1.2025
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Maternal obesity is associated with significant racial disparities. People who identify as non-Hispanic Black and Latinx are at the highest risk related adverse short- and long-term health outcomes (eg, hypertension in pregnancy and postpartum weight retention). Remote lifestyle interventions delivered during and after pregnancy hold promise for supporting healthy weight outcomes; however, few are tested in groups of people who self-identify as non-Hispanic Black and Latinx or address the neighborhood-level and psychosocial factors driving maternal health disparities. Implementing remote lifestyle interventions within community-based programs that serve birthing people may optimize trust and engagement, promote scalability and sustainability, and have the broadest public health impact. Objective: The goal of this trial is to test the effectiveness of a culturally adapted remote lifestyle intervention (Healthy for Two–Home Visiting) implemented within home visiting compared to usual home visiting services on postpartum weight retention among pregnant or postpartum individuals, in particular those who identify as non-Hispanic Black and Latinx. Facilitators and barriers to implementation of the intervention within home visiting will be examined. Methods: We describe the rationale and protocol for this hybrid type I effectiveness-implementation randomized controlled trial. In this paper, we highlight the community-engaged approach and trial design features that enable the implementation of the intervention within home visiting and demonstrate its applicability to the target population. Participants will be 360 pregnant individuals with overweight or obesity enrolled between 20 and 33 weeks of gestation and randomized 1:1 to Healthy for Two–Home Visiting or usual home visiting services. The primary outcome is weight retention at 6 months post partum, calculated as 6-month postpartum weight minus earliest pregnancy weight (≤18 wk of gestation). The measures of implementation include intervention feasibility, acceptability, reach, adoption, and fidelity. Throughout the paper, we highlight the community input used to improve intervention effectiveness and study implementation and as a strategy to promote maternal health equity. Results: This study was funded in June 2021, and recruitment began in April 2023. As of November 2024, we enrolled 90 participants. Data collection to assess the intervention’s effectiveness is expected to end in June 2026. Implementation evaluation is expected to conclude in December 2026. Conclusions: This hybrid type I effectiveness-implementation randomized controlled trial integrates a culturally adapted remote lifestyle intervention into early home visiting services to examine its effectiveness on postpartum weight retention compared to usual home visiting. We anticipate that the study results will enable an understanding of the drivers of successful implementation within a community-based setting to maximize the future sustainability and dissemination of a strategy for reducing long-term obesity and other maternal health disparities. Trial Registration: Clinicaltrials.gov NCT05619705; https://clinicaltrials.gov/study/NCT05619705 International Registered Report Identifier (IRRID): DERR1-10.2196/62847 
%M 39773922
%R 10.2196/62847
%U https://www.researchprotocols.org/2025/1/e62847
%U https://doi.org/10.2196/62847
%U http://www.ncbi.nlm.nih.gov/pubmed/39773922

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 12
%N 
%P e53057
%T Gender-Inclusive Language in Public-Facing Labor and Delivery Web Pages in the New York Tristate Area: Cross-Sectional Study
%A Isaac,Sarah Mohsen
%A Dawes,Mark
%A Howell,Emily Ruth
%A Oladipo,Antonia Francis
%K OBGYN
%K transgender
%K nonbinary
%K pregnancy
%K maternity
%K transmasculine
%K observational study
%K gestational
%K perinatal care
%K communication
%K labor
%K USA
%K United States
%K New York City
%K sexual orientation
%K inclusion
%K parents
%K obstetrician gynecologist
%K delivery
%D 2025

%7 6.1.2025
%9 
%J JMIR Hum Factors
%G English
                
%X Background: Transgender and nonbinary (TGNB) individuals are increasingly intentionally becoming pregnant to raise children, and hospital websites should reflect these trends. For prospective TGNB parents, a hospital website is the only way they can assess their safety from discrimination while receiving perinatal care. Cisnormativity enforced by communication gaps between medical institutions and TGNB patients can and has caused delays in receiving urgent care during their pregnancy. Objective: The aim of this study was to evaluate the current prevalence of gender-inclusive terminology among labor and delivery services in the New York tristate area. Methods: The labor and delivery web pages of 189 hospitals from New York, New Jersey, and Connecticut were examined for gender-inclusive language. “Fully inclusive” websites explicitly acknowledged lesbian, gay, bisexual, transgender, queer, intersex, and asexual plus other gender- and sexual-oriented (LGBTQIA+) parents, “inclusive” websites did not use gendered terminology for parents, and “noninclusive” websites used gendered terms at least once in the text reviewed. The hospitals’ web pages were further stratified by Healthcare Equality Index scores and population classifications defined by the 2013 National Center for Health Statistics Urban-Rural classification given to the county that each hospital was located in. Results: Of the 300 hospital websites reviewed, only 189 websites met the criteria for inclusion. Overall, only 6.3% (n=12) of labor and delivery web pages were “inclusive” or “fully inclusive.” No geographic areas (P=.61) or Healthcare Equality Index scores (P=.81) were associated with inclusive or fully inclusive language. Conclusions: Hospitals need to use inclusive language to help TGNB people identify hospitals where their existence and needs are acknowledged and thus feel more comfortable in their transition to parenthood. 
%R 10.2196/53057
%U https://humanfactors.jmir.org/2025/1/e53057
%U https://doi.org/10.2196/53057

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 11
%N 
%P e63334
%T Optimization of a Web-Based Self-Assessment Tool for Preconception Health in People of Reproductive Age in Australia: User Feedback and User-Experience Testing Study
%A Dorney,Edwina
%A Hammarberg,Karin
%A Rodgers,Raymond
%A Black,Kirsten I
%K technology
%K internet
%K eHealth
%K user experience
%K patient engagement
%K self-assessment tool
%K preconception
%K health communication
%D 2024

%7 24.12.2024
%9 
%J JMIR Hum Factors
%G English
                
%X Background: Good preconception health reduces the incidence of preventable morbidity and mortality for women, their babies, and future generations. In Australia, there is a need to increase health literacy and awareness about the importance of good preconception health. Digital health tools are a possible enabler to increase this awareness at a population level. The Healthy Conception Tool (HCT) is an existing web-based, preconception health self-assessment tool, that has been developed by academics and clinicians. Objective: This study aims to optimize the HCT and to seek user feedback to increase the engagement and impact of the tool. Methods: In-depth interviews were held with women and men aged 18‐41 years, who spoke and read English and were residing in Australia. Interview transcripts were analyzed, and findings were used to inform an enhanced HCT prototype. This prototype underwent user-experience testing and feedback from users to inform a final round of design changes to the tool. Results: A total of 20 women and 5 men were interviewed; all wanted a tool that was quick and easy to use with personalized results. Almost all participants were unfamiliar with the term “preconception care” and stated they would not have found this tool on the internet with its current title. User-experience testing with 6 women and 5 men identified 11 usability issues. These informed further changes to the tool’s title, the information on how to use the tool, and the presentation of results. Conclusions: Web-based self-assessment tools need to be easy to find and should communicate health messages effectively. End users’ feedback informed changes to improve the tool’s acceptability, engagement, and impact. We expect that the revised tool will have greater reach and prompt more people to prepare well for pregnancy. 
%R 10.2196/63334
%U https://humanfactors.jmir.org/2024/1/e63334
%U https://doi.org/10.2196/63334

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e54366
%T Investigating eHealth Lifestyle Interventions for Vulnerable Pregnant Women: Scoping Review of Facilitators and Barriers
%A Smit,Ashley JP
%A Al-Dhahir,Isra
%A Schiphof-Godart,Lieke
%A Breeman,Linda D
%A Evers,Andrea WM
%A Joosten,Koen FM
%+ Department of Neonatal and Pediatric Intensive Care, Erasmus Medical Center, Sophia Children's Hospital, Dr. Molewaterplein 40, Rotterdam, 3015 GD, Netherlands, 31 10 704 0704, a.j.p.smit@erasmusmc.nl
%K eHealth
%K pregnancy
%K vulnerability
%K socioeconomic status
%K lifestyle intervention
%K intervention development
%K barriers
%K facilitators
%K mobile phone
%K PRISMA
%D 2024

%7 20.12.2024
%9 Review
%J J Med Internet Res
%G English
                
%X Background: The maintenance of a healthy lifestyle significantly influences pregnancy outcomes. Certain pregnant women are more at risk of engaging in unhealthy behaviors due to factors such as having a low socioeconomic position and low social capital. eHealth interventions tailored to pregnant women affected by these vulnerability factors can provide support and motivation for healthier choices. However, there is still a lack of insight into how interventions for this target group are best designed, used, and implemented and how vulnerable pregnant women are best reached. Objective: This review aimed to identify the strategies used in the design, reach, use, and implementation phases of eHealth lifestyle interventions for vulnerable pregnant women; assess whether these strategies acted as facilitators; and identify barriers that were encountered. Methods: We conducted a search on MEDLINE, Embase, Web of Science, CINAHL, and Google Scholar for studies that described an eHealth intervention for vulnerable pregnant women focusing on at least one lifestyle component (diet, physical activity, alcohol consumption, smoking, stress, or sleep) and provided information on the design, reach, use, or implementation of the intervention. Results: The literature search identified 3904 records, of which 29 (0.74%) met our inclusion criteria. These 29 articles described 20 eHealth lifestyle interventions, which were primarily delivered through apps and frequently targeted multiple lifestyle components simultaneously. Barriers identified in the design and use phases included financial aspects (eg, budgetary constraints) and technological challenges for the target group (eg, limited internet connectivity). In addition, barriers were encountered in reaching vulnerable pregnant women, including a lack of interest and time constraints among eligible participants and limited support from health care providers. Facilitators identified in the design and use phases included collaborating with the target group and other stakeholders (eg, health care providers), leveraging existing eHealth platforms for modifications or extensions, and adhering to clinical and best practice guidelines and behavior change frameworks. Furthermore, tailoring (eg, matching the content of the intervention to the target groups’ norms and values) and the use of incentives (eg, payments for abstaining from unhealthy behavior) were identified as potential facilitators to eHealth use. Facilitators in the interventions’ reach and implementation phases included stakeholder collaboration and a low workload for the intervention deliverers involved in these phases. Conclusions: This scoping review offers a comprehensive overview of strategies used in different phases of eHealth lifestyle interventions for vulnerable pregnant women, highlighting specific barriers and facilitators. Limited reporting on the impact of the strategies used and barriers encountered hinders a complete identification of facilitators and barriers. Nevertheless, this review sheds light on how to optimize the development of eHealth lifestyle interventions for vulnerable pregnant women, ultimately enhancing the health of both future mothers and their offspring. 
%M 39705692
%R 10.2196/54366
%U https://www.jmir.org/2024/1/e54366
%U https://doi.org/10.2196/54366
%U http://www.ncbi.nlm.nih.gov/pubmed/39705692

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e51566
%T Effects of a Smartphone-Based Breastfeeding Coparenting Intervention Program on Breastfeeding-Related Outcomes in Couples During First Pregnancy: Randomized Controlled Trial
%A Huang,Yi-Yan
%A Wang,Rong
%A Huang,Wei-Peng
%A Wu,Tian
%A Wang,Shi-Yun
%A R. Redding,Sharon
%A Ouyang,Yan-Qiong
%+ School of Nursing, Wuhan University, 115 Donghu Rd, Wuchang District, Wuhan, 430072, China, 86 27 68759710, ouyangyq@whu.edu.cn
%K breastfeeding
%K co-parenting
%K randomized controlled
%K child
%K efficacy
%K depressive symptoms
%D 2024

%7 17.12.2024
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: A low breastfeeding rate causes an increased health care burden and negative health outcomes for individuals and society. Coparenting is an essential tactic for encouraging breastfeeding when raising a child. The efficacy of the coparenting interventions in enhancing breastfeeding-related outcomes is controversial. Objective: This study aimed to examine the effects of coparenting interventions on exclusive breastfeeding rates, exclusive breastfeeding duration, breastfeeding knowledge, parenting sense of competence, coparenting relationships, depressive symptoms in new couples at 1 and 6 months post partum, and the BMI of infants 42 days post partum. Methods: This was a randomized, single-blinded controlled clinical trial. Eligible couples in late pregnancy in a hospital in central China were randomly assigned to 2 groups. While couples in the control group received general care, couples in the intervention group had access to parenting classes, a fathers’ support group, and individual counseling. Data were collected at baseline (T0), 1 month post partum (T1), and 6 months post partum (T2). Data on exclusive breastfeeding rate and exclusive breastfeeding duration were analyzed using the chi-square, Fisher exact, or Mann-Whitney U tests; coparenting relationships and the infant’s BMI were analyzed using an independent samples t test; and breastfeeding knowledge, parenting sense of competence, and depressive symptoms were analyzed using a generalized estimation equation. Results: A total of 96 couples were recruited, and 79 couples completed the study. The intervention group exhibited significantly higher exclusive breastfeeding rates at T1 (90% vs 65%, P=.02) and T2 (43.6% vs 22.5%, P=.02), compared with the control group. Exclusive breastfeeding duration was extended in the intervention group than in the control group at T1 (30, range 30-30 days vs 30, range 26.5-30 days; P=.01) and T2 (108, range 60-180 days vs 89, range 28-149.3 days; P<.05). The intervention group exhibited greater improvements in maternal breastfeeding knowledge (β=.07, 95% CI 0.006-0.13; P=.03) and maternal parenting sense of competence (β=5.49, 95% CI 2.09-8.87; P<.01) at T1, enhanced coparenting relationships at T1 (P<.001) and T2 (P=.02), paternal breastfeeding knowledge at T2 (β=.25, 95% CI 0.15-0.35, P<.001), paternal parenting sense of competence at T1 (β=5.35, 95% CI 2.23-8.47, P<.01), and reduced paternal depressive symptoms at T2 (β=.25, 95% CI 0.15-0.35, P<.001), and there was a rise in infants’ BMI at 42 days post partum (β=.33, 95% CI 0.01-0.64, P=.04). Conclusions: An evidence-based breastfeeding coparenting intervention is effective in improving exclusive breastfeeding rate, prolonging exclusive breastfeeding duration within the initial 6 months post partum, enhancing parental breastfeeding knowledge, levels of parenting sense of competence and coparenting relationship, infant’s BMI, and reducing paternal depressive symptoms. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300069648; https://tinyurl.com/2p8st2p8 
%M 39689308
%R 10.2196/51566
%U https://www.jmir.org/2024/1/e51566
%U https://doi.org/10.2196/51566
%U http://www.ncbi.nlm.nih.gov/pubmed/39689308

%0 Journal Article
        
%@ 2564-1891
%I JMIR Publications
%V 4
%N 
%P e64577
%T Changes in Reproductive Health Information-Seeking Behaviors After the Dobbs Decision: Systematic Search of the Wikimedia Database
%A Lemieux,Mackenzie
%A Zhou,Cyrus
%A Cary,Caroline
%A Kelly,Jeannie
%+ Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave St. Louis, MO 63110, St Louis, MO, 63110-1010, United States, 1 (314) 362 7080, l.mackenzie@wustl.edu
%K abortion
%K Dobbs
%K internet
%K viewer trends
%K Wikipedia
%K women’s health
%K contraception
%K contraceptive
%K trend
%K information seeking
%K page view
%K reproductive
%K reproduction
%D 2024

%7 16.12.2024
%9 Original Paper
%J JMIR Infodemiology
%G English
                
%X Background: After the US Supreme Court overturned Roe v. Wade, confusion followed regarding the legality of abortion in different states across the country. Recent studies found increased Google searches for abortion-related terms in restricted states after the Dobbsv. Jackson Women’s Health Organization decision was leaked. As patients and providers use Wikipedia (Wikimedia Foundation) as a predominant medical information source, we hypothesized that changes in reproductive health information-seeking behavior could be better understood by examining Wikipedia article traffic. Objective: This study aimed to examine trends in Wikipedia usage for abortion and contraception information before and after the Dobbs decision. Methods: Page views of abortion- and contraception-related Wikipedia pages were scraped. Temporal changes in page views before and after the Dobbs decision were then analyzed to explore changes in baseline views, differences in views for abortion-related information in states with restrictive abortion laws versus nonrestrictive states, and viewer trends on contraception-related pages. Results: Wikipedia articles related to abortion topics had significantly increased page views following the leaked and final Dobbs decision. There was a 103-fold increase in the page views for the Wikipedia article Roe v. Wade following the Dobbs decision leak (mean 372,654, SD 135,478 vs mean 3614, SD 248; P<.001) and a 67-fold increase in page views following the release of the final Dobbs decision (mean 8942, SD 402 vs mean 595,871, SD 178,649; P<.001). Articles about abortion in the most restrictive states had a greater increase in page views (mean 40.6, SD 12.7; 18/51, 35% states) than articles about abortion in states with some restrictions or protections (mean 26.8, SD 7.3; 24/51, 47% states; P<.001) and in the most protective states (mean 20.6, SD 5.7; 8/51, 16% states; P<.001). Finally, views to pages about common contraceptive methods significantly increased after the Dobbs decision. “Vasectomy” page views increased by 183% (P<.001), “IUD” (intrauterine device) page views increased by 80% (P<.001), “Combined oral contraceptive pill” page views increased by 24% (P<.001), “Emergency Contraception” page views increased by 224% (P<.001), and “Tubal ligation” page views increased by 92% (P<.001). Conclusions: People sought information on Wikipedia about abortion and contraception at increased rates after the Dobbs decision. Increased traffic to abortion-related Wikipedia articles correlated to the restrictiveness of state abortion policies. Increased interest in contraception-related pages reflects the increased demand for contraceptives observed after the Dobbs decision. Our work positions Wikipedia as an important source of reproductive health information and demands increased attention to maintain and improve Wikipedia as a reliable source of health information after the Dobbs decision. 
%M 39680890
%R 10.2196/64577
%U https://infodemiology.jmir.org/2024/1/e64577
%U https://doi.org/10.2196/64577
%U http://www.ncbi.nlm.nih.gov/pubmed/39680890

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 7
%N 
%P e58482
%T Exploring Pregnancy-Related Information-Sharing Behavior Among First-Time Southeast Asian Fathers: Qualitative Semistructured Interview Study
%A Ageng,Kidung
%A Inthiran,Anushia
%+ Department of Accounting and Information Systems, University of Canterbury, Meremere building, University Drive, Ilam, Christchurch, 8041, New Zealand, 64 274118469, kidung.ageng@pg.canterbury.ac.nz
%K pregnancy
%K first-time fathers
%K information sharing
%K Southeast Asia
%K information-seeking behavior
%K cultural factors
%D 2024

%7 9.12.2024
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: While the benefits of fathers’ engagement in pregnancy are well researched, little is known about first-time expectant fathers’ information-seeking practices in Southeast Asia regarding pregnancy. In addition, there is a notable gap in understanding their information-sharing behaviors during the pregnancy journey. This information is important, as cultural norms are prevalent in Southeast Asia, and this might influence their information-sharing behavior, particularly about pregnancy. Objective: This study aims to explore and analyze the pregnancy-related information-sharing behavior of first-time expectant fathers in Southeast Asia. This study specifically aims to investigate whether first-time fathers share pregnancy information, with whom they share it, through what means, and the reasons behind the decisions to share the information or not. Methods: We conducted semistructured interviews with first-time Southeast Asian fathers in Indonesia, a sample country in the Southeast Asian region. We analyzed the data using quantitative descriptive analysis and qualitative content theme analysis. A total of 40 first-time expectant fathers were interviewed. Results: The results revealed that 90% (36/40) of the participants shared pregnancy-related information with others. However, within this group, more than half (22/40, 55%) of the participants shared the information exclusively with their partners. Only a small proportion, 10% (4/40), did not share any information at all. Among those who did share, the most popular approach was face-to-face communication (36/40, 90%), followed by online messaging apps (26/40, 65%). The most popular reason for sharing was to validate information (14/40, 35%), while the most frequent reason for not sharing with anyone beyond their partner was because of the preference for asking for information rather than sharing (12/40, 30%). Conclusions: This study provides valuable insights into the pregnancy-related information-sharing behaviors of first-time fathers in Southeast Asia. It enhances our understanding of how first-time fathers share pregnancy-related information and how local cultural norms and traditions influence these practices. In contrast to first-time fathers in high-income countries, the information-sharing behavior of first-time Southeast Asian fathers is defined by cultural nuances. Culture plays a crucial role in their daily decision-making processes. Therefore, this emphasizes the importance of cultural considerations in future discussions and the development of intervention programs related to pregnancy for first-time Southeast Asian fathers. In addition, this study sheds light on the interaction processes that first-time fathers engage in with others, highlighting areas where intervention programs may be necessary to improve their involvement during pregnancy. For example, first-time fathers actively exchange new information found with their partners; therefore, creating features or platforms that facilitate this process could improve their overall experience. Furthermore, health practitioners should take a more proactive approach in engaging with first-time fathers, as currently there is a communication gap between them. 
%M 39652862
%R 10.2196/58482
%U https://pediatrics.jmir.org/2024/1/e58482
%U https://doi.org/10.2196/58482
%U http://www.ncbi.nlm.nih.gov/pubmed/39652862

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e58608
%T A Reflective Thematic Analysis Into the Perceptions of Pregnant Radiographers Regarding the Usefulness of the PregiDose Mobile App to Enhance Fetal Dosimetry and Well-Being: Qualitative Exploration
%A Essop,Hafsa
%A Kekana,Ramadimetja Mable
%A Brosens,Jacques
%A Smuts,Hanlie
%+ Department of Radiography, University of Pretoria, 30 Bophelo Road, Gezina, Pretoria, 0008, South Africa, 27 0715897939, hafsa.essop@up.ac.za
%K mobile app
%K design science research
%K usefulness
%K pregnant radiographers
%K fetal dosimetry
%K occupational health and safety
%K mobile phone
%K maternal and child health
%K PregiDose
%D 2024

%7 15.11.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Pregnancy apps are widely used by pregnant women, who benefit from self-tracking features to support their health goals. Pregnant radiographers are considered a high-risk group of health workers practicing in ionizing radiation environments. Radiation exposure above threshold limits can cause harmful genetic effects on a fetus. Accordingly, pregnant radiographers are required to wear special fetal dosimeters, which provide real-time readings of radiation dose exposure to the fetus. Pregnant radiographers have the responsibility to self-track their fetal doses to ensure that the threshold limit of 1 mGy is not exceeded. The traditional method used to track doses includes a written log of doses in a notebook. Thus, PregiDose, a unique offering in the context of pregnancy apps, was developed to enhance fetal dose tracking and monitoring using technological methods. Objective: This study aims to describe the users’ perceptions of the app’s usefulness using PregiDose in a natural setting. Methods: The overarching framework adopted for the study was a design science research (DSR) methodology encompassing five steps, namely (1) problem awareness, (2) suggestion, (3) development, (4) evaluation, and (5) conclusion. This paper presents the evaluation step of DSR. DSR step 4 included a qualitative approach to explore users’ perceptions regarding the app. Data were collected using a semistructured interview guide. Open-ended questions were guided by the app’s core features, namely dose tracking, education, and wellness. In total, 17 pregnant radiographers in South Africa enrolled to use the app, 9 (53%) engaged with the app, and 4 (24%) agreed to participate in the feedback interviews. The data were collected from October 2023 to March 2024 and analyzed using a reflective thematic data analysis method. Results: Three overarching themes emerged from the data, namely (1) usefulness of PregiDose, (2) barriers to PregiDose adoption and use, and (3) recommendations for the advancement of PregiDose. Users labeled the app’s usefulness as positive and perceived it as a modern approach to traditional dose-tracking methods. They perceived the graph output of the dose-tracking feature to be useful for viewing their accumulative doses. They did not fully engage with the journaling feature, indicating that it was a personal preference and not a practice they would usually engage in. Physiological barriers, such as fatigue and “pregnancy brain,” were contributors to decreased engagement. Finally, because of the demanding workload and fast-paced nature of the radiography department, users recommended the automation of fetal dosimetry through the Internet of Things. Conclusions: PregiDose is an occupational health and safety mobile app developed for pregnant radiographers through a DSR approach. The app offers a modern method of dose tracking consistent with technological advancements in the context of self-tracking. However, future implementation would require using Internet of Things to make fetal dose tracking more effective. 
%M 39546780
%R 10.2196/58608
%U https://formative.jmir.org/2024/1/e58608
%U https://doi.org/10.2196/58608
%U http://www.ncbi.nlm.nih.gov/pubmed/39546780

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 7
%N 
%P e56807
%T Development and Refinement of a Chatbot for Birthing Individuals and Newborn Caregivers: Mixed Methods Study
%A Rivera Rivera,Jessica Nathalie
%A AuBuchon,Katarina E
%A Smith,Marjanna
%A Starling,Claire
%A Ganacias,Karen G
%A Danielson,Aimee
%A Patchen,Loral
%A Rethy,Janine A
%A Blumenthal,H Joseph
%A Thomas,Angela D
%A Arem,Hannah
%+ Healthcare Delivery Research Network, MedStar Health Research Institute, 3007 Tilden Street NW, Suite 6N, Washington, DC, 20008, United States, 1 4436921138, jessica.n.riverarivera@medstar.net
%K postpartum care
%K newborn care
%K health education
%K chatbot
%K mHealth
%K mobile health
%K feedback
%K health equity
%D 2024

%7 14.11.2024
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: The 42 days after delivery (“fourth trimester”) are a high-risk period for birthing individuals and newborns, especially those who are racially and ethnically marginalized due to structural racism. Objective: To fill a gap in the critical “fourth trimester,” we developed 2 ruled-based chatbots—one for birthing individuals and one for newborn caregivers—that provided trusted information about postbirth warning signs and newborn care and connected patients with health care providers. Methods: A total of 4370 individuals received the newborn chatbot outreach between September 1, 2022, and December 31, 2023, and 3497 individuals received the postpartum chatbot outreach between November 16, 2022, and December 31, 2023. We conducted surveys and interviews in English and Spanish to understand the acceptability and usability of the chatbot and identify areas for improvement. We sampled from hospital discharge lists that distributed the chatbot, stratified by prenatal care location, age, type of insurance, and racial and ethnic group. We analyzed quantitative results using descriptive analyses in SPSS (IBM Corp) and qualitative results using deductive coding in Dedoose (SocioCultural Research Consultants). Results: Overall, 2748 (63%) individuals opened the newborn chatbot messaging, and 2244 (64%) individuals opened the postpartum chatbot messaging. A total of 100 patients engaged with the chatbot and provided survey feedback; of those, 40% (n=40) identified as Black, 27% (n=27) identified as Hispanic/Latina, and 18% (n=18) completed the survey in Spanish. Payer distribution was 55% (n=55) for individuals with public insurance, 39% (n=39) for those with commercial insurance, and 2% (n=2) for uninsured individuals. The majority of surveyed participants indicated that chatbot messaging was timely and easy to use (n=80, 80%) and found the reminders to schedule the newborn visit (n=59, 59%) and postpartum visit (n=66, 66%) useful. Across 23 interviews (n=14, 61% Black; n=4, 17% Hispanic/Latina; n=2, 9% in Spanish; n=11, 48% public insurance), 78% (n=18) of interviewees engaged with the chatbot. Interviewees provided positive feedback on usability and content and recommendations for improving the outreach messages. Conclusions: Chatbots are a promising strategy to reach birthing individuals and newborn caregivers with information about postpartum recovery and newborn care, but intentional outreach and engagement strategies are needed to optimize interaction. Future work should measure the chatbot’s impact on health outcomes and reduce disparities. 
%M 39541147
%R 10.2196/56807
%U https://pediatrics.jmir.org/2024/1/e56807
%U https://doi.org/10.2196/56807
%U http://www.ncbi.nlm.nih.gov/pubmed/39541147

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e53299
%T Development and Usability of the OHiFamily Mobile App to Enhance Accessibility to Maternal and Infant Information for Expectant Families in Ohio: Qualitative Study
%A Perme,Natalie
%A Reid,Endia
%A Eluagu,Macdonald Chinwenwa
%A Thompson,John
%A Hebert,Courtney
%A Gabbe,Steven
%A Swoboda,Christine Marie
%+ The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University Wexner Medical Center, Suite 4101, 700 Ackerman Rd., Columbus, OH, 43210, United States, 1 13157612701, swoboda.2@osu.edu
%K health resources
%K pregnancy
%K patient engagement
%K mHealth
%K maternal
%K mobile health
%K app
%K focus group
%K landscape analysis
%K birth
%K preterm
%K premature
%K mortality
%K death
%K pediatric
%K infant
%K neonatal
%K design
%K development
%K obstetric
%K mobile phone
%D 2024

%7 8.11.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The Infant Mortality Research Partnership in Ohio is working to help pregnant individuals and families on Medicaid who are at risk for infant mortality and preterm birth. As part of this initiative, researchers at The Ohio State University worked to develop a patient-facing mobile app, OHiFamily, targeted toward, and created for, this population. To address the social determinants of health that can affect maternal and infant health, the app provides curated information on community resources, health care services, and educational materials in a format that is easily accessible and intended to facilitate contact between families and resources. The OHiFamily app includes 3 distinct features, that is, infant care logging (eg, feeding and diaper changes), curated educational resources, and a link to the curated Ohio resource database (CORD). This paper describes the development and assessment of the OHiFamily app as well as CORD. Objective: This study aimed to describe the development of the OHiFamily mobile app and CORD and the qualitative feedback received by the app’s intended audience. Methods: The researchers performed a landscape analysis and held focus groups to determine the resources and app features of interest to Ohio families on Medicaid. Results: Participants from several focus groups were interested in an app that could offer community resources with contact information, information about medical providers and information and ways to contact them, health tips, and information about pregnancy and infant development. Feedback was provided by 9 participants through 3 focus group sessions. Using this feedback, the team created a curated resource database and mobile app to help users locate and access resources, as well as access education materials and infant tracking features. Conclusions: OHiFamily offers a unique combination of features and access to local resources for families on Medicaid in Ohio not seen in other smartphone apps. 
%M 39514852
%R 10.2196/53299
%U https://formative.jmir.org/2024/1/e53299
%U https://doi.org/10.2196/53299
%U http://www.ncbi.nlm.nih.gov/pubmed/39514852

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e60001
%T Spatial Analyses of Crisis Pregnancy Centers and Abortion Facilities in the United States, 2021 (Pre-Dobbs): Cross-Sectional Study
%A Swartzendruber,Andrea
%A Luisi,Nicole
%A Johnson,Erin R
%A Lambert,Danielle N
%+ Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 101 Buck Road, Athens, GA, 30602, United States, 1 706 583 8149, aswartz@uga.edu
%K crisis pregnancy center
%K abortion, induced
%K reproductive health
%K policy
%K access to information
%K internet
%K directory
%K geographic information system
%K spatial analyses
%D 2024

%7 6.11.2024
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Crisis pregnancy centers (CPCs) are religious nonprofit organizations with a primary mission of diverting people from having abortions. One CPC tactic has been to locate near abortion facilities. Despite medical groups’ warnings that CPCs do not adhere to medical and ethical standards and pose risks, government support for CPCs has significantly increased. Objective: This study aims to map CPCs, abortion facilities, and geographical areas in the United States into 4 zones based on their proximity to CPCs and abortion facilities. We sought to describe the number and percentage of reproductive-aged women living in each zone and the proximity of CPCs to abortion facilities. Methods: Using 2021 data from CPC Map and the Advancing New Standards in Reproductive Health Abortion Facility Database, we determined the ratio of CPCs to abortion facilities. Along with census data, we categorized and mapped US block groups into 4 distinct zones based on locations of block group centroids within 15-mile (1 mile is approximately 1.609 km) radii of CPCs and abortion facilities, namely “no presence,” “CPC only,” “abortion facility only,” and “dual presence.” We calculated the number and percentage of block groups and reproductive-aged (15-49 years) women living in each zone. We calculated driving distances and drive times from abortion facilities to the nearest CPC and mapped abortion facilities with CPCs in close proximity. All analyses were conducted nationally and by region, division, and state. Results: Nationally, the ratio of CPCs to abortion facilities was 3.4, and 54.9% (131,410/239,462) of block groups were categorized in the “dual presence” zone, 26.6% (63,679/239,462) as “CPC only,” and 0.8% (63,679/239,462) as “abortion facility only.” Most reproductive-aged women (45,150,110/75,582,028, 59.7%) lived in a “dual presence” zone, 26.1% (19,696,572/75,582,028) in a “CPC only” zone, and 0.8% (625,403/75,582,028) in an “abortion facility only” zone. The number of block groups and women classified as living in each zone varied by region, division, and state. Nationally, the median distance from abortion facilities to the nearest CPC was 2 miles, and the median drive time was 5.5 minutes. Minimum drive times were <1 minute in all but 11 states. The percentages of abortion facilities with a CPC within 0.25, 0.5, 1, and 3 miles were 14.1% (107/757), 22.6% (171/757), 36.1% (273/757), and 66.3% (502/757), respectively. Conclusions: The findings suggest that CPCs’ tactic of locating near abortion facilities was largely realized before the 2022 US Supreme Court decision that overturned the federal right to abortion. Research on CPCs’ locations and tactics should continue given the dynamic abortion policy landscape and risks posed by CPCs. Tailored programming to raise awareness about CPCs and help people identify and access safe sources of health care may mitigate harm. Increased regulation of CPCs and government divestment may also mitigate CPC harms. 
%M 39504544
%R 10.2196/60001
%U https://publichealth.jmir.org/2024/1/e60001
%U https://doi.org/10.2196/60001
%U http://www.ncbi.nlm.nih.gov/pubmed/39504544

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 7
%N 
%P e56247
%T Digital Health as a Mechanism to Reduce Neonatal Intensive Care Unit Admissions: Retrospective Cohort Study
%A Brinson,Alison K
%A Jahnke,Hannah R
%A Henrich,Natalie
%A Moss,Christa
%A Shah,Neel
%K digital health
%K education
%K gestational conditions
%K Maven Clinic
%K mental health management
%K neonatal
%K NICU admissions
%K neonatal intensive care unit
%K mobile phone
%D 2024

%7 16.10.2024
%9 
%J JMIR Pediatr Parent
%G English
                
%X Background: Admission to the neonatal intensive care unit (NICU) is costly and has been associated with financial and emotional stress among families. Digital health may be well equipped to impact modifiable health factors that contribute to NICU admission rates. Objective: The aim of the study is to investigate how the use of a comprehensive prenatal digital health platform is associated with gestational age at birth and mechanisms to reduce the risk of admission to the NICU. Methods: Data were extracted from 3326 users who enrolled in a comprehensive digital health platform between January 2020 and May 2022. Multivariable linear and logistic regression models were used to estimate the associations between hours of digital health use and (1) gestational age at birth and (2) mechanisms to reduce the risk of a NICU admission. Multivariable logistic regression models estimated the associations between (1) gestational age at birth and (2) mechanisms to reduce the risk of a NICU admission and the likelihood of a NICU admission. All analyses were stratified by the presence of any gestational conditions during pregnancy. Results: For users both with and without gestational conditions, hours of digital health use were positively associated with gestational age at birth (in weeks; with gestational conditions: β=.01; 95% CI 0.0006-0.02; P=.04 and without gestational conditions: β=.01; 95% CI 0.0006-0.02; P=.04) and mechanisms that have the potential to reduce risk of a NICU admission, including learning medically accurate information (with gestational conditions: adjusted odds ratio [AOR] 1.05, 95% CI 1.03-1.07; P<.001 and without gestational conditions: AOR 1.04, 95% CI 1.02-1.06; P<.001), mental health management (with gestational conditions: AOR 1.06, 95% CI 1.04-1.08; P<.001 and without gestational conditions: AOR 1.03, 95% CI 1.02-1.05; P<.001), and understanding warning signs during pregnancy (with gestational conditions: AOR 1.08, 95% CI 1.06-1.11; P<.001 and without gestational conditions: AOR 1.09, 95% CI 1.07-1.11; P<.001). For users with and without gestational conditions, an increase in gestational age at birth was associated with a decreased likelihood of NICU admission (with gestational conditions: AOR 0.62, 95% CI 0.55-0.69; P<.001 and without gestational conditions: AOR 0.59, 95% CI 0.53-0.65; P<.001). Among users who developed gestational conditions, those who reported that the platform helped them understand warning signs during pregnancy had lower odds of a NICU admission (AOR 0.63, 95% CI 0.45-0.89; P=.01). Conclusions: Digital health use may aid in extending gestational age at birth and reduce the risk of NICU admission. 
%R 10.2196/56247
%U https://pediatrics.jmir.org/2024/1/e56247
%U https://doi.org/10.2196/56247

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 12
%N 
%P e55819
%T Evaluating the Adoption of mHealth Technologies by Community Health Workers to Improve the Use of Maternal Health Services in Sub-Saharan Africa: Systematic Review
%A Kachimanga,Chiyembekezo
%A Zaniku,Haules Robbins
%A Divala,Titus Henry
%A Ket,Johannes C.F
%A Mukherjee,Joia S
%A Palazuelos,Daniel
%A Kulinkina,Alexandra V
%A Abejirinde,Ibukun-Oluwa Omolade
%A Akker,Thomas van den
%+ Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam, 1081 HV, Netherlands, 31 887247777, c.kachimanga@vu.nl
%K maternal health
%K antenatal care
%K postnatal care
%K facility-based births
%K sub-Saharan Africa
%K mobile health
%K mHealth
%K review
%K narrative synthesis
%K mobile phone
%D 2024

%7 24.9.2024
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Limited information exists on the impact of mobile health (mHealth) use by community health workers (CHWs) on improving the use of maternal health services in sub-Saharan Africa (SSA). Objective: This systematic review addresses 2 objectives: evaluating the impact of mHealth use by CHWs on antenatal care (ANC) use, facility-based births, and postnatal care (PNC) use in SSA; and identifying facilitators and barriers to mHealth use by CHWs in programs designed to increase ANC use, facility-based births, and PNC use in SSA using a sociotechnical system approach. Methods: We searched for articles in 6 databases (MEDLINE, CINAHL, Web of Science, Embase, Scopus, and Africa Index Medicus) from inception up to September 2022, with additional articles identified from Google Scholar. After article selection, 2 independent reviewers performed title and abstract screening, full-text screening, and data extraction using Covidence software (Veritas Health Innovation Ltd). In addition, we manually screened the references lists of the included articles. Finally, we performed a narrative synthesis of the outcomes. Results: Among the 2594 records retrieved, 10 (0.39%) studies (n=22, 0.85% articles) met the inclusion criteria and underwent data extraction. The studies were published between 2012 and 2022 in 6 countries. Of the studies reporting on ANC outcomes, 43% (3/7) reported that mHealth use by CHWs increased ANC use. Similarly, of the studies reporting on facility-based births, 89% (8/9) demonstrated an increase due to mHealth use by CHWs. In addition, in the PNC studies, 75% (3/4) showed increased PNC use associated with mHealth use by CHWs. Many of the studies reported on the importance of addressing factors related to the social environment of mHealth-enabled CHWs, including the perception of CHWs by the community, trust, relationships, digital literacy, training, mentorship and supervision, skills, CHW program ownership, and the provision of incentives. Very few studies reported on how program goals and culture influenced mHealth use by CHWs. Providing free equipment, accessories, and internet connectivity while addressing ongoing challenges with connectivity, power, the ease of using mHealth software, and equipment maintenance support allowed mHealth-enabled CHW programs to thrive. Conclusions: mHealth use by CHWs was associated with an increase in ANC use, facility-based births, and PNC use in SSA. Identifying and addressing social and technical barriers to the use of mHealth is essential to ensure the success of mHealth programs. Trial Registration: PROSPERO CRD42022346364; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346364 
%M 39316427
%R 10.2196/55819
%U https://mhealth.jmir.org/2024/1/e55819
%U https://doi.org/10.2196/55819
%U http://www.ncbi.nlm.nih.gov/pubmed/39316427

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e53171
%T Uncovering the Complexity of Perinatal Polysubstance Use Disclosure Patterns on X: Mixed Methods Study
%A Wu,Dezhi
%A Shead,Hannah
%A Ren,Yang
%A Raynor,Phyllis
%A Tao,Youyou
%A Villanueva,Harvey
%A Hung,Peiyin
%A Li,Xiaoming
%A Brookshire,Robert G
%A Eichelberger,Kacey
%A Guille,Constance
%A Litwin,Alain H
%A Olatosi,Bankole
%+ Department of Integrated Information Technology, University of South Carolina, 550 Assembly Street, Columbia, SC, 29208, United States, 1 8037774691, dezhiwu@cec.sc.edu
%K polysubstance use
%K prenatal care
%K perinatal care
%K pregnant care
%K social media
%K Twitter
%K sentiment analysis
%D 2024

%7 20.9.2024
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: According to the Morbidity and Mortality Weekly Report, polysubstance use among pregnant women is prevalent, with 38.2% of those who consume alcohol also engaging in the use of one or more additional substances. However, the underlying mechanisms, contexts, and experiences of polysubstance use are unclear. Organic information is abundant on social media such as X (formerly Twitter). Traditional quantitative and qualitative methods, as well as natural language processing techniques, can be jointly used to derive insights into public opinions, sentiments, and clinical and public health policy implications. Objective: Based on perinatal polysubstance use (PPU) data that we extracted on X from May 1, 2019, to October 31, 2021, we proposed two primary research questions: (1) What is the overall trend and sentiment of PPU discussions on X? (2) Are there any distinct patterns in the discussion trends of PPU-related tweets? If so, what are the implications for perinatal care and associated public health policies? Methods: We used X’s application programming interface to extract >6 million raw tweets worldwide containing ≥2 prenatal health- and substance-related keywords provided by our clinical team. After removing all non–English-language tweets, non-US tweets, and US tweets without disclosed geolocations, we obtained 4848 PPU-related US tweets. We then evaluated them using a mixed methods approach. The quantitative analysis applied frequency, trend analysis, and several natural language processing techniques such as sentiment analysis to derive statistics to preview the corpus. To further understand semantics and clinical insights among these tweets, we conducted an in-depth thematic content analysis with a random sample of 500 PPU-related tweets with a satisfying κ score of 0.7748 for intercoder reliability. Results: Our quantitative analysis indicates the overall trends, bigram and trigram patterns, and negative sentiments were more dominant in PPU tweets (2490/4848, 51.36%) than in the non-PPU sample (1323/4848, 27.29%). Paired polysubstance use (4134/4848, 85.27%) was the most common, with the combination alcohol and drugs identified as the most mentioned. From the qualitative analysis, we identified 3 main themes: nonsubstance, single substance, and polysubstance, and 4 subthemes to contextualize the rationale of underlying PPU behaviors: lifestyle, perceptions of others’ drug use, legal implications, and public health. Conclusions: This study identified underexplored, emerging, and important topics related to perinatal PPU, with significant stigmas and legal ramifications discussed on X. Overall, public sentiments on PPU were mixed, encompassing negative (2490/4848, 51.36%), positive (1884/4848, 38.86%), and neutral (474/4848, 9.78%) sentiments. The leading substances in PPU were alcohol and drugs, and the normalization of PPU discussed on X is becoming more prevalent. Thus, this study provides valuable insights to further understand the complexity of PPU and its implications for public health practitioners and policy makers to provide proper access and support to individuals with PPU. 
%M 39302713
%R 10.2196/53171
%U https://www.jmir.org/2024/1/e53171
%U https://doi.org/10.2196/53171
%U http://www.ncbi.nlm.nih.gov/pubmed/39302713

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e56804
%T Public Maternal Health Dashboards in the United States: Descriptive Assessment
%A Callaghan-Koru,Jennifer A
%A Newman Chargois,Paige
%A Tiwari,Tanvangi
%A Brown,Clare C
%A Greenfield,William
%A Koru,Güneş
%+ Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, 2708 S. 48th St., Springdale, AR, 72762, United States, 1 479 713 8102, jck@uams.edu
%K dashboard
%K maternal health
%K data visualization
%K data communication
%K perinatal health
%D 2024

%7 17.9.2024
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Data dashboards have become more widely used for the public communication of health-related data, including in maternal health. Objective: We aimed to evaluate the content and features of existing publicly available maternal health dashboards in the United States. Methods: Through systematic searches, we identified 80 publicly available, interactive dashboards presenting US maternal health data. We abstracted and descriptively analyzed the technical features and content of identified dashboards across four areas: (1) scope and origins, (2) technical capabilities, (3) data sources and indicators, and (4) disaggregation capabilities. Where present, we abstracted and qualitatively analyzed dashboard text describing the purpose and intended audience. Results: Most reviewed dashboards reported state-level data (58/80, 72%) and were hosted on a state health department website (48/80, 60%). Most dashboards reported data from only 1 (33/80, 41%) or 2 (23/80, 29%) data sources. Key indicators, such as the maternal mortality rate (10/80, 12%) and severe maternal morbidity rate (12/80, 15%), were absent from most dashboards. Included dashboards used a range of data visualizations, and most allowed some disaggregation by time (65/80, 81%), geography (65/80, 81%), and race or ethnicity (55/80, 69%). Among dashboards that identified their audience (30/80, 38%), legislators or policy makers and public health agencies or organizations were the most common audiences. Conclusions: While maternal health dashboards have proliferated, their designs and features are not standard. This assessment of maternal health dashboards in the United States found substantial variation among dashboards, including inconsistent data sources, health indicators, and disaggregation capabilities. Opportunities to strengthen dashboards include integrating a greater number of data sources, increasing disaggregation capabilities, and considering end-user needs in dashboard design. 
%M 39288409
%R 10.2196/56804
%U https://www.jmir.org/2024/1/e56804
%U https://doi.org/10.2196/56804
%U http://www.ncbi.nlm.nih.gov/pubmed/39288409

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e54737
%T Artificial Intelligence–Augmented Clinical Decision Support Systems for Pregnancy Care: Systematic Review
%A Lin,Xinnian
%A Liang,Chen
%A Liu,Jihong
%A Lyu,Tianchu
%A Ghumman,Nadia
%A Campbell,Berry
%+ Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, 850 Republican Street, Seattle, WA, 98109, United States, 1 2065432259, cl0512@uw.edu
%K artificial intelligence
%K biomedical ontologies
%K clinical decision support systems
%K implementation science
%K obstetrics
%K pregnancy
%K AI
%K systematic review
%K CDSS
%K functionality
%K methodology
%K implementation
%K database query
%K database queries
%K bibliography
%K record
%K records
%K eligibility
%K literature review
%K prenatal
%K early pregnancy
%K obstetric care
%K postpartum care
%K pregnancy care
%K diagnostic support
%K clinical prediction
%K knowledge base
%K therapeutic
%K therapeutics
%K recommendation
%K recommendations
%K diagnosis
%K abnormality
%K abnormalities
%K cost-effective
%K surveillance
%K ultrasound
%K ontology
%D 2024

%7 16.9.2024
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Despite the emerging application of clinical decision support systems (CDSS) in pregnancy care and the proliferation of artificial intelligence (AI) over the last decade, it remains understudied regarding the role of AI in CDSS specialized for pregnancy care. Objective: To identify and synthesize AI-augmented CDSS in pregnancy care, CDSS functionality, AI methodologies, and clinical implementation, we reported a systematic review based on empirical studies that examined AI-augmented CDSS in pregnancy care. Methods: We retrieved studies that examined AI-augmented CDSS in pregnancy care using database queries involved with titles, abstracts, keywords, and MeSH (Medical Subject Headings) terms. Bibliographic records from their inception to 2022 were retrieved from PubMed/MEDLINE (n=206), Embase (n=101), and ACM Digital Library (n=377), followed by eligibility screening and literature review. The eligibility criteria include empirical studies that (1) developed or tested AI methods, (2) developed or tested CDSS or CDSS components, and (3) focused on pregnancy care. Data of studies used for review and appraisal include title, abstract, keywords, MeSH terms, full text, and supplements. Publications with ancillary information or overlapping outcomes were synthesized as one single study. Reviewers independently reviewed and assessed the quality of selected studies. Results: We identified 30 distinct studies of 684 studies from their inception to 2022. Topics of clinical applications covered AI-augmented CDSS from prenatal, early pregnancy, obstetric care, and postpartum care. Topics of CDSS functions include diagnostic support, clinical prediction, therapeutics recommendation, and knowledge base. Conclusions: Our review acknowledged recent advances in CDSS studies including early diagnosis of prenatal abnormalities, cost-effective surveillance, prenatal ultrasound support, and ontology development. To recommend future directions, we also noted key gaps from existing studies, including (1) decision support in current childbirth deliveries without using observational data from consequential fetal or maternal outcomes in future pregnancies; (2) scarcity of studies in identifying several high-profile biases from CDSS, including social determinants of health highlighted by the American College of Obstetricians and Gynecologists; and (3) chasm between internally validated CDSS models, external validity, and clinical implementation. 
%M 39283665
%R 10.2196/54737
%U https://www.jmir.org/2024/1/e54737
%U https://doi.org/10.2196/54737
%U http://www.ncbi.nlm.nih.gov/pubmed/39283665

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e54323
%T Capitalizing on Community Groups to Improve Women’s Resilience to Maternal and Child Health Challenges: Protocol for a Human-Centered Design Study in Tanzania
%A Isangula,Kahabi Ganka
%A Usiri,Aminieli Itaeli
%A Pallangyo,Eunice Siaity
%+ School of Nursing and Midwifery, Aga Khan University, Salama House, 344 Urambo Street, P.O.Box 125, Dar Es Salaam, 255, United Republic of Tanzania, 255 754030726, kahabi.isangula@aku.edu
%K maternal and child health
%K maternal and child deaths
%K human-centered design
%K income generating associations
%K sub-Saharan Africa
%K Tanzania
%K community groups
%K community
%K capitalizing
%K resilience
%K maternal deaths
%K neonatal deaths
%K mortality
%K co-design
%D 2024

%7 10.9.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Maternal and neonatal deaths remain a major public health issue worldwide. Income Generation Associations (IGAs) could form a critical entry point to addressing poverty-related contributors. However, there have been limited practical interventions to leverage the power of IGAs in addressing the challenges associated with maternal care and childcare. Objective: This study aims to co-design an intervention package with women in IGAs to improve their readiness and resilience to address maternal and child health (MCH) challenges using a human-centered design approach. Methods: The study will use a qualitative descriptive design with purposefully selected women in IGAs and key MCH stakeholders in the Shinyanga and Arusha Regions of Tanzania. A 4-step adaptation of the human-centered design process will be used involving (1) mapping of IGAs and exploring their activities, level of women’s engagement, and MCH challenges faced; (2) co-designing of the intervention package to address identified MCH challenges or needs considering the perceived acceptability, feasibility, and sustainability; (3) validation of the emerging intervention package through gathering insights of women in IGAs who did not take part in initial steps; and (4) refinement of the intervention package with MCH stakeholders based on the validation findings. Results: The participants, procedures, and findings of each co-design step will be presented. More specifically, MCH challenges facing women in IGAs, a list of potential solutions proposed, and the emerging prototype will be presented. As of August 2024, we have completed the co-design of the intervention package and are preparing validation. The findings from the validation of the emerging prototype with a new group of women in IGAs and its refinement through multistakeholder engagement will be presented. A final co-designed intervention package with the potential to improve women’s resilience and readiness to handle MCH challenges will be generated. Conclusions: The emerging intervention package will be discussed given relevant literature on the topic. We believe that subsequent testing and refinement of the package could form the basis for scaling up to broader settings and that the package could then be promoted as one of the key strategies in addressing MCH challenges facing women in low- and middle-income countries. International Registered Report Identifier (IRRID): DERR1-10.2196/54323 
%M 39255483
%R 10.2196/54323
%U https://www.researchprotocols.org/2024/1/e54323
%U https://doi.org/10.2196/54323
%U http://www.ncbi.nlm.nih.gov/pubmed/39255483

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e59928
%T Prevention of Recurrent Spontaneous Preterm Delivery Using Probiotics (Clostridium butyricum, Enterococcus faecium, and Bacillus subtilis; PPP Trial): Protocol for a Prospective, Single-Arm, Nonblinded, Multicenter Trial
%A Yoneda,Satoshi
%A Kobayashi,Tohru
%A Kikuchi,Kayoko
%A Iwamoto,Shintaro
%A Teramoto,Tsuyoshi
%A Chujo,Daisuke
%A Otsuki,Katsufumi
%A Nakai,Akihito
%A Saito,Shigeru
%+ University of Toyama, 3190 Gofuku, Toyama-shi, Toyama, 930-8555, Japan, 81 076 445 6000, s30saito@med.u-toyama.ac.jp
%K clostridium
%K multicenter open label trial
%K preterm delivery
%K probiotics
%K recurrent spontaneous preterm delivery
%K prospective single-arm
%K spontaneous preterm delivery
%K infection
%K oral probiotics
%K pregnant women
%K pregnant
%K pregnancy
%K neonates
%K preterm births
%K systematic review
%K meta-analysis
%D 2024

%7 9.9.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The rate of recurrent spontaneous preterm delivery (sPTD) ranges between 27% and 34% and is 22.3% in Japan. Although it currently remains unclear whether probiotics prevent sPTD, retrospective studies recently reported a reduction in the rate of recurrent sPTD with the administration of probiotics including Clostridium spp., which induce regulatory T cells that play an important role in maintaining pregnancy. Objective: The objective of this trial is to evaluate the preventative effects of available oral probiotics, including Clostridium butyricum, on recurrent sPTD. Methods: This is a prospective, single-arm, nonblinded, multicenter trial in Japan. The sample size required for this trial is 345 pregnant women with a history of sPTD, considering a clinically significant reduction in the relative risk of 30% (risk ratio=0.7). The primary endpoint is the rate of recurrent sPTD at <37 weeks of gestation. The secondary endpoints are the rate of sPTD at <34 weeks of gestation, the rate of recurrent sPTD at <28 weeks of gestation, the ratio of intestinal Clostridium spp. (detected by next-generation sequencing), and bacterial vaginosis (using the Nugent score). Results: The trial procedures were approved by the Clinical Research Review Board of Toyama University Hospital (SCR2020008) on March 31, 2021. The trial was registered on the Japan Registry of Clinical Trial website on April 28, 2021. Recruitment began on May 1, 2021, and the trial is estimated to finish on March 31, 2025. Conclusions: The findings will clarify the rate of recurrent sPTD following probiotic administration including Clostridium butyricum. Outcomes from this trial will inform clinical practice and guide future randomized controlled trials. Trial Registration: Japan Registry of Clinical Trials jRCTs041210014; https://jrct.niph.go.jp/latest-detail/jRCTs041210014 International Registered Report Identifier (IRRID): DERR1-10.2196/59928 
%M 39250784
%R 10.2196/59928
%U https://www.researchprotocols.org/2024/1/e59928
%U https://doi.org/10.2196/59928
%U http://www.ncbi.nlm.nih.gov/pubmed/39250784

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e58653
%T A Chatbot (Juno) Prototype to Deploy a Behavioral Activation Intervention to Pregnant Women: Qualitative Evaluation Using a Multiple Case Study
%A Mancinelli,Elisa
%A Magnolini,Simone
%A Gabrielli,Silvia
%A Salcuni,Silvia
%+ Department of Developmental and Socialization Psychology, University of Padova, Via Venezia 8, Padova, 35131, Italy, 39 3342799698, elisa.mancinelli@phd.unipd.it
%K chatbot prototype
%K co-design
%K pregnancy
%K prevention
%K behavioral activation
%K multiple case study
%D 2024

%7 14.8.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Despite the increasing focus on perinatal care, preventive digital interventions are still scarce. Furthermore, the literature suggests that the design and development of these interventions are mainly conducted through a top-down approach that limitedly accounts for direct end user perspectives. Objective: Building from a previous co-design study, this study aimed to qualitatively evaluate pregnant women’s experiences with a chatbot (Juno) prototype designed to deploy a preventive behavioral activation intervention. Methods: Using a multiple–case study design, the research aims to uncover similarities and differences in participants’ perceptions of the chatbot while also exploring women’s desires for improvement and technological advancements in chatbot-based interventions in perinatal mental health. Five pregnant women interacted weekly with the chatbot, operationalized in Telegram, following a 6-week intervention. Self-report questionnaires were administered at baseline and postintervention time points. About 10-14 days after concluding interactions with Juno, women participated in a semistructured interview focused on (1) their personal experience with Juno, (2) user experience and user engagement, and (3) their opinions on future technological advancements. Interview transcripts, comprising 15 questions, were qualitatively evaluated and compared. Finally, a text-mining analysis of transcripts was performed. Results: Similarities and differences have emerged regarding women’s experiences with Juno, appreciating its esthetic but highlighting technical issues and desiring clearer guidance. They found the content useful and pertinent to pregnancy but differed on when they deemed it most helpful. Women expressed interest in receiving increasingly personalized responses and in future integration with existing health care systems for better support. Accordingly, they generally viewed Juno as an effective momentary support but emphasized the need for human interaction in mental health care, particularly if increasingly personalized. Further concerns included overreliance on chatbots when seeking psychological support and the importance of clearly educating users on the chatbot’s limitations. Conclusions: Overall, the results highlighted both the positive aspects and the shortcomings of the chatbot-based intervention, providing insight into its refinement and future developments. However, women stressed the need to balance technological support with human interactions, particularly when the intervention involves beyond preventive mental health context, to favor a greater and more reliable monitoring. 
%M 39140593
%R 10.2196/58653
%U https://formative.jmir.org/2024/1/e58653
%U https://doi.org/10.2196/58653
%U http://www.ncbi.nlm.nih.gov/pubmed/39140593

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e58580
%T Protective Assets Reinforced With Integrated Care and Technology (PARITY): Protocol for a Randomized Controlled Trial
%A Mollard,Elizabeth
%A Cooper Owens,Deirdre
%A Bach,Christina
%A Gaines,Cydney
%A Maloney,Shannon
%A Moore,Tiffany
%A Wichman,Christopher
%A Shah,Neel
%A Balas,Michele
%+ College of Nursing, University of Nebraska Medical Center, 4111 Dewey Ave, Omaha, NE, 68198, United States, 1 402 472 3665, elizabeth.mollard@unmc.edu
%K maternal health
%K health disparities
%K doula
%K African American
%K mobile phone
%D 2024

%7 8.8.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Black women are significantly more likely to experience severe maternal morbidity and are 3 times as likely to die from pregnancy-related causes compared to White women. Using a strengths-based wellness approach within an integrated supportive care program provided by a community doula could offer pragmatic solutions for Black maternal disparities. The Protective Assets Reinforced with Integrated Care and Technology (PARITY) program consists of a wellness technology platform, including informational links to wellness content and reinforcing motivational SMS text messages, as well as community-based doula support delivered both in person and through the technology platform to improve Black maternal wellness. Objective: This pilot randomized controlled trial (RCT) and mixed methods evaluation aims to (1) determine the feasibility and acceptability of the PARITY intervention; (2) investigate the preliminary efficacy of the PARITY intervention on clinical outcomes (maternal blood pressure, gestational weight gain, and cesarean birth); and (3) investigate changes to wellness behavioral outcomes (nutrition, physical activity, sleep, and health care adherence) and empowered strengths (self-efficacy, social support, motivation, resilience, problem-solving, and self-regulation) in the intervention group compared to a control group. Methods: A 2-arm RCT and mixed methods evaluation will be conducted. Overall, 60 Black pregnant individuals will be randomized in a ratio of 1:1 to either the intervention or informational control group. Participants in the intervention group will receive access to the technology platform over a 12-week period that ends before birth. Intervention participants will be assigned a doula interventionist, who will meet with them 4 times during the intervention. All participants (intervention and control) will receive a referral for a birth doula at no cost, printed materials about having a healthy pregnancy, and community resources. Feasibility and acceptability will be assessed at the end of the program. Measures will be obtained at baseline (20-28 weeks), the 36th week of pregnancy, birth, and 6-12 weeks post partum. Summary statistics and distribution plots will be used to describe measured variables at each time point. A generalized linear mixed model with a shared random component will be used to analyze the effects of PARITY on clinical, wellness behavioral, and empowered strength outcomes, including baseline nutrition, physical activity, and sleep measures as covariates. For significant effects, post hoc contrasts will be adjusted using the Holm method to maintain comparison-wise error at or <.05. Missing data will be addressed using a pattern-mixture model. Results: The National Institute of Nursing Research funded this pilot RCT. Recruitment, enrollment, and data collection are ongoing, and the estimated study completion date is October 2024. Conclusions: The expected results of this study will provide the feasibility and preliminary efficacy of the PARITY intervention, to be used in a larger trial with a 12-month PARITY program intervention. Trial Registration: ClinicalTrials.gov NCT05802615; https://clinicaltrials.gov/study/NCT05802615 International Registered Report Identifier (IRRID): DERR1-10.2196/58580 
%M 39116423
%R 10.2196/58580
%U https://www.researchprotocols.org/2024/1/e58580
%U https://doi.org/10.2196/58580
%U http://www.ncbi.nlm.nih.gov/pubmed/39116423

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e53508
%T Exploring User Experiences of the Mom2B mHealth Research App During the Perinatal Period: Qualitative Study
%A Bilal,Ayesha-Mae
%A Pagoni,Konstantina
%A Iliadis,Stavros I
%A Papadopoulos,Fotios C
%A Skalkidou,Alkistis
%A Öster,Caisa
%+ Department of Medical Sciences, Psychiatry, Uppsala University, Academic Hospital, Entrance 10, Floor 4, Uppsala, 751 85, Sweden, 46 737240915, ayesha.bilal@uu.se
%K digital phenotyping
%K smartphone app
%K mHealth
%K mobile health
%K qualitative study
%K user experience
%K usability
%K perinatal depression
%K depression
%K app
%K user
%K users
%K qualitative
%K perinatal
%K mobile app
%K clinical research
%K acceptability
%K behavioral data
%K depressive symptoms
%K interview
%K pregnant
%K postpartum
%K women
%K thematic analysis
%K well-being
%K monitor
%K mobile phone
%D 2024

%7 8.8.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Perinatal depression affects a significant number of women during pregnancy and after birth, and early identification is imperative for timely interventions and improved prognosis. Mobile apps offer the potential to overcome barriers to health care provision and facilitate clinical research. However, little is known about users’ perceptions and acceptability of these apps, particularly digital phenotyping and ecological momentary assessment apps, a relatively novel category of apps and approach to data collection. Understanding user’s concerns and the challenges they experience using the app will facilitate adoption and continued engagement. Objective: This qualitative study explores the experiences and attitudes of users of the Mom2B mobile health (mHealth) research app (Uppsala University) during the perinatal period. In particular, we aimed to determine the acceptability of the app and any concerns about providing data through a mobile app. Methods: Semistructured focus group interviews were conducted digitally in Swedish with 13 groups and a total of 41 participants. Participants had been active users of the Mom2B app for at least 6 weeks and included pregnant and postpartum women, both with and without depression symptomatology apparent in their last screening test. Interviews were recorded, transcribed verbatim, translated to English, and evaluated using inductive thematic analysis. Results: Four themes were elicited: acceptability of sharing data, motivators and incentives, barriers to task completion, and user experience. Participants also gave suggestions for the improvement of features and user experience. Conclusions: The study findings suggest that app-based digital phenotyping is a feasible and acceptable method of conducting research and health care delivery among perinatal women. The Mom2B app was perceived as an efficient and practical tool that facilitates engagement in research as well as allows users to monitor their well-being and receive general and personalized information related to the perinatal period. However, this study also highlights the importance of trustworthiness, accessibility, and prompt technical issue resolution in the development of future research apps in cooperation with end users. The study contributes to the growing body of literature on the usability and acceptability of mobile apps for research and ecological momentary assessment and underscores the need for continued research in this area. 
%M 39115893
%R 10.2196/53508
%U https://formative.jmir.org/2024/1/e53508
%U https://doi.org/10.2196/53508
%U http://www.ncbi.nlm.nih.gov/pubmed/39115893

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e59434
%T Use of Generative AI for Improving Health Literacy in Reproductive Health: Case Study
%A Burns,Christina
%A Bakaj,Angela
%A Berishaj,Amonda
%A Hristidis,Vagelis
%A Deak,Pamela
%A Equils,Ozlem
%+ MiOra, 17328 Ventura Boulevard Number 190, Encino, CA, 91316, United States, 1 3105954094, oequils@yahoo.com
%K ChatGPT
%K chatGPT
%K chat-GPT
%K chatbots
%K chat-bot
%K chat-bots
%K artificial intelligence
%K AI
%K machine learning
%K ML
%K large language model
%K large language models
%K LLM
%K LLMs
%K natural language processing
%K NLP
%K deep learning
%K chatbot
%K Google Search
%K internet
%K communication
%K English proficiency
%K readability
%K health literacy
%K health information
%K health education
%K health related questions
%K health information seeking
%K health access
%K reproductive health
%K oral contraceptive
%K birth control
%K emergency contraceptive
%K comparison
%K clinical
%K patients
%D 2024

%7 6.8.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Patients find technology tools to be more approachable for seeking sensitive health-related information, such as reproductive health information. The inventive conversational ability of artificial intelligence (AI) chatbots, such as ChatGPT (OpenAI Inc), offers a potential means for patients to effectively locate answers to their health-related questions digitally. Objective: A pilot study was conducted to compare the novel ChatGPT with the existing Google Search technology for their ability to offer accurate, effective, and current information regarding proceeding action after missing a dose of oral contraceptive pill. Methods: A sequence of 11 questions, mimicking a patient inquiring about the action to take after missing a dose of an oral contraceptive pill, were input into ChatGPT as a cascade, given the conversational ability of ChatGPT. The questions were input into 4 different ChatGPT accounts, with the account holders being of various demographics, to evaluate potential differences and biases in the responses given to different account holders. The leading question, “what should I do if I missed a day of my oral contraception birth control?” alone was then input into Google Search, given its nonconversational nature. The results from the ChatGPT questions and the Google Search results for the leading question were evaluated on their readability, accuracy, and effective delivery of information. Results: The ChatGPT results were determined to be at an overall higher-grade reading level, with a longer reading duration, less accurate, less current, and with a less effective delivery of information. In contrast, the Google Search resulting answer box and snippets were at a lower-grade reading level, shorter reading duration, more current, able to reference the origin of the information (transparent), and provided the information in various formats in addition to text. Conclusions: ChatGPT has room for improvement in accuracy, transparency, recency, and reliability before it can equitably be implemented into health care information delivery and provide the potential benefits it poses. However, AI may be used as a tool for providers to educate their patients in preferred, creative, and efficient ways, such as using AI to generate accessible short educational videos from health care provider-vetted information. Larger studies representing a diverse group of users are needed. 
%M 38986153
%R 10.2196/59434
%U https://formative.jmir.org/2024/1/e59434
%U https://doi.org/10.2196/59434
%U http://www.ncbi.nlm.nih.gov/pubmed/38986153

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e53879
%T Association Between Particulate Matter Exposure and Preterm Birth in Women With Abnormal Preconception Thyrotropin Levels: Large Cohort Study
%A Xu,Ting
%A Ni,Haobo
%A Cai,Xiaoyan
%A Dai,Tingting
%A Wang,Lingxi
%A Xiao,Lina
%A Zeng,Qinghui
%A Yu,Xiaolin
%A Han,Lu
%A Guo,Pi
%K PM2.5
%K particulate matter with an aerodynamic diameter of ≤2.5 μm
%K thyroid stimulating hormone
%K preterm birth
%K cohort study
%K preconception
%D 2024

%7 2.8.2024
%9 
%J JMIR Public Health Surveill
%G English
                
%X Background: Prior research has linked exposure to particulate matter with an aerodynamic diameter of ≤2.5 μm (PM2.5) with preterm birth (PTB). However, the modulating effect of preconception thyroid stimulating hormone (TSH) levels on the relationship between PM2.5 exposure and PTB has not been investigated. Objective: This study aimed to assess whether preconception TSH levels modulate the impact of PM2.5 exposure on PTB. Methods: This cohort study was conducted in Guangdong, China, as a part of the National Free Pre-Pregnancy Checkups Project. PM2.5 exposure was estimated by using the inverse distance weighting method. To investigate the moderating effects of TSH levels on trimester-specific PM2.5 exposure and PTB, we used the Cox proportional hazards model. Additionally, to identify the susceptible exposure windows for weekly specific PM2.5 exposure and PTB, we built distributed lag models incorporating Cox proportional hazards models. Results: A total of 633,516 women who delivered between January 1, 2014, to December 31, 2019, were included. In total, 34,081 (5.4%) of them had abnormal preconception TSH levels. During the entire pregnancy, each 10-μg/m3 increase in PM2.5 was linked to elevated risks of PTB (hazard ratio [HR] 1.559, 95% CI 1.390‐1.748), early PTB (HR 1.559, 95% CI 1.227‐1.980), and late PTB (HR 1.571, 95% CI 1.379‐1.791) among women with abnormal TSH levels. For women with normal preconception TSH levels, PM2.5 exposure during the entire pregnancy was positively associated with the risk of PTB (HR 1.345, 95% CI 1.307‐1.385), early PTB (HR 1.203, 95% CI 1.126‐1.285), and late PTB (HR 1.386, 95% CI 1.342‐1432). The critical susceptible exposure windows were the 3rd-13th and 28th-35th gestational weeks for women with abnormal preconception TSH levels, compared to the 1st-13th and 21st-35th gestational weeks for those with normal preconception TSH levels. Conclusions: PM2.5 exposure was linked with a higher PTB risk, particularly in women with abnormal preconception TSH levels. PM2.5 exposure appears to have a greater effect on pregnant women who are in the early or late stages of pregnancy. 
%R 10.2196/53879
%U https://publichealth.jmir.org/2024/1/e53879
%U https://doi.org/10.2196/53879

%0 Journal Article
        
%@ 2291-5222
%I 
%V 12
%N 
%P e55617
%T Impact of Remote Blood Pressure Monitoring Device Connectivity on Engagement Among Pregnant Individuals Enrolled in the Delfina Care Platform: Observational Study
%A Charifson,Mia
%A Wen,Timothy
%A Zell,Bonnie
%A Vaidya,Priyanka
%A Rios,Cynthia I
%A Fagbohun,C Funsho
%A Fulcher,Isabel
%K blood pressure
%K hypertension
%K remote patient monitoring
%K pregnancy
%K digital health
%K remote monitoring
%K user engagement
%K users
%K connected
%K unconnected
%K comparison
%K patient engagement
%K prospective pregnancy cohort
%K device
%K devices
%K female
%K females
%K women
%K logistic regression
%K Poisson
%D 2024

%7 12.7.2024
%9 
%J JMIR Mhealth Uhealth
%G English
                
%X User engagement with remote blood pressure monitoring during pregnancy is critical to optimize the associated benefits of blood pressure control and early detection of hypertensive disorders of pregnancy. In our study population of pregnant individuals, we found that connected blood pressure cuffs, which automatically sync measures to a monitoring platform or health record, increase engagement (2.13 [95% CI 1.36‐3.35] times more measures per day) with remote blood pressure monitoring compared to unconnected cuffs that require manual entry of measures.
%R 10.2196/55617
%U https://mhealth.jmir.org/2024/1/e55617
%U https://doi.org/10.2196/55617

%0 Journal Article
        
%@ 2368-7959
%I 
%V 11
%N 
%P e51074
%T Technologies for Supporting Individuals and Caregivers Living With Fetal Alcohol Spectrum Disorder: Scoping Review
%A Chu,Joanna Ting Wai
%A Wilson,Holly
%A Cai,Cynthia Zhiyin
%A McCormack,Jessica C
%A Newcombe,David
%A Bullen,Chris
%K fetal alcohol
%K scoping review
%K technology
%K caregivers
%K diagnosis
%K support
%K intervention
%K fetal alcohol spectrum disorder
%K FASD
%K developmental disability
%K lifelong support
%K caregiver
%K accessibility
%K alcohol
%K alcohol intake
%K pregnant substance
%K pregnant
%K fetal
%K PRISMA
%K Preferred Reporting Items for Systematic Reviews and Meta-Analyses
%K mobile phone
%D 2024

%7 11.7.2024
%9 
%J JMIR Ment Health
%G English
                
%X Background: Fetal alcohol spectrum disorder (FASD) is a common developmental disability that requires lifelong and ongoing support but is often difficult to find due to the lack of trained professionals, funding, and support available. Technology could provide cost-effective, accessible, and effective support to those living with FASD and their caregivers. Objective: In this review, we aimed to explore the use of technology available for supporting people living with FASD and their caregivers. Methods: We conducted a scoping review to identify studies that included technology for people with FASD or their caregivers; focused on FASD; used an empirical study design; were published since 2005; and used technology for assessment, diagnosis, monitoring, or support for people with FASD. We searched MEDLINE, Web of Science, Scopus, Embase, APA PsycINFO, ACM Digital Library, JMIR Publications journals, the Cochrane Library, EBSCOhost, IEEE, study references, and gray literature to find studies. Searches were conducted in November 2022 and updated in January 2024. Two reviewers (CZC and HW) independently completed study selection and data extraction. Results: In total, 17 studies exploring technology available for people with FASD showed that technology could be effective at teaching skills, supporting caregivers, and helping people with FASD develop skills. Conclusions: Technology could provide support for people affected by FASD; however, currently there is limited technology available, and the potential benefits are largely unexplored. Trial Registration: PROSPERO CRD42022364885; https://tinyurl.com/3zaatu9u 
%R 10.2196/51074
%U https://mental.jmir.org/2024/1/e51074
%U https://doi.org/10.2196/51074

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e53396
%T Harnessing Artificial Intelligence to Predict Ovarian Stimulation Outcomes in In Vitro Fertilization: Scoping Review
%A AlSaad,Rawan
%A Abd-alrazaq,Alaa
%A Choucair,Fadi
%A Ahmed,Arfan
%A Aziz,Sarah
%A Sheikh,Javaid
%+ AI Center for Precision Health, Weill Cornell Medicine-Qatar, Education City, Street 2700, Doha, Qatar, 974 44928830, rta4003@qatar-med.cornell.edu
%K artificial intelligence
%K AI
%K AI models
%K AI model
%K in vitro fertilization
%K IVF
%K ovarian stimulation
%K infertility
%K fertility
%K ovary
%K ovaries
%K reproductive
%K reproduction
%K gynecology
%K prediction
%K predictions
%K predictive
%K prediction model
%K ovarian
%K adverse outcome
%K fertilization
%K pregnancy
%D 2024

%7 5.7.2024
%9 Review
%J J Med Internet Res
%G English
                
%X Background: In the realm of in vitro fertilization (IVF), artificial intelligence (AI) models serve as invaluable tools for clinicians, offering predictive insights into ovarian stimulation outcomes. Predicting and understanding a patient’s response to ovarian stimulation can help in personalizing doses of drugs, preventing adverse outcomes (eg, hyperstimulation), and improving the likelihood of successful fertilization and pregnancy. Given the pivotal role of accurate predictions in IVF procedures, it becomes important to investigate the landscape of AI models that are being used to predict the outcomes of ovarian stimulation. Objective: The objective of this review is to comprehensively examine the literature to explore the characteristics of AI models used for predicting ovarian stimulation outcomes in the context of IVF. Methods: A total of 6 electronic databases were searched for peer-reviewed literature published before August 2023, using the concepts of IVF and AI, along with their related terms. Records were independently screened by 2 reviewers against the eligibility criteria. The extracted data were then consolidated and presented through narrative synthesis. Results: Upon reviewing 1348 articles, 30 met the predetermined inclusion criteria. The literature primarily focused on the number of oocytes retrieved as the main predicted outcome. Microscopy images stood out as the primary ground truth reference. The reviewed studies also highlighted that the most frequently adopted stimulation protocol was the gonadotropin-releasing hormone (GnRH) antagonist. In terms of using trigger medication, human chorionic gonadotropin (hCG) was the most commonly selected option. Among the machine learning techniques, the favored choice was the support vector machine. As for the validation of AI algorithms, the hold-out cross-validation method was the most prevalent. The area under the curve was highlighted as the primary evaluation metric. The literature exhibited a wide variation in the number of features used for AI algorithm development, ranging from 2 to 28,054 features. Data were mostly sourced from patient demographics, followed by laboratory data, specifically hormonal levels. Notably, the vast majority of studies were restricted to a single infertility clinic and exclusively relied on nonpublic data sets. Conclusions: These insights highlight an urgent need to diversify data sources and explore varied AI techniques for improved prediction accuracy and generalizability of AI models for the prediction of ovarian stimulation outcomes. Future research should prioritize multiclinic collaborations and consider leveraging public data sets, aiming for more precise AI-driven predictions that ultimately boost patient care and IVF success rates. 
%M 38967964
%R 10.2196/53396
%U https://www.jmir.org/2024/1/e53396
%U https://doi.org/10.2196/53396
%U http://www.ncbi.nlm.nih.gov/pubmed/38967964

%0 Journal Article
        
%@ 2373-6658
%I JMIR Publications
%V 8
%N 
%P e57128
%T Association Between Gestational Weeks, Initial Maternal Perception of Fetal Movement, and Individual Interoceptive Differences in Pregnant Women: Cross-Sectional Study
%A Furusho,Miku
%A Noda,Minami
%A Sato,Yoko
%A Suetsugu,Yoshiko
%A Morokuma,Seiichi
%+ Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan, 81 926426708, morokuma.seiichi.845@m.kyushu-u.ac.jp
%K fetal movement
%K gestational weeks
%K gestation
%K gestational
%K heartbeat counting task
%K interoception
%K pregnancy
%K pregnant
%K maternal
%K fetus
%K fetal
%K association
%K associations
%K correlation
%K correlations
%K obstetric
%K obstetrics
%K interoceptive
%K perception
%K perceptions
%K awareness
%K sense
%K sensing
%K senses
%K internal stimulus
%K internal stimuli
%D 2024

%7 26.6.2024
%9 Original Paper
%J Asian Pac Isl Nurs J
%G English
                
%X Background: Interoception encompasses the conscious awareness of homeostasis in the body. Given that fetal movement awareness is a component of interoception in pregnant women, the timing of initial detection of fetal movement may indicate individual differences in interoceptive sensitivity. Objective: The aim of this study is to determine whether the association between the gestational week of initial movement awareness and interoception can be a convenient evaluation index for interoception in pregnant women. Methods: A cross-sectional study was conducted among 32 pregnant women aged 20 years or older at 22-29 weeks of gestation with stable hemodynamics in the Obstetric Outpatient Department. Interoception was assessed using the heartbeat-counting task, with gestational weeks at the first awareness of fetal movement recorded via a questionnaire. Spearman rank correlation was used to compare the gestational weeks at the first awareness of fetal movement and heartbeat-counting task scores. Results: A significant negative correlation was found between the gestational weeks at the first fetal movement awareness and heartbeat-counting task performance among all participants (r=–0.43, P=.01) and among primiparous women (r=–0.53, P=.03) but not among multiparous women. Conclusions: Individual differences in interoception appear to correlate with the differences observed in the timing of the first awareness of fetal movement. 
%M 38924785
%R 10.2196/57128
%U https://apinj.jmir.org/2024/1/e57128
%U https://doi.org/10.2196/57128
%U http://www.ncbi.nlm.nih.gov/pubmed/38924785

%0 Journal Article
        
%@ 2564-1891
%I JMIR Publications
%V 4
%N 
%P e58056
%T Analyzing Questions About Alcohol in Pregnancy Using Web-Based Forum Topics: Qualitative Content Analysis
%A Frennesson,Nessie Felicia
%A Barnett,Julie
%A Merouani,Youssouf
%A Attwood,Angela
%A Zuccolo,Luisa
%A McQuire,Cheryl
%+ Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, United Kingdom, 44 1173746633, felicia.frennesson@bristol.ac.uk
%K social media
%K web-based forum
%K alcohol
%K pregnancy
%K prenatal health
%K prenatal alcohol exposure
%D 2024

%7 20.6.2024
%9 Original Paper
%J JMIR Infodemiology
%G English
                
%X Background: Prenatal alcohol exposure represents a substantial public health concern as it may lead to detrimental outcomes, including pregnancy complications and fetal alcohol spectrum disorder. Although UK national guidance recommends abstaining from alcohol if pregnant or planning a pregnancy, evidence suggests that confusion remains on this topic among members of the public, and little is known about what questions people have about consumption of alcohol in pregnancy outside of health care settings. Objective: This study aims to assess what questions and topics are raised on alcohol in pregnancy on a web-based UK-based parenting forum and how these correspond to official public health guidelines with respect to 2 critical events: the implementation of the revised UK Chief Medical Officers’ (CMO) low-risk drinking guidelines (2016) and the first COVID-19 pandemic lockdown (2020). Methods: All thread starts mentioning alcohol in the “Pregnancy” forum were collected from Mumsnet for the period 2002 to 2022 and analyzed using qualitative content analysis. Descriptive statistics were used to characterize the number and proportion of thread starts for each topic over the whole study period and for the periods corresponding to the change in CMO guidance and the COVID-19 pandemic. Results: A total of 395 thread starts were analyzed, and key topics included “Asking for advice on whether it is safe to consume alcohol” or on “safe limits” and concerns about having consumed alcohol before being aware of a pregnancy. In addition, the Mumsnet thread starts included discussions and information seeking on “Research, guidelines, and official information about alcohol in pregnancy.” Topics discussed on Mumsnet regarding alcohol in pregnancy remained broadly similar between 2002 and 2022, although thread starts disclosing prenatal alcohol use were more common before the introduction of the revised CMO guidance than in later periods. Conclusions: Web-based discussions within a UK parenting forum indicated that users were often unclear on guidance and risks associated with prenatal alcohol use and that they used this platform to seek information and reassurance from peers. 
%M 38900536
%R 10.2196/58056
%U https://infodemiology.jmir.org/2024/1/e58056
%U https://doi.org/10.2196/58056
%U http://www.ncbi.nlm.nih.gov/pubmed/38900536

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e55000
%T Health Information System Strengthening During Antenatal Care in Haiti: Continuous Quality Improvement Study
%A Casella Jean-Baptiste,Meredith
%A Vital Julmiste,Thamar Monide
%A Ball,Ellen
%+ Hôpital Universitaire de Mirebalais, Sante Fanm, Rue Chatulee, Mirebalais, HT 5210, Haiti, 509 4892 3626, mjeanbaptiste@pih.org
%K maternal health
%K health informatics
%K quality improvement
%K Plan-Do-Study-Act
%K PDSA
%K maternal
%K neonatal
%K data collection
%K prenatal
%K outpatient
%K electronic data
%K nursing
%K nursing staff
%K nursing leadership
%D 2024

%7 14.6.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Journey to 9 Plus (J9) is an integrated reproductive, maternal, neonatal, and child health approach to care that has at its core the goal of decreasing the rate of maternal and neonatal morbidity and mortality in rural Haiti. For the maximum effectiveness of this program, it is necessary that the data system be of the highest quality. OpenMRS, an electronic medical record (EMR) system, has been in place since 2013 throughout a tertiary referral hospital, the Hôpital Universitaire de Mirebalais, in Haiti and has been expanded for J9 data collection and reporting. The J9 program monthly reports showed that staff had limited time and capacity to perform double charting, which contributed to incomplete and inconsistent reports. Initial evaluation of the quality of EMR data entry showed that only 18% (58/325) of the J9 antenatal visits were being documented electronically at the start of this quality improvement project. Objective: This study aimed to improve the electronic documentation of outpatient antenatal care from 18% (58/325) to 85% in the EMR by J9 staff from November 2020 to September 2021. The experiences that this quality improvement project team encountered could help others improve electronic data collection as well as the transition from paper to electronic documentation within a burgeoning health care system. Methods: A continuous quality improvement strategy was undertaken as the best approach to improve the EMR data collection at Hôpital Universitaire de Mirebalais. The team used several continuous quality improvement tools to conduct this project: (1) a root cause analysis using Ishikawa and Pareto diagrams, (2) baseline evaluation measurements, and (3) Plan-Do-Study-Act improvement cycles to document incremental changes and the results of each change. Results: At the beginning of the quality improvement project in November 2020, the baseline data entry for antenatal visits was 18% (58/325). Ten months of improvement strategies resulted in an average of 89% (272/304) of antenatal visits documented in the EMR at point of care every month. Conclusions: The experiences that this quality improvement project team encountered can contribute to the transition from paper to electronic documentation within burgeoning health care systems. Essential to success was having a strong and dedicated nursing leadership to transition from paper to electronic data and motivated nursing staff to perform data collection to improve the quality of data and thus, the reports on patient outcomes. Engaging the nursing team closely in the design and implementation of EMR and quality improvement processes ensures long-term success while centering nurses as key change agents in patient care systems. 
%M 38875702
%R 10.2196/55000
%U https://formative.jmir.org/2024/1/e55000
%U https://doi.org/10.2196/55000
%U http://www.ncbi.nlm.nih.gov/pubmed/38875702

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e49510
%T Effectiveness of mHealth Apps for Maternal Health Care Delivery: Systematic Review of Systematic Reviews
%A Ameyaw,Edward Kwabena
%A Amoah,Padmore Adusei
%A Ezezika,Obidimma
%+ Institute of Policy Studies, Lingnan University, Tuen Mun, Hong Kong, China (Hong Kong), 852 55381568, edmeyaw19@gmail.com
%K mHealth
%K mobile health
%K maternal health
%K telemedicine
%K technology
%K health care
%K newborn
%K systematic review
%K database
%K mHealth impact
%K mHealth effectiveness
%K health care applications
%D 2024

%7 29.5.2024
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Globally, the use of mobile health (mHealth) apps or interventions has increased. Robust synthesis of existing systematic reviews on mHealth apps may offer useful insights to guide maternal health clinicians and policy makers. Objective: This systematic review aims to assess the effectiveness or impact of mHealth apps on maternal health care delivery globally. Methods: We systematically searched Scopus, Web of Science (Core Collection), MEDLINE or PubMed, CINAHL, and Cochrane Database of Systematic Reviews using a predeveloped search strategy. The quality of the reviews was independently assessed by 3 reviewers, while study selection was done by 2 independent raters. We presented a narrative synthesis of the findings, highlighting the specific mHealth apps, where they are implemented, and their effectiveness or outcomes toward various maternal conditions. Results: A total of 2527 documents were retrieved, out of which 16 documents were included in the review. Most mHealth apps were implemented by sending SMS text messages with mobile phones. mHealth interventions were most effective in 5 areas: maternal anxiety and depression, diabetes in pregnancy, gestational weight management, maternal health care use, behavioral modification toward smoking cessation, and controlling substance use during pregnancy. We noted that mHealth interventions for maternal health care are skewed toward high-income countries (13/16, 81%). Conclusions: The effectiveness of mHealth apps for maternity health care has drawn attention in research and practice recently. The study showed that research on mHealth apps and their use dominate in high-income countries. As a result, it is imperative that low- and middle-income countries intensify their commitment to these apps for maternal health care, in terms of use and research. Trial Registration: PROSPERO CRD42022365179; https://tinyurl.com/e5yxyx77 
%M 38810250
%R 10.2196/49510
%U https://www.jmir.org/2024/1/e49510
%U https://doi.org/10.2196/49510
%U http://www.ncbi.nlm.nih.gov/pubmed/38810250

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e56052
%T Preconception Care Interventions for Adolescents and Young Adults to Prevent Adverse Maternal and Child Health Outcomes: Protocol for an Evidence Gap Map
%A Padhani,Zahra Ali
%A Tessema,Gizachew A
%A Avery,Jodie C
%A Rahim,Komal Abdul
%A Boyle,Jacqueline A
%A Meherali,Salima
%A Salam,Rehana A
%A Lassi,Zohra S
%+ School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Level 4, Rundle Mall Plaza, 50 Rundle Mall, Adelaide, 5000, Australia, 61 83139266, zohra.lassi@adelaide.edu.au
%K preconception health
%K adolescent
%K young adult
%K maternal health
%K perinatal outcomes
%K child health
%K infant health
%K evidence gap map
%K EGM
%K interventions
%K perinatal health
%K preconception
%K young woman
%K woman
%K evidence gap
%K perinatal
%K map
%K gap
%K offspring
%K maternal
%K infancy
%K prepregnancy
%D 2024

%7 24.5.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Preconception is the period before a young woman or woman conceives, which draws attention to understanding how her health condition and certain risk factors affect her and her baby’s health once she becomes pregnant. Adolescence and youth represent a life-course continuum between childhood and adulthood, in which the prepregnancy phase lacks sufficient research. Objective: The aim of the study is to identify, map, and describe existing empirical evidence on preconception interventions that enhance health outcomes for adolescents, young adults, and their offspring. Methods: We will conduct an evidence gap map (EGM) activity following the Campbell guidelines by populating searches identified from electronic databases such as MEDLINE, Embase, CINAHL, and Cochrane Library. We will include interventional studies and reviews of interventional studies that report the impact of preconception interventions for adolescents and young adults (aged 10 to 25 years) on adverse maternal, perinatal, and child health outcomes. All studies will undergo title or abstract and full-text screening on Covidence software (Veritas Health Innovation). All included studies will be coded using the Evidence for Policy and Practice Information (EPPI) Reviewer software (EPPI Centre, UCL Social Research Institute, University College London). Cochrane Risk of Bias tool 2.0 and Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2) tool will be used to assess the quality of the included trials and reviews. A 2D graphical EGM will be developed using the EPPI Mapper software (version 2.2.4; EPPI Centre, UCL Social Research Institute, University College London). Results: This EGM exercise began in July 2023. Through electronic search, 131,031 publications were identified after deduplication, and after the full-text screening, 18 studies (124 papers) were included in the review. We plan to submit the paper to a peer-reviewed journal once it is finalized, with an expected completion date in May 2024. Conclusions: This study will facilitate the prioritization of future research and allocation of funding while also suggesting interventions that may improve maternal, perinatal, and child health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/56052 
%M 38788203
%R 10.2196/56052
%U https://www.researchprotocols.org/2024/1/e56052
%U https://doi.org/10.2196/56052
%U http://www.ncbi.nlm.nih.gov/pubmed/38788203

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 11
%N 
%P e50098
%T A Digital Behavioral Activation Intervention (JuNEX) for Pregnant Women With Subclinical Depression Symptoms: Explorative Co-Design Study
%A Mancinelli,Elisa
%A Gabrielli,Silvia
%A Salcuni,Silvia
%+ Department of Developmental and Socialization Psychology, University of Padova, Via Venezia 8, Padova, 35131, Italy, 39 3342799698, elisa.mancinelli@phd.unipd.it
%K digital intervention
%K behavioral activation
%K feasibility
%K pregnancy
%K subclinical depression symptoms
%D 2024

%7 16.5.2024
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: Digital interventions are gaining increasing interest due to their structured nature, ready availability, and self-administered capabilities. Perinatal women have expressed a desire for such interventions. In this regard, behavioral activation interventions may be particularly suitable for digital administration. Objective: This study aims to exploratorily investigate and compare the feasibility of the internet-based self-help guided versus unguided version of the Brief Behavioral Activation Treatment for Depression-Revised, an empirically supported in-person behavioral activation protocol, targeting pregnant women with subclinical depression symptoms. A user-centered design is used, whereby data are collected with the intent of evaluating how to adjust the intervention in line with pregnant women’s needs. Usability and user engagement were evaluated. Methods: A total of 11 Italian pregnant women with subclinical depressive symptoms based on the Patient Health Questionnaire-9 (scoring<15) participated in this study; of them, 6 (55%) women were randomly assigned to the guided group (age: mean 32.17, SD 4.36 years) and 5 (45%) to the unguided group (age: mean 31, SD 4.95 years). The Moodle platform was used to deliver the interventions in an e-learning format. It consisted of 6 core modules and 3 optional modules; the latter aimed at revising the content of the former. In the guided group, each woman had weekly chats with their assigned human guide to support them in the homework revisions. The intervention content included text, pictures, and videos. Semistructured interviews were conducted, and descriptive statistics were analyzed. Results: Collectively, the data suggest that the guided intervention was better accepted than the unguided one. However, the high rates of dropout (at T6: guided group: 3/6, 50%; unguided: 4/5, 80%) suggest that a digital replica of Behavioral Activation Treatment for Depression-Revised may not be feasible in an e-learning format. The reduced usability of the platform used was reported, and homework was perceived as too time-consuming and effort-intensive. Moreover, the 6 core modules were deemed sufficient for the intervention’s goals, suggesting that the 3 optional modules could be eliminated. Nevertheless, participants from both groups expressed satisfaction with the content and found it relevant to their pregnancy experiences. Conclusions: Overall, the findings have emphasized both the intervention’s merits and shortcomings. Results highlight the unsuitability of replicating an in-person protocol digitally as well as of the use of nonprofessional tools for the implementation of self-help interventions, ultimately making the intervention not feasible. Pregnant women have nonetheless expressed a desire to receive psychological support and commented on the possibilities of digital psychosocial supports, particularly those that are app-based. The information collected and the issues identified here are important to guide the development and co-design of a more refined platform for the intervention deployment and to tailor the intervention’s content to pregnant women’s needs. 
%M 38753421
%R 10.2196/50098
%U https://humanfactors.jmir.org/2024/1/e50098
%U https://doi.org/10.2196/50098
%U http://www.ncbi.nlm.nih.gov/pubmed/38753421

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e58326
%T Examining the Effectiveness of Interactive Webtoons for Premature Birth Prevention: Protocol for a Randomized Controlled Trial
%A Kim,Sun-Hee
%A De Gagne,Jennie C
%+ College of Nursing, Research Institute of Nursing Science, Daegu Catholic University, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea, 82 536504831, sunhee421@cu.ac.kr
%K cartoon
%K cartoons
%K webtoon
%K webtoons
%K story
%K stories
%K storytelling
%K preterm
%K infant
%K infants
%K infancy
%K baby
%K babies
%K neonate
%K neonates
%K neonatal
%K newborn
%K newborns
%K perception
%K perceptions
%K web-based
%K satisfaction
%K client satisfaction
%K clinical trial protocol
%K education
%K health belief model
%K web-based intervention
%K premature birth
%K prevention and control
%K prevention
%K premature
%K maternal
%K pregnant
%K pregnancy
%K randomized controlled feasibility trials
%K self-efficacy
%K women
%K randomized
%K controlled trial
%K controlled trials
%K birth
%K mobile phone
%D 2024

%7 15.5.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Premature birth poses significant health challenges globally, impacting infants, families, and society. Despite recognition of its contributing factors, efforts to reduce its incidence have seen limited success. A notable gap exists in the awareness among women of childbearing age (WCA) regarding both the risks of premature birth and the preventative measures they can take. Research suggests that enhancing health beliefs and self-management efficacy in WCA could foster preventive health behaviors. Interactive webtoons offer an innovative, cost-effective avenue for delivering engaging, accessible health education aimed at preventing premature birth. Objective: This protocol describes a randomized controlled trial to assess the effectiveness and feasibility of a novel, self-guided, web-based intervention—Pregnancy Story I Didn’t Know in Interactive Webtoon Series (PSIDK-iWebtoons)—designed to enhance self-management efficacy and promote behaviors preventing premature birth in WCA. Methods: Using an explanatory sequential mixed methods design, this study first conducts a quantitative analysis followed by a qualitative inquiry to evaluate outcomes and feasibility. Participants are randomly assigned to 2 groups: one accessing the PSIDK-iWebtoons and the other receiving Pregnancy Story I Didn’t Know in Text-Based Information (PSIDK-Texts) over 3 weeks. We measure primary efficacy through the self-management self-efficacy scale for premature birth prevention (PBP), alongside secondary outcomes including perceptions of susceptibility, severity, benefits, and barriers based on the health belief model for PBP and PBP intention. Additional participant-reported outcomes are assessed at baseline, the postintervention time point, and the 4-week follow-up. The feasibility of the intervention is assessed after the end of the 3-week intervention period. Outcome analysis uses repeated measures ANOVA for quantitative data, while qualitative data are explored through content analysis of interviews with 30 participants. Results: The study received funding in June 2021 and institutional review board approval in October 2023. Both the PSIDK-iWebtoons and PSIDK-Texts interventions have been developed and pilot-tested from July to November 2023, with the main phase of quantitative data collection running from November 2023 to March 2024. Qualitative data collection commenced in February 2024 and will conclude in May 2024. Ongoing analyses include process evaluation and data interpretation. Conclusions: This trial will lay foundational insights into the nexus of interactive web-based interventions and the improvement of knowledge and practices related to PBP among WCA. By demonstrating the efficacy and feasibility of a web-based, interactive educational tool, this study will contribute essential evidence to the discourse on accessible and scientifically robust digital platforms. Positive findings will underscore the importance of such interventions in fostering preventive health behaviors, thereby supporting community-wide efforts to mitigate the risk of premature births through informed self-management practices. Trial Registration: Korea Disease Control and Prevention Agency (KDCA) KCT0008931; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=25857 International Registered Report Identifier (IRRID): DERR1-10.2196/58326 
%M 38748471
%R 10.2196/58326
%U https://www.researchprotocols.org/2024/1/e58326
%U https://doi.org/10.2196/58326
%U http://www.ncbi.nlm.nih.gov/pubmed/38748471

%0 Journal Article
        
%@ 1947-2579
%I JMIR Publications
%V 16
%N 
%P e51601
%T Intention to Use Mobile-Based Partograph and Its Predictors Among Obstetric Health Care Providers Working at Public Referral Hospitals in the Oromia Region of Ethiopia in 2022: Cross-Sectional Questionnaire Study
%A Tilahun,Kefyalew Naniye
%A Adem,Jibril Bashir
%A Atinafu,Wabi Temesgen
%A Walle,Agmasie Damtew
%A Mengestie,Nebyu Demeke
%A Birhanu,Abraham Yeneneh
%+ College of Medicine and Health Sciences, Ambo University, Addis Ababa, Ambo, Ethiopia, 251 922298660, kefyalewnaniye64@gmail.com
%K mobile-based partograph
%K mHealth
%K mobile health
%K cross-sectional
%K questionnaire
%K questionnaires
%K survey
%K surveys
%K modified TAM
%K technology acceptance model
%K intention to use
%K obstetric health care providers
%K Ethiopia
%K intent
%K intention
%K TAM
%K experience
%K experiences
%K attitude
%K attitudes
%K opinion
%K opinions
%K perception
%K perceptions
%K perspective
%K perspectives
%K acceptance
%K adoption
%K partograph
%K digital health
%K health technology
%K birth
%K women's health
%K obstetrics
%K obstetric
%K obstetric health care
%K labor monitoring
%D 2024

%7 10.5.2024
%9 Original Paper
%J Online J Public Health Inform
%G English
                
%X Background: A partograph is a pictorial representation of the relationship between cervical dilatation and the time used to diagnose prolonged and obstructed labor. However, the utilization of paper-based partograph is low and it is prone to documentation errors, which can be avoided with the use of electronic partographs. There is only limited information on the proportion of intention to use mobile-based partographs and its predictors. Objective: The objective of this study was to determine the proportion of obstetric health care providers at public referral hospitals in Oromia, Ethiopia, in 2022 who had the intention to use mobile-based partographs and to determine the predictors of their intention to use mobile-based partographs. Methods: We performed an institution-based cross-sectional study from June 1 to July 1, 2022. Census was conducted on 649 participants. A self-administered structured English questionnaire was used, and a 5% pretest was performed. Data were entered into EpiData version 4.6 and exported to SPSS version 25 for descriptive analysis and AMOS (analysis of moment structure; version 23) for structural and measurement model assessment. Descriptive and structural equation modeling analyses were performed. The hypotheses developed based on a modified Technology Acceptance Model were tested using path coefficients and P values <.05. Results: About 65.7% (414/630; 95% CI 61.9%-69.4%) of the participants intended to use mobile-based electronic partographs, with a 97% (630/649) response rate. Perceived usefulness had a positive influence on intention to use (β=.184; P=.02) and attitude (β=.521; P=.002). Perceived ease of use had a positive influence on attitude (β=.382; P=.003), perceived usefulness (β=.503; P=.002), and intention to use (β=.369; P=.001). Job relevance had a positive influence on perceived usefulness (β=.408; P=.001) and intention to use (β=.185; P=.008). Attitude positively influenced intention to use (β=.309; P=.002). Subjective norms did not have a significant influence on perceived usefulness (β=.020; P=.61) and intention to use (β=–.066; P=.07). Conclusions: Two-thirds of the obstetric health care providers in our study intended to use mobile-based partographs. Perceived usefulness, perceived ease of use, job relevance, and attitude positively and significantly influenced their intention to use mobile-based electronic partographs. The development of a user-friendly mobile-based partograph that meets job and user expectations can enhance the intention to use. 
%M 38728079
%R 10.2196/51601
%U https://ojphi.jmir.org/2024/1/e51601
%U https://doi.org/10.2196/51601
%U http://www.ncbi.nlm.nih.gov/pubmed/38728079

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e53890
%T A Mindfulness-Based App Intervention for Pregnant Women: Protocol for a Pilot Feasibility Study
%A Rizzi,Silvia
%A Poggianella,Stefania
%A Pavesi,Maria Chiara
%A Gios,Lorenzo
%A Bincoletto,Giorgia
%A Scolari,Isabella
%A Paoli,Claudia
%A Marroni,Debora
%A Tassinari,Irene
%A Baietti,Barbara
%A Gianatti,Anna
%A Albertini,Veronica
%A Burlon,Barbara
%A Chiodega,Vanda
%A Endrizzi,Barbara
%A Benini,Elena
%A Guella,Chiara
%A Gadotti,Erik
%A Forti,Stefano
%A Taddei,Fabrizio
%+ Digital Health Research, Centre for Digital Health & Wellbeing, Fondazione Bruno Kessler, Via Sommarive 18, Trento, 38123, Italy, 39 0461312415, srizzi@fbk.eu
%K mindfulness
%K promoting well-being
%K pregnancy
%K eHealth
%K mobile health
%K mHealth
%K mobile apps
%K development
%K usability
%K user-centered design
%K mindfulness based
%K intervention
%K pregnant women
%K pregnant
%K feasibility study
%K well-being
%K women
%K quality of life
%K psychological symptoms
%K digital solution
%K virtual coach
%K smartphone
%K mobile phone
%D 2024

%7 10.5.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Pregnancy is a complex time characterized by major transformations in a woman, which impact her physical, mental, and social well-being. How a woman adapts to these changes can affect her quality of life and psychological well-being. The literature indicates that pregnant women commonly experience psychological symptoms, with anxiety, stress, and depression being among the most frequent. Hence, promoting a healthy lifestyle focused on women’s psychological well-being is crucial. Recently developed digital solutions have assumed a crucial role in supporting psychological well-being in physiologically pregnant women. Therefore, the need becomes evident for the development and implementation of digital solutions, such as a virtual coach implemented in a smartphone, as a support for the psychological well-being of pregnant women who do not present psychological and psychiatric disorders. Objective: This study aims to assess the feasibility, acceptability, and utility of a mindfulness-based mobile app. The primary objective is to explore the feasibility of using a virtual coach, Maia, developed within the TreC Mamma app to promote women’s psychological well-being during pregnancy through a psychoeducational module based on mindfulness. Finally, through the delivery of this module, the level of psychological well-being will be explored as a secondary objective. Methods: This is a proof-of-concept study in which a small sample (N=50) is sufficient to achieve the intended purposes. Recruitment will occur within the group of pregnant women belonging to the pregnancy care services of the Trento Azienda Provinciale per i Servizi Sanitari di Trento. The convenience sampling method will be used. Maia will interact with the participating women for 8 weeks, starting from weeks 24 and 26 of pregnancy. Specifically, there will be 2 sessions per week, which the woman can choose, to allow more flexibility toward her needs. Results: The psychoeducational pathway is expected to lead to significant results in terms of usability and engagement in women’s interactions with Maia. Furthermore, it is anticipated that there will be improvements in psychological well-being and overall quality of life. The analysis of the data collected in this study will be mainly descriptive, orientated toward assessing the achievement of the study objectives. Conclusions: Literature has shown that women preferred web-based support during the perinatal period, suggesting that implementing digital interventions can overcome barriers to social stigma and asking for help. Maia can be a valuable resource for regular psychoeducational support for women during pregnancy. International Registered Report Identifier (IRRID): RR1-10.2196/53890 
%M 38567964
%R 10.2196/53890
%U https://www.researchprotocols.org/2024/1/e53890
%U https://doi.org/10.2196/53890
%U http://www.ncbi.nlm.nih.gov/pubmed/38567964

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e52397
%T Patient and Provider Perspectives About the Use of Patient-Generated Health Data During Pregnancy: Qualitative Exploratory Study
%A MacEwan,Sarah R
%A Olvera,Ramona G
%A Jonnalagadda,Pallavi
%A Fareed,Naleef
%A McAlearney,Ann Scheck
%+ Division of General Internal Medicine, College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4100, Columbus, OH, 43202, United States, 1 614 293 0164, Sarah.MacEwan@osumc.edu
%K patient-generated health data
%K patient-centered care
%K obstetrics
%K postpartum period
%K qualitative methods
%D 2024

%7 8.5.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: There is increasing interest in using patient-generated health data (PGHD) to improve patient-centered care during pregnancy. However, little research has examined the perspectives of patients and providers as they report, collect, and use PGHD to inform obstetric care. Objective: This study aims to explore the perspectives of patients and providers about the use of PGHD during pregnancy, including the benefits and challenges of reporting, collecting, and using these data, as well as considerations for expanding the use of PGHD to improve obstetric care. Methods: We conducted one-on-one interviews with 30 pregnant or postpartum patients and 14 health care providers from 2 obstetrics clinics associated with an academic medical center. Semistructured interview guides included questions for patients about their experience and preferences for sharing PGHD and questions for providers about current processes for collecting PGHD, opportunities to improve or expand the collection of PGHD, and challenges faced when collecting and using this information. Interviews were conducted by phone or videoconference and were audio recorded, transcribed verbatim, and deidentified. Interview transcripts were analyzed deductively and inductively to characterize and explore themes in the data. Results: Patients and providers described how PGHD, including physiologic measurements and experience of symptoms, were currently collected during and between in-person clinic visits for obstetric care. Both patients and providers reported positive perceptions about the collection and use of PGHD during pregnancy. Reported benefits of collecting PGHD included the potential to use data to directly inform patient care (eg, identify issues and adjust medication) and to encourage ongoing patient involvement in their care (eg, increase patient attention to their health). Patients and providers had suggestions for expanding the collection and use of PGHD during pregnancy, and providers also shared considerations about strategies that could be used to expand PGHD collection and use. These strategies included considering the roles of both patients and providers in reporting and interpreting PGHD. Providers also noted the need to consider the unintended consequences of using PGHD that should be anticipated and addressed. Conclusions: Acknowledging the challenges, suggestions, and considerations voiced by patients and providers can inform the development and implementation of strategies to effectively collect and use PGHD to support patient-centered care during pregnancy. 
%M 38718395
%R 10.2196/52397
%U https://formative.jmir.org/2024/1/e52397
%U https://doi.org/10.2196/52397
%U http://www.ncbi.nlm.nih.gov/pubmed/38718395

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e54768
%T Social Transfers for Exclusive Breastfeeding (STEB) Intervention in Lao People’s Democratic Republic: Protocol for a Randomized Controlled Trial
%A Sonephet,Souliviengkham
%A Kounnavong,Sengchanh
%A Zinsstag,Lucienne
%A Vonaesch,Pascale
%A Sayasone,Somphou
%A Siengsounthone,Latsamy
%A Odermatt,Peter
%A Fink,Günther
%A Wallenborn,Jordyn Tinka
%+ Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, Switzerland, 41 765250183, jordyn.wallenborn@swisstph.ch
%K breastfeeding
%K lactation
%K human milk
%K breastmilk
%K child
%K infant
%K health
%K growth and development
%K cash transfer
%K incentive
%K intervention
%D 2024

%7 3.5.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Children in Lao People’s Democratic Republic (Lao PDR) receive suboptimal nutrition because of low breastfeeding rates, undermining their developmental potential. While major public health campaigns have attempted to increase breastfeeding rates, they have been largely unsuccessful. One explanation for these unsuccessful interventions is the economic and financial constraints faced by mothers. A potential solution for alleviating these pressures is providing social transfers to support breastfeeding; defined as a cash or in-kind transfer. Capitalizing on key strategies used in previous social transfer programs, we will assess the effectiveness of social transfer intervention for increasing exclusive breastfeeding rates in Vientiane, Lao PDR. Objective: This study aims to conduct a randomized controlled trial (RCT) designed to assess whether social transfers can increase exclusive breastfeeding rates in Vientiane Capital, Lao PDR. Methods: A prospective, parallel cluster-RCT was conducted among 300 mothers who recently gave birth and initiated breastfeeding. Enrolling 100 participants for each intervention arm provided us with 80% power to detect an increase in exclusive breastfeeding from the anticipated 21% in the control arm to 40% in either of the 2 intervention arms. Mother-infant dyads were enrolled at approximately 1 month post partum. Follow-up visits will occur at 6 months, 1 year, 2 years, and 3 years post partum; with the ambition to extend the follow-up period. Mother-infant dyads were enrolled between August 2022 and April 2023 with follow-up until 3 years post partum (2026). A local study team comprised of 2 nurses and 2 laboratory technicians is responsible for enrollment and follow-up of participants. Participants were randomly assigned to one of three groups during the baseline, 1-month visit: (1) control group, no social transfer; (2) intervention group 1, an unconditional social transfer at 6 months post partum; and (3) intervention group 2, a social transfer at 6 months post partum conditional upon mothers exclusively breastfeeding. All groups received educational materials supporting mothers to exclusively breastfeed. The primary end point will be exclusive breastfeeding at 6 months post partum. Secondary end points will include exclusive and complementary breastfeeding duration, childhood wasting and stunting, child growth, maternal and infant stress, predictors of early breastfeeding cessation, intestinal inflammation, anemia, maternal weight loss, maternal blood pressure, maternal anxiety, and GRIT personality score. Questionnaires and physical examinations were used to collect information. Results: As of November 2023, the study has enrolled 300 participants. Study participation is ongoing until December 2026 at minimum. Over the study lifetime, 93% have completed all visits. Conclusions: We see potential for a long-term program that may be implemented in other low- or lower-middle-income countries with only minor modifications. The RCT will be used as a basis for observational studies and to investigate the impact of human milk on child fecal microbiota and growth. Trial Registration: ClinicalTrials.gov NCT05665049; https://clinicaltrials.gov/study/NCT05665049 International Registered Report Identifier (IRRID): DERR1-10.2196/54768 
%M 38700928
%R 10.2196/54768
%U https://www.researchprotocols.org/2024/1/e54768
%U https://doi.org/10.2196/54768
%U http://www.ncbi.nlm.nih.gov/pubmed/38700928

%0 Journal Article
        
%@ 2564-1891
%I JMIR Publications
%V 4
%N 
%P e49335
%T Experiences of Women With Medical Abortion Care Reflected in Social Media (VEILLE Study): Noninterventional Retrospective Exploratory Infodemiology Study
%A Gouy,Giulia
%A Attali,Luisa
%A Voillot,Paméla
%A Fournet,Patrick
%A Agostini,Aubert
%+ Service de Gynécologie-Obstétrique, Hôpital de la Croix-Rousse, 103 Gd Rue de la Croix-Rousse, Lyon, 69004, France, 33 472 071 936, giulia.gouy@chu-lyon.fr
%K infodemiology
%K medical abortion
%K patient experience
%K real-world evidence
%K social media
%K abortion
%K women's health
%K reproduction
%K reproductive
%K obstetric
%K obstetrics
%K gynecology
%K gynecological
%K text mining
%K topic model
%K topic modeling
%K natural language processing
%K NLP
%D 2024

%7 2.5.2024
%9 Original Paper
%J JMIR Infodemiology
%G English
                
%X Background: Abortion (also known as termination of pregnancy) is an essential element of women’s reproductive health care. Feedback from women who underwent medical termination of pregnancy about their experience is crucial to help practitioners identify women’s needs and develop necessary tools to improve the abortion care process. However, the collection of this feedback is quite challenging. Social media offer anonymity for women who share their abortion experience. Objective: This exploratory infodemiology study aimed to analyze, through French social media posts, personal medical symptoms and the different experiences and information dynamics associated with the medical abortion process. Methods: A retrospective study was performed by analyzing posts geolocated in France and published from January 1, 2017, to November 30, 2021. Posts were extracted from all French-language general and specialized publicly available web forums using specific keywords. Extracted messages were cleaned and pseudonymized. Automatic natural language processing methods were used to identify posts from women having experienced medical abortion. Biterm topic modeling was used to identify the main discussion themes and the Medical Dictionary for Regulatory Activities was used to identify medical terms. Encountered difficulties were explored using qualitative research methods until the saturation of concepts was reached. Results: Analysis of 5398 identified posts (3409 users) led to the identification of 9 major topics: personal experience (n=2413 posts, 44.7%), community support (n=1058, 19.6%), pain and bleeding (n=797, 14.8%), psychological experience (n=760, 14.1%), questioned efficacy (n=410, 7.6%), social pressure (n=373, 6.9%), positive experiences (n=257, 4.8%), menstrual cycle disorders (n=107, 2%), and reported inefficacy (n=104, 1.9%). Pain, which was mentioned in 1627 (30.1%) of the 5398 posts by 1024 (30.0%) of the 3409 users, was the most frequently reported medical term. Pain was considered severe to unbearable in 24.5% of the cases (399 of the 1627 posts). Lack of information was the most frequently reported difficulty during and after the process. Conclusions: Our findings suggest that French women used social media to share their experiences, offer and find support, and provide and receive information regarding medical abortion. Infodemiology appears to be a useful tool to obtain women’s feedback, therefore offering the opportunity to enhance care in women undergoing medical abortion. 
%M 38696232
%R 10.2196/49335
%U https://infodemiology.jmir.org/2024/1/e49335
%U https://doi.org/10.2196/49335
%U http://www.ncbi.nlm.nih.gov/pubmed/38696232

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 11
%N 
%P e48218
%T Effective Communication Supported by an App for Pregnant Women: Quantitative Longitudinal Study
%A Kötting,Lukas
%A Anand-Kumar,Vinayak
%A Keller,Franziska Maria
%A Henschel,Nils Tobias
%A Lippke,Sonia
%+ Psychology and Methods, School of Business, Social & Decision Sciences, Constructor University Bremen gGmbH, Campus Ring 1, Bremen, 28759, Germany, 49 421 200 4730, s.lippke@jacobs-university.de
%K clinical care
%K health action process approach
%K HAPA
%K intention
%K communication behavior
%K patient safety
%K patient education
%K internet intervention
%K dropout
%K digital health
%K behavior change
%K prediction
%K obstetric
%K pregnant women
%K pregnancy
%K safe communication
%K health behaviors
%K obstetric care
%D 2024

%7 26.4.2024
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: In the medical field of obstetrics, communication plays a crucial role, and pregnant women, in particular, can benefit from interventions improving their self-reported communication behavior. Effective communication behavior can be understood as the correct transmission of information without misunderstanding, confusion, or losses. Although effective communication can be trained by patient education, there is limited research testing this systematically with an app-based digital intervention. Thus, little is known about the success of such a digital intervention in the form of a web-app, potential behavioral barriers for engagement, as well as the processes by which such a web-app might improve self-reported communication behavior. Objective: This study fills this research gap by applying a web-app aiming at improving pregnant women’s communication behavior in clinical care. The goals of this study were to (1) uncover the potential risk factors for early dropout from the web-app and (2) investigate the social-cognitive factors that predict self-reported communication behavior after having used the web-app. Methods: In this study, 1187 pregnant women were recruited. They all started to use a theory-based web-app focusing on intention, planning, self-efficacy, and outcome expectancy to improve communication behavior. Mechanisms of behavior change as a result of exposure to the web-app were explored using stepwise regression and path analysis. Moreover, determinants of dropout were tested using logistic regression. Results: We found that dropout was associated with younger age (P=.014). Mechanisms of behavior change were consistent with the predictions of the health action process approach. The stepwise regression analysis revealed that action planning was the best predictor for successful behavioral change over the course of the app-based digital intervention (β=.331; P<.001). The path analyses proved that self-efficacy beliefs affected the intention to communicate effectively, which in turn, elicited action planning and thereby improved communication behavior (β=.017; comparative fit index=0.994; Tucker–Lewis index=0.971; root mean square error of approximation=0.055). Conclusions: Our findings can guide the development and improvement of apps addressing communication behavior in the following ways in obstetric care. First, such tools would enable action planning to improve communication behavior, as action planning is the key predictor of behavior change. Second, younger women need more attention to keep them from dropping out. However, future research should build upon the gained insights by conducting similar internet interventions in related fields of clinical care. The focus should be on processes of behavior change and strategies to minimize dropout rates, as well as replicating the findings with patient safety measures. Trial Registration: ClinicalTrials.gov identifier: NCT03855735; https://classic.clinicaltrials.gov/ct2/show/NCT03855735 
%M 38669073
%R 10.2196/48218
%U https://humanfactors.jmir.org/2024/1/e48218
%U https://doi.org/10.2196/48218
%U http://www.ncbi.nlm.nih.gov/pubmed/38669073

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e54026
%T Detection of Urinary Misfolded Proteins for Imminent Prediction of Preeclampsia in Pregnant Women With Suspected Cases: Protocol for a Prospective Noninterventional Study
%A Tang,Haiyang
%A Tian,Yijia
%A Fang,Jing
%A Yuan,Xiaoying
%A Yao,Minli
%A Wang,Yujia
%A Feng,Yan
%A Shu,Jia
%A Ni,Yan
%A Yu,Ying
%A Wang,Yuanhe
%A Liang,Ping
%A Li,Xingmin
%A Bai,Xiaoxia
%+ Women’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Shangcheng District, Hangzhou, 310006, China, 86 57189995378, baixiaoxia@zju.edu.cn
%K preeclampsia
%K misfolded protein
%K congophilia
%K noninvasive
%K prospective
%D 2024

%7 26.4.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Preeclampsia (PE) is one of the most common hypertensive diseases, affecting 2%-8% of all pregnancies. The high maternal and fetal mortality rates of PE are due to a lack of early identification of affected pregnant women that would have led to closer monitoring and care. Recent data suggest that misfolded proteins might be a promising biomarker for PE prediction, which can be detected in urine samples of pregnant women according to their congophilia (aggregated) characteristic. Objective: The main purpose of this trial is to evaluate the value of the urine congophilia-based detection of misfolded proteins for the imminent prediction of PE in women presenting with suspected PE. The secondary objectives are to demonstrate that the presence of urine misfolded proteins correlates with PE-related maternal or neonatal adverse outcomes, and to establish an accurate PE prediction model by combining misfolded proteins with multiple indicators. Methods: At least 300 pregnant women with clinical suspicion of PE will be enrolled in this prospective cohort study. Participants should meet the following inclusion criteria in addition to a suspicion of PE: ≥18 years old, gestational week between 20+0 and 33+6, and single pregnancy. Consecutive urine samples will be collected, blinded, and tested for misfolded proteins and other PE-related biomarkers at enrollment and at 4 follow-up visits. Clinical assessments of PE status and related complications for all participants will be performed at regular intervals using strict diagnostic criteria. Investigators and participants will remain blinded to the results. Follow-up will be performed until 42 days postpartum. Data from medical records, including maternal and fetal outcomes, will be collected. The performance of urine misfolded proteins alone and combined with other biomarkers or clinical variables for the prediction of PE will be statistically analyzed. Results: Enrollment started in July 2023 and was still open upon manuscript submission. As of March 2024, a total of 251 eligible women have been enrolled in the study and enrollment is expected to continue until August 2024. Results analysis is scheduled to start after all participants reach the follow-up endpoint and complete clinical data are collected. Conclusions: Upon completion of the study, we expect to derive an accurate PE prediction model, which will allow for proactive management of pregnant women with clinical suspicion of PE and possibly reduce the associated adverse pregnancy outcomes. The additional prognostic value of misfolded proteins is also expected to be confirmed. Trial Registration: Chinese Clinical Trials Registry ChiCTR2300074878; https://www.chictr.org.cn/showproj.html?proj=202096 International Registered Report Identifier (IRRID): PRR1-10.2196/54026 
%M 38669061
%R 10.2196/54026
%U https://www.researchprotocols.org/2024/1/e54026
%U https://doi.org/10.2196/54026
%U http://www.ncbi.nlm.nih.gov/pubmed/38669061

%0 Journal Article
        
%@ 2561-1011
%I JMIR Publications
%V 8
%N 
%P e53091
%T Use of Machine Learning for Early Detection of Maternal Cardiovascular Conditions: Retrospective Study Using Electronic Health Record Data
%A Shara,Nawar
%A Mirabal-Beltran,Roxanne
%A Talmadge,Bethany
%A Falah,Noor
%A Ahmad,Maryam
%A Dempers,Ramon
%A Crovatt,Samantha
%A Eisenberg,Steven
%A Anderson,Kelley
%+ School of Nursing, Georgetown University, 3700 Reservoir Road, NW, Washington, DC, 20057, United States, 1 2026873496, rm1910@georgetown.edu
%K machine learning
%K preeclampsia
%K cardiovascular
%K maternal
%K obstetrics
%K health disparities
%K woman
%K women
%K pregnancy
%K pregnant
%K cardiovascular
%K cardiovascular condition
%K retrospective study
%K electronic health record
%K EHR
%K technology
%K decision-making
%K health disparity
%K virtual server
%K thromboembolism
%K kidney failure
%K HOPE-CAT
%D 2024

%7 22.4.2024
%9 Original Paper
%J JMIR Cardio
%G English
                
%X Background: Cardiovascular conditions (eg, cardiac and coronary conditions, hypertensive disorders of pregnancy, and cardiomyopathies) were the leading cause of maternal mortality between 2017 and 2019. The United States has the highest maternal mortality rate of any high-income nation, disproportionately impacting those who identify as non-Hispanic Black or Hispanic. Novel clinical approaches to the detection and diagnosis of cardiovascular conditions are therefore imperative. Emerging research is demonstrating that machine learning (ML) is a promising tool for detecting patients at increased risk for hypertensive disorders during pregnancy. However, additional studies are required to determine how integrating ML and big data, such as electronic health records (EHRs), can improve the identification of obstetric patients at higher risk of cardiovascular conditions. Objective: This study aimed to evaluate the capability and timing of a proprietary ML algorithm, Healthy Outcomes for all Pregnancy Experiences-Cardiovascular-Risk Assessment Technology (HOPE-CAT), to detect maternal-related cardiovascular conditions and outcomes. Methods: Retrospective data from the EHRs of a large health care system were investigated by HOPE-CAT in a virtual server environment. Deidentification of EHR data and standardization enabled HOPE-CAT to analyze data without pre-existing biases. The ML algorithm assessed risk factors selected by clinical experts in cardio-obstetrics, and the algorithm was iteratively trained using relevant literature and current standards of risk identification. After refinement of the algorithm’s learned risk factors, risk profiles were generated for every patient including a designation of standard versus high risk. The profiles were individually paired with clinical outcomes pertaining to cardiovascular pregnancy conditions and complications, wherein a delta was calculated between the date of the risk profile and the actual diagnosis or intervention in the EHR. Results: In total, 604 pregnancies resulting in birth had records or diagnoses that could be compared against the risk profile; the majority of patients identified as Black (n=482, 79.8%) and aged between 21 and 34 years (n=509, 84.4%). Preeclampsia (n=547, 90.6%) was the most common condition, followed by thromboembolism (n=16, 2.7%) and acute kidney disease or failure (n=13, 2.2%). The average delta was 56.8 (SD 69.7) days between the identification of risk factors by HOPE-CAT and the first date of diagnosis or intervention of a related condition reported in the EHR. HOPE-CAT showed the strongest performance in early risk detection of myocardial infarction at a delta of 65.7 (SD 81.4) days. Conclusions: This study provides additional evidence to support ML in obstetrical patients to enhance the early detection of cardiovascular conditions during pregnancy. ML can synthesize multiday patient presentations to enhance provider decision-making and potentially reduce maternal health disparities. 
%M 38648629
%R 10.2196/53091
%U https://cardio.jmir.org/2024/1/e53091
%U https://doi.org/10.2196/53091
%U http://www.ncbi.nlm.nih.gov/pubmed/38648629

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 11
%N 
%P e53614
%T Stimulating Preconception Care Uptake by Women With a Vulnerable Health Status Through a Mobile Health App (Pregnant Faster): Pilot Feasibility Study
%A Smith,Sharissa M
%A Bais,Babette
%A Ismaili M'hamdi,Hafez
%A Schermer,Maartje HN
%A Steegers-Theunissen,Régine PM
%+ Department of Obstetrics and Gynecology, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam, 3015 CD, Netherlands, 31 10704 ext 0704, r.steegers@erasmusmc.nl
%K preconception care
%K mHealth
%K mobile health
%K pregnancy preparation
%K nudge
%K health inequality
%K socioeconomic status
%K lifestyle
%K women
%K pregnancy
%K pregnant women
%K pregnant
%K socioeconomic
%K pilot feasibility study
%K mHealth app
%K mHealth application
%K app
%K application
%K risk factor
%K nutrition
%K stress
%K chronic stress
%K health literacy
%K usability
%K user satisfaction
%K user
%K users
%D 2024

%7 22.4.2024
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: A low socioeconomic status is associated with a vulnerable health status (VHS) through the accumulation of health-related risk factors, such as poor lifestyle behaviors (eg, inadequate nutrition, chronic stress, and impaired health literacy). For pregnant women, a VHS translates into a high incidence of adverse pregnancy outcomes and therefore pregnancy-related inequity. We hypothesize that stimulating adequate pregnancy preparation, targeting lifestyle behaviors and preconception care (PCC) uptake, can reduce these inequities and improve the pregnancy outcomes of women with a VHS. A nudge is a behavioral intervention aimed at making healthy choices easier and more attractive and may therefore be a feasible way to stimulate engagement in pregnancy preparation and PCC uptake, especially in women with a VHS. To support adequate pregnancy preparation, we designed a mobile health (mHealth) app, Pregnant Faster, that fits the preferences of women with a VHS and uses nudging to encourage PCC consultation visits and engagement in education on healthy lifestyle behaviors. Objective: This study aimed to test the feasibility of Pregnant Faster by determining usability and user satisfaction, the number of visited PCC consultations, and the course of practical study conduction. Methods: Women aged 18-45 years, with low-to-intermediate educational attainment, who were trying to become pregnant within 12 months were included in this open cohort. Recruitment took place through social media, health care professionals, and distribution of flyers and posters from September 2021 until June 2022. Participants used Pregnant Faster daily for 4 weeks, earning coins by reading blogs on pregnancy preparation, filling out a daily questionnaire on healthy lifestyle choices, and registering for a PCC consultation with a midwife. Earned coins could be spent on rewards, such as fruit, mascara, and baby products. Evaluation took place through the mHealth App Usability Questionnaire (MAUQ), an additional interview or questionnaire, and assessment of overall study conduction. Results: Due to limited inclusions, the inclusion criterion “living in a deprived neighborhood” was dropped. This resulted in the inclusion of 47 women, of whom 39 (83%) completed the intervention. In total, 16 (41%) of 39 participants visited a PCC consultation, with their main motivation being obtaining personalized information. The majority of participants agreed with 16 (88.9%) of 18 statements of the MAUQ, indicating high user satisfaction. The mean rating was 7.7 (SD 1.0) out of 10. Points of improvement included recruitment of the target group, simplification of the log-in system, and automation of manual tasks. Conclusions: Nudging women through Pregnant Faster to stimulate pregnancy preparation and PCC uptake has proven feasible, but the inclusion criteria must be revised. A substantial number of PCC consultations were conducted, and this study will therefore be continued with an open cohort of 400 women, aiming to establish the (cost-)effectiveness of an updated version, named Pregnant Faster 2. International Registered Report Identifier (IRRID): RR2-10.2196/45293 
%M 38648092
%R 10.2196/53614
%U https://humanfactors.jmir.org/2024/1/e53614
%U https://doi.org/10.2196/53614
%U http://www.ncbi.nlm.nih.gov/pubmed/38648092

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e52456
%T Mutual Associations of Exposure to Ambient Air Pollutants in the First 1000 Days of Life With Asthma/Wheezing in Children: Prospective Cohort Study in Guangzhou, China
%A Tian,Fenglin
%A Zhong,Xinqi
%A Ye,Yufeng
%A Liu,Xiaohan
%A He,Guanhao
%A Wu,Cuiling
%A Chen,Zhiqing
%A Zhu,Qijiong
%A Yu,Siwen
%A Fan,Jingjie
%A Yao,Huan
%A Ma,Wenjun
%A Dong,Xiaomei
%A Liu,Tao
%+ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Number 601, West Huangpu Avenue, Guangzhou, 510632, Guangdong, China, 86 18927588462, gztt_2002@163.com
%K pregnancy
%K air pollution
%K asthma
%K wheezing
%K birth cohort
%K children
%D 2024

%7 17.4.2024
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: The first 1000 days of life, encompassing pregnancy and the first 2 years after birth, represent a critical period for human health development. Despite this significance, there has been limited research into the associations between mixed exposure to air pollutants during this period and the development of asthma/wheezing in children. Furthermore, the finer sensitivity window of exposure during this crucial developmental phase remains unclear. Objective: This study aims to assess the relationships between prenatal and postnatal exposures to various ambient air pollutants (particulate matter 2.5 [PM2.5], carbon monoxide [CO], sulfur dioxide [SO2], nitrogen dioxide [NO2], and ozone [O3]) and the incidence of childhood asthma/wheezing. In addition, we aimed to pinpoint the potential sensitivity window during which air pollution exerts its effects. Methods: We conducted a prospective birth cohort study wherein pregnant women were recruited during early pregnancy and followed up along with their children. Information regarding maternal and child characteristics was collected through questionnaires during each round of investigation. Diagnosis of asthma/wheezing was obtained from children’s medical records. In addition, maternal and child exposures to air pollutants (PM2.5 CO, SO2, NO2, and O3) were evaluated using a spatiotemporal land use regression model. To estimate the mutual associations of exposure to mixed air pollutants with the risk of asthma/wheezing in children, we used the quantile g-computation model. Results: In our study cohort of 3725 children, 392 (10.52%) were diagnosed with asthma/wheezing. After the follow-up period, the mean age of the children was 3.2 (SD 0.8) years, and a total of 14,982 person-years were successfully followed up for all study participants. We found that each quartile increase in exposure to mixed air pollutants (PM2.5, CO, SO2, NO2, and O3) during the second trimester of pregnancy was associated with an adjusted hazard ratio (HR) of 1.24 (95% CI 1.04-1.47). Notably, CO made the largest positive contribution (64.28%) to the mutual effect. After categorizing the exposure according to the embryonic respiratory development stages, we observed that each additional quartile of mixed exposure to air pollutants during the pseudoglandular and canalicular stages was associated with HRs of 1.24 (95% CI 1.03-1.51) and 1.23 (95% CI 1.01-1.51), respectively. Moreover, for the first year and first 2 years after birth, each quartile increment of exposure to mixed air pollutants was associated with HRs of 1.65 (95% CI 1.30-2.10) and 2.53 (95% CI 2.16-2.97), respectively. Notably, SO2 made the largest positive contribution in both phases, accounting for 50.30% and 74.70% of the association, respectively. Conclusions: Exposure to elevated levels of mixed air pollutants during the first 1000 days of life appears to elevate the risk of childhood asthma/wheezing. Specifically, the second trimester, especially during the pseudoglandular and canalicular stages, and the initial 2 years after birth emerge as crucial susceptibility windows. Trial Registration: Chinese Clinical Trial Registry ChiCTR-ROC-17013496; https://tinyurl.com/2ctufw8n 
%M 38631029
%R 10.2196/52456
%U https://publichealth.jmir.org/2024/1/e52456
%U https://doi.org/10.2196/52456
%U http://www.ncbi.nlm.nih.gov/pubmed/38631029

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e47396
%T Preeclampsia Onset, Days to Delivery, and Autism Spectrum Disorders in Offspring: Clinical Birth Cohort Study
%A Carter,Sarah
%A Lin,Jane C
%A Chow,Ting
%A Martinez,Mayra P
%A Qiu,Chunyuan
%A Feldman,R Klara
%A McConnell,Rob
%A Xiang,Anny H
%+ Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA, 91101, United States, 1 626 564 3966, Anny.H.Xiang@kp.org
%K autism spectrum disorders
%K autism
%K clinical management
%K diagnosis
%K expectant management
%K fetal exposure
%K fetal
%K management
%K preeclampsia
%K pregnancy
%K pregnant women
%K risk
%D 2024

%7 17.4.2024
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Maternal preeclampsia is associated with a risk of autism spectrum disorders (ASD) in offspring. However, it is unknown whether the increased ASD risk associated with preeclampsia is due to preeclampsia onset or clinical management of preeclampsia after onset, as clinical expectant management of preeclampsia allows pregnant women with this complication to remain pregnant for potentially weeks depending on the onset and severity. Identifying the risk associated with preeclampsia onset and exposure provides evidence to support the care of high-risk pregnancies and reduce adverse effects on offspring. Objective: This study aimed to fill the knowledge gap by assessing the ASD risk in children associated with the gestational age of preeclampsia onset and the number of days from preeclampsia onset to delivery. Methods: This retrospective population-based clinical cohort study included 364,588 mother-child pairs of singleton births between 2001 and 2014 in a large integrated health care system in Southern California. Maternal social demographic and pregnancy health data, as well as ASD diagnosis in children by the age of 5 years, were extracted from electronic medical records. Cox regression models were used to assess hazard ratios (HRs) of ASD risk in children associated with gestational age of the first occurrence of preeclampsia and the number of days from first occurrence to delivery. Results: Preeclampsia occurred in 16,205 (4.4%) out of 364,588 pregnancies; among the 16,205 pregnancies, 2727 (16.8%) first occurred at <34 weeks gestation, 4466 (27.6%) first occurred between 34 and 37 weeks, and 9012 (55.6%) first occurred at ≥37 weeks. Median days from preeclampsia onset to delivery were 4 (IQR 2,16) days, 1 (IQR 1,3) day, and 1 (IQR 0,1) day for those first occurring at <34, 34-37, and ≥37 weeks, respectively. Early preeclampsia onset was associated with greater ASD risk (P=.003); HRs were 1.62 (95% CI 1.33-1.98), 1.43 (95% CI 1.20-1.69), and 1.23 (95% CI 1.08-1.41), respectively, for onset at <34, 34-37, and ≥37 weeks, relative to the unexposed group. Within the preeclampsia group, the number of days from preeclampsia onset to delivery was not associated with ASD risk in children; the HR was 0.995 (95% CI 0.986-1.004) after adjusting for gestational age of preeclampsia onset. Conclusions: Preeclampsia during pregnancy was associated with ASD risk in children, and the risk was greater with earlier onset. However, the number of days from first preeclampsia onset to delivery was not associated with ASD risk in children. Our study suggests that ASD risk in children associated with preeclampsia is not increased by expectant management of preeclampsia in standard clinical practice. Our results emphasize the need to identify effective approaches to preventing the onset of preeclampsia, especially during early pregnancy. Further research is needed to confirm if this finding applies across different populations and clinical settings. 
%M 38630528
%R 10.2196/47396
%U https://publichealth.jmir.org/2024/1/e47396
%U https://doi.org/10.2196/47396
%U http://www.ncbi.nlm.nih.gov/pubmed/38630528

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e48793
%T User-Centered Development of a Patient Decision Aid for Choice of Early Abortion Method: Multi-Cycle Mixed Methods Study
%A Wahl,Kate J
%A Brooks,Melissa
%A Trenaman,Logan
%A Desjardins-Lorimer,Kirsten
%A Bell,Carolyn M
%A Chokmorova,Nazgul
%A Segall,Romy
%A Syring,Janelle
%A Williams,Aleyah
%A Li,Linda C
%A Norman,Wendy V
%A Munro,Sarah
%+ Department of Obstetrics and Gynecology, University of British Columbia, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada, 1 4165231923, kate.wahl@cw.bc.ca
%K family planning
%K abortion
%K shared decision-making
%K patient decision aid
%K qualitative
%K evaluation
%K Canada
%K health equity
%D 2024

%7 16.4.2024
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive—there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people in making informed, values-aligned health care choices. Objective: We aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction. Methods: We used a systematic, user-centered design approach guided by principles of integrated knowledge translation. We first developed a prototype using available evidence for abortion seekers’ decisional needs and the risks, benefits, and consequences of each option. We then refined the prototype through think-aloud interviews with participants at risk of unintended pregnancy (“patient” participants). Interviews were audio-recorded and documented through field notes. Finally, we conducted a web-based survey of patients and health care professionals involved with abortion care, which included the System Usability Scale. We used content analysis to identify usability issues described in the field notes and open-ended survey questions, and descriptive statistics to summarize participant characteristics and close-ended survey responses. Results: A total of 61 individuals participated in this study. Further, 11 patients participated in think-aloud interviews. Overall, the response to the PtDA was positive; however, the content analysis identified issues related to the design, language, and information about the process and experience of obtaining abortion care. In response, we adapted the PtDA into an interactive website and revised it to include consistent and plain language, additional information (eg, pain experience narratives), and links to additional resources on how to find an abortion health care professional. In total, 25 patients and 25 health care professionals completed the survey. The mean System Usability Scale score met the threshold for good usability among both patient and health care professional participants. Most participants felt that the PtDA was user-friendly (patients: n=25, 100%; health care professionals: n=22, 88%), was not missing information (patients: n=21, 84%; health care professionals: n=18, 72%), and that it was appropriate for patients to complete the PtDA before a consultation (patients: n=23, 92%; health care professionals: n=23, 92%). Open-ended responses focused on improving usability by reducing the length of the PtDA and making the website more mobile-friendly. Conclusions: We systematically designed the PtDA to address an unmet need to support informed, values-aligned decision-making about the method of abortion. The design process responded to a need identified by potential users and addressed unique sensitivities related to reproductive health decision-making. 
%M 38625731
%R 10.2196/48793
%U https://www.jmir.org/2024/1/e48793
%U https://doi.org/10.2196/48793
%U http://www.ncbi.nlm.nih.gov/pubmed/38625731

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e54109
%T Fast Healthcare Interoperability Resources–Based Support System for Predicting Delivery Type: Model Development and Evaluation Study
%A Coutinho-Almeida,João
%A Cardoso,Alexandrina
%A Cruz-Correia,Ricardo
%A Pereira-Rodrigues,Pedro
%+ Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, Porto, 4200-319, Portugal, 351 225513600, joaofilipe90@gmail.com
%K obstetrics
%K machine-learning
%K clinical decision support
%K interoperability
%K interoperable
%K obstetric
%K cesarean delivery
%K cesarean
%K cesarean deliveries
%K decision support
%K pregnant
%K pregnancy
%K maternal
%K algorithm
%K algorithms
%K simulation
%K simulations
%D 2024

%7 8.4.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The escalating prevalence of cesarean delivery globally poses significant health impacts on mothers and newborns. Despite this trend, the underlying reasons for increased cesarean delivery rates, which have risen to 36.3% in Portugal as of 2020, remain unclear. This study delves into these issues within the Portuguese health care context, where national efforts are underway to reduce cesarean delivery occurrences. Objective: This paper aims to introduce a machine learning, algorithm-based support system designed to assist clinical teams in identifying potentially unnecessary cesarean deliveries. Key objectives include developing clinical decision support systems for cesarean deliveries using interoperability standards, identifying predictive factors influencing delivery type, assessing the economic impact of implementing this tool, and comparing system outputs with clinicians’ decisions. Methods: This study used retrospective data collected from 9 public Portuguese hospitals, encompassing maternal and fetal data and delivery methods from 2019 to 2020. We used various machine learning algorithms for model development, with light gradient-boosting machine (LightGBM) selected for deployment due to its efficiency. The model’s performance was compared with clinician assessments through questionnaires. Additionally, an economic simulation was conducted to evaluate the financial impact on Portuguese public hospitals. Results: The deployed model, based on LightGBM, achieved an area under the receiver operating characteristic curve of 88%. In the trial deployment phase at a single hospital, 3.8% (123/3231) of cases triggered alarms for potentially unnecessary cesarean deliveries. Financial simulation results indicated potential benefits for 30% (15/48) of Portuguese public hospitals with the implementation of our tool. However, this study acknowledges biases in the model, such as combining different vaginal delivery types and focusing on potentially unwarranted cesarean deliveries. Conclusions: This study presents a promising system capable of identifying potentially incorrect cesarean delivery decisions, with potentially positive implications for medical practice and health care economics. However, it also highlights the challenges and considerations necessary for real-world application, including further evaluation of clinical decision-making impacts and understanding the diverse reasons behind delivery type choices. This study underscores the need for careful implementation and further robust analysis to realize the full potential and real-world applicability of such clinical support systems. 
%M 38587885
%R 10.2196/54109
%U https://formative.jmir.org/2024/1/e54109
%U https://doi.org/10.2196/54109
%U http://www.ncbi.nlm.nih.gov/pubmed/38587885

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 7
%N 
%P e54788
%T Internet-Based Interventions for Preventing Premature Birth Among Pregnant Women: Systematic Review
%A Kim,Sun-Hee
%A Park,Jin-Hwa
%A Jung,Sun-Young
%A De Gagne,Jennie C
%+ College of Nursing, Research Institute of Nursing Science, Daegu Catholic University, Duryugongwon-ro 17-gil 33, Nam-gu, Daegu, 42472, Republic of Korea, 82 53 650 4977, syjung@cu.ac.kr
%K anxiety
%K body weight
%K depression
%K gestational diabetes mellitus
%K high-risk behavior
%K internet-based interventions
%K neonatal outcomes
%K pregnancy
%K premature birth
%K pregnancy outcomes
%K stress
%K systematic review
%D 2024

%7 2.4.2024
%9 Review
%J JMIR Pediatr Parent
%G English
                
%X Background: Premature birth rates have slightly increased globally, making its prevention critical for both short-term and long-term health outcomes. Various interventions have been developed in response to the multifaceted risk factors for premature birth, including internet-based programs. These programs offer accessibility and enhanced engagement; however, their overall efficacy in preventing premature births requires thorough evaluation. Objective: This systematic review aims to identify the study designs and assess the effectiveness of internet-based interventions in preventing premature birth among pregnant women. Methods: A comprehensive search of the MEDLINE, Embase, CINAHL, and Cochrane Library databases 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 (RoB) in each study was independently assessed by 3 authors forming pairs, using the revised Cochrane RoB tool (RoB 2) for randomized trials, as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Owing to heterogeneity in populations, measurements, and interventions, a meta-analysis was not conducted. Results: This review included 26 articles, comprising 12 intention-to-treat and 14 per-protocol studies. The overall RoB was high in most intention-to-treat studies and of some concern in most per-protocol studies. The target populations varied, including nonspecific pregnant women, those with gestational diabetes mellitus (GDM) or those at risk of GDM, individuals with anxiety or depression, and those experiencing preterm labor. Psychosocial, physiological, and wellness health outcomes were evaluated. Internet-based interventions effectively reduced stress/distress in nonspecific 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 levels but did not consistently manage glycated hemoglobin levels. These interventions did not reduce the incidence of premature births across the various populations studied. The effectiveness of these internet-based interventions in addressing substance or alcohol abuse and insomnia also varied. Conclusions: Internet-based interventions show promise in improving psychosocial health and managing blood sugar to prevent premature birth, highlighting variability in effectiveness across different risk factors. Further research, including clinical trials, is vital for developing, evaluating, and disseminating effective, safe internet-based interventions. Establishing standardized measurement tools and rigorous evaluation processes is crucial for enhancing these interventions’ effectiveness and reliability in clinical practice, significantly contributing to preventing premature births and improving maternal health outcomes. Trial Registration: PROSPERO CRD42021278847; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021278847 
%M 38564247
%R 10.2196/54788
%U https://pediatrics.jmir.org/2024/1/e54788
%U https://doi.org/10.2196/54788
%U http://www.ncbi.nlm.nih.gov/pubmed/38564247

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e55701
%T Comparison of Spontaneous Pushing and Directed Pushing During the Second Stage of Labor Among Chinese Women Without Epidural Analgesia: Protocol for a Noninferior Feasibility Study
%A Yao,Jiasi
%A Roth,Heike
%A Anderson,Debra
%A Lu,Hong
%A Rong,Huijuan
%A Baird,Kathleen
%+ Faculty of Health, University of Technology Sydney, 235 Jones Street, Ultimo, Sydney, 2007, Australia, 61 0415 786 708, jiasi.yao@student.uts.edu.au
%K spontaneous pushing
%K directed pushing
%K labour stage, labour
%K labor
%K obstetric
%K obstetrics
%K child
%K birth
%K delivery
%K second
%K feasibility study
%K China
%K Chinese
%K women
%K protocol
%K maternal-neonatal outcomes
%K maternal
%K healthcare
%K labouring women
%K cohort
%K effectiveness
%K Midwives
%K midwife
%K midwifery
%K childbirth
%D 2024

%7 26.3.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Maternal pushing during the second stage of labor could influence labor progress and maternal-neonatal outcomes. Although the image of health care providers directing the laboring women to push during the second stage of labor could be commonly observed globally, this practice is not sufficiently researched and is questioned regarding its effectiveness and outcomes on the mother and baby. Meanwhile, a strategy referred to as “spontaneous pushing,” which supports women to push by following their bodily urges, has been evaluated in several trials. However, in China, spontaneous pushing is not common practice. Notwithstanding the evaluation of spontaneous pushing, there is a lack of high-quality evidence to support either strategies of directed pushing or spontaneous pushing. Objective: This study aims to test the feasibility of a future randomized controlled trial to compare the effects of spontaneous pushing and directed pushing during the second stage of labor for maternal and neonatal outcomes in China. Methods: A nonrandomized, single-group, noninferiority feasibility study will be conducted in a public hospital in Hebei Province, China. In total, 105 women meeting the selection criteria will be recruited to receive the intervention (spontaneous pushing), while 105 sets of medical notes from women who received routine care (directed pushing) will be identified and reviewed to compare outcomes for both cohorts. A mixed methods approach will be used to assess primary outcomes (feasibility and acceptability) and secondary outcomes (effectiveness). Results: Data collection took place between May and October 2023. A total of 110 women were invited to participate in the intervention of spontaneous pushing. Midwives’ interviews were conducted and will be transcribed for analysis in March 2024. The data analysis is planned to be completed by May 2024. Conclusions: This feasibility study will provide important information by conducting a full-scale clinical trial in the future as well as the potential facilitators and barriers of it. A future randomized controlled trial is likely to have considerable policy and funding impacts regarding pushing management during the second stage of labor and improvement in women’s childbirth experience. Trial Registration: Chinese Clinical Trial Register ChiCTR2300071178; https://tinyurl.com/mudtnbft International Registered Report Identifier (IRRID): DERR1-10.2196/55701 
%M 38530330
%R 10.2196/55701
%U https://www.researchprotocols.org/2024/1/e55701
%U https://doi.org/10.2196/55701
%U http://www.ncbi.nlm.nih.gov/pubmed/38530330

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e53722
%T Vitamin D Deficiency and Its Association With Vitamin D Receptor Gene Variants Among Malaysian Women With Hypertensive Disorders in Pregnancy: Protocol for a Nutrigenomics Study
%A Ibrahim,Yakubu
%A Basri,Nurul Iftida
%A Nordin,Norshariza
%A Mohd Jamil,Amilia Afzan
%+ Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, 43400, Malaysia, 60 0397699339, nurul.iftida@upm.edu.my
%K gestational hypertension
%K preeclampsia
%K hypertensive disorder
%K vitamin D deficiency
%K vitamin D receptor gene polymorphism
%K vitamin D sequence
%D 2024

%7 26.3.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Vitamin D deficiency has been associated with hypertensive disorders in pregnancy (HDP). The risk of developing HDP was reported to be further augmented among individuals with a vitamin D receptor (VDR) genetic variant. However, the reported roles of VDR variants in hypertensive disorders are inconsistent among different populations. Given the relatively higher incidence of vitamin D deficiency among Malaysian pregnant women and the high incidence of HDP in this population, we hypothesize that there may be associations between the risk of vitamin D deficiency and HDP with VDR genetic variants. Objective: This paper outlines the protocol for a study to determine the association of vitamin D status and VDR sequence variants among Malaysian pregnant women with HDP. Methods: This prospective study consists of two phases. The first phase is a cross-sectional study that will entail gathering medical records, a questionnaire survey, and laboratory testing for vitamin D status, with a planned recruitment of 414 pregnant women. The questionnaire will be utilized to assess the risk factors for vitamin D deficiency. The vitamin D status will be obtained from measurement of the vitamin D (25-hydroxyvitamin D3) level in the blood. The second phase is a case-control study involving a Malay ethnic cohort with vitamin D deficiency. Participants will be divided into two groups with and without HDP (n=150 per group). Genomic DNA will be extracted from the peripheral blood monocytes of participants using the Qiagen DNA blood kit, and VDR sequence variants will be determined using polymerase chain reaction–high-resolution melting (PCR-HRM) analysis. Sanger sequencing will then be used to sequence randomly selected samples corresponding to each identified variant to validate our PCR-HRM results. The VDR genotype and mutation frequencies of BsmI, ApaI, TaqI, and FokI will be statistically analyzed to evaluate their relationships with developing HDP. Results: As of December 2023, 340 subjects have been recruited for the phase 1 study, 63% of whom were determined to have vitamin D deficiency. In the phase 2 study, 50 and 22 subjects have been recruited from the control and case groups, respectively. Recruitment is expected to be completed by March 2024 and all analyses should be completed by August 2024. Conclusions: The outcome of the study will identify the nonmodifiable genetic components contributing to developing vitamin D deficiency leading to HDP. This will in turn enable gaining a better understanding of the contribution of genetic variability to the development of HDP, thus providing more evidence for a need of customized vitamin D supplementation during pregnancy according to the individual variability in the response to vitamin D intake. Trial Registration: ClinicalTrials.gov NCT05659173; https://clinicaltrials.gov/study/NCT05659173 International Registered Report Identifier (IRRID): DERR1-10.2196/53722 
%M 38530345
%R 10.2196/53722
%U https://www.researchprotocols.org/2024/1/e53722
%U https://doi.org/10.2196/53722
%U http://www.ncbi.nlm.nih.gov/pubmed/38530345

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e48493
%T Mitigating Health-Related Uncertainties During Pregnancy: The Role of Smart Health Monitoring Technologies
%A Tretter,Max
%+ Chair of Systematic Theology (Ethics), Seminar for Systematic Theology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kochstr 6, Erlangen, 91054, Germany, 49 9131 85 26078, max.tretter@fau.de
%K stress
%K anxiety
%K reproductive technologies
%K fetal health
%K epistemology
%K ethics
%D 2024

%7 25.3.2024
%9 Viewpoint
%J J Med Internet Res
%G English
                
%X Pregnancy is a time filled with uncertainties, which can be challenging and lead to fear or anxiety for expectant parents. Health monitoring technologies that allow monitoring of the vital signs of both the mother and fetus offer a way to address health-related uncertainties. But are smart health monitoring technologies (SHMTs) actually an effective means to reduce uncertainties during pregnancy, or do they have the opposite effect? Using conceptual reasoning and phenomenological approaches grounded in existing literature, this Viewpoint explores the effects of SHMTs on health-related uncertainties during pregnancy. The argument posits that while SHMTs can alleviate some health-related uncertainties, they may also create new ones. This is particularly the case when the abundance of vital data overwhelms pregnant persons, leads to false-positive diagnoses, or raises concerns about the accuracy and analysis of data. Consequently, it is concluded that the use of SHMTs is not a cure-all for overcoming health-related uncertainties during pregnancy. Since the use of such monitoring technologies can introduce new uncertainties, it is important to carefully consider where and for what purpose they are used, use them sparingly, and promote a pragmatic approach to uncertainties.Using conceptual reasoning and phenomenological approaches grounded in existing literature, the effects of SHMTs on health-related uncertainties during pregnancy are explored. The argument posits that while SHMTs can alleviate some health-related uncertainties, they may also create new ones. This is particularly the case when the abundance of vital data overwhelms pregnant persons, leads to false-positive diagnoses, or raises concerns about the accuracy and analysis of data.
Consequently, it is concluded that the use of SHMTs is not a cure-all for overcoming health-related uncertainties during pregnancy. Since the use of such monitoring technologies can introduce new uncertainties, it is important to carefully consider where and for what purpose they are used, use them sparingly, and promote a pragmatic approach to uncertainties.
%M 38526554
%R 10.2196/48493
%U https://www.jmir.org/2024/1/e48493
%U https://doi.org/10.2196/48493
%U http://www.ncbi.nlm.nih.gov/pubmed/38526554

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e52583
%T Tailoring of Health-Promotion Video Messaging for Reproductive-Aged Women at Risk for Developing Cardiometabolic Disease: Qualitative Focus-Groups Study
%A Kent-Marvick,Jacqueline
%A Gibson,Bryan
%A Bristol,Alycia A
%A St Clair,Stephanie
%A Simonsen,Sara E
%+ College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, United States, 1 4356686932, jacqueline.kent-marvick@utah.edu
%K cardiometabolic disease
%K type 2 diabetes mellitus
%K gestational diabetes mellitus
%K hypertensive disorder of pregnancy
%K prediabetes
%K obesity
%K women’s health
%K lifestyle change
%K health promotion technology
%K qualitative research
%D 2024

%7 5.3.2024
%9 Short Paper
%J JMIR Form Res
%G English
                
%X Background: Targeting reproductive-aged women at high risk for type 2 diabetes (T2D) provides an opportunity for prevention earlier in the life course. A woman’s experiences during her reproductive years may have a large impact on her future risk of T2D. Her risk is 7 to 10 times higher if she has had gestational diabetes (GDM). Despite these risks, T2D is preventable. Evidence-based programs, such as the National Diabetes Prevention Program (DPP), can reduce the risk of developing T2D by nearly 60%. However, only 0.4% of adults with prediabetes have participated in the DPP to date and reproductive-aged women are 50% less likely to participate than older women. In prior work, our team developed a mobile 360° video to address diabetes risk awareness and promote DPP enrollment among at-risk adults; this video was not designed, however, for reproductive-aged women. Objective: This study aims to obtain feedback from reproductive-aged women with cardiometabolic disease risk about a 360° video designed to promote enrollment in the DPP, and to gather suggestions about tailoring video messages to reproductive-aged women. Methods: Focus groups and a qualitative descriptive approach were used. Women with at least 1 previous pregnancy, aged 18 to 40 years, participated in one of three focus groups stratified by the following health risks: (1) a history of GDM or a hypertensive disorder of pregnancy, (2) a diagnosis of prediabetes, or (3) a BMI classified as obese. Focus-group questions addressed several topics; this report shared findings regarding video feedback. The 3 focus-group discussions were conducted via Zoom and were recorded and transcribed for analysis. Deductive codes were used to identify concepts related to the research question and inductive codes were created for novel insights shared by participants. The codes were then organized into categories and themes. Results: The main themes identified were positive feedback, negative feedback, centering motherhood, and the importance of storytelling. While some participants said the video produced a sense of urgency for health-behavior change, all participants agreed that design changes could improve the video’s motivating effect on health-behavior change in reproductive-aged women. Participants felt a tailored video should recognize the complexities of being a mother and how these dynamics contribute to women’s difficulty engaging in healthy behaviors without stirring feelings of guilt. Women desired a video with a positive, problem-solving perspective, and recommended live links as clickable resources for practical solutions promoting health behavior change. Women suggested using storytelling, both to describe how complications experienced during pregnancy impact long-term health and to motivate health behavior change. Conclusions: Reproductive-aged women require tailored lifestyle-change messaging that addresses barriers commonly encountered by this population (eg, parenting or work responsibilities). Moreover, messaging should prioritize a positive tone that harnesses storytelling and human connection while offering realistic solutions. 
%M 38441920
%R 10.2196/52583
%U https://formative.jmir.org/2024/1/e52583
%U https://doi.org/10.2196/52583
%U http://www.ncbi.nlm.nih.gov/pubmed/38441920

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e53170
%T Mediating Effect of Tobacco Dependence on the Association Between Maternal Smoking During Pregnancy and Chronic Obstructive Pulmonary Disease: Case-Control Study
%A Li,Jinxuan
%A Xu,Jianying
%A Yang,Lan
%A Xu,Yongjian
%A Zhang,Xiangyan
%A Bai,Chunxue
%A Kang,Jian
%A Ran,Pixin
%A Shen,Huahao
%A Wen,Fuqiang
%A Huang,Kewu
%A Yao,Wanzhen
%A Sun,Tieying
%A Shan,Guangliang
%A Yang,Ting
%A Lin,Yingxiang
%A Zhu,Jianguo
%A Wang,Ruiying
%A Shi,Zhihong
%A Zhao,Jianping
%A Ye,Xianwei
%A Song,Yuanlin
%A Wang,Qiuyue
%A Hou,Gang
%A Zhou,Yumin
%A Li,Wen
%A Ding,Liren
%A Wang,Hao
%A Chen,Yahong
%A Guo,Yanfei
%A Xiao,Fei
%A Lu,Yong
%A Peng,Xiaoxia
%A Zhang,Biao
%A Wang,Zuomin
%A Zhang,Hong
%A Bu,Xiaoning
%A Zhang,Xiaolei
%A An,Li
%A Zhang,Shu
%A Cao,Zhixin
%A Zhan,Qingyuan
%A Yang,Yuanhua
%A Liang,Lirong
%A Cao,Bin
%A Dai,Huaping
%A Chung,Kian Fan
%A Chen,Zhengming
%A He,Jiang
%A Wu,Sinan
%A Xiao,Dan
%A Wang,Chen
%A ,
%+ Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Yinghua Street, Beijing, 100029, China, 86 010 8420 5425, danxiao@263.net
%K chronic obstructive pulmonary disease
%K tobacco dependence
%K smoking
%K mediating effects
%K lung function
%D 2024

%7 22.2.2024
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Maternal smoking during pregnancy (MSDP) is a known risk factor for offspring developing chronic obstructive pulmonary disease (COPD), but the underlying mechanism remains unclear. Objective: This study aimed to explore whether the increased COPD risk associated with MSDP could be attributed to tobacco dependence (TD). Methods: This case-control study used data from the nationwide cross-sectional China Pulmonary Health study, with controls matched for age, sex, and smoking status. TD was defined as smoking within 30 minutes of waking, and the severity of TD was assessed using the Fagerstrom Test for Nicotine Dependence. COPD was diagnosed when the ratio of forced expiratory volume in 1 second to forced vital capacity was <0.7 in a postbronchodilator pulmonary function test according to the 2017 Global Initiative for Chronic Obstructive Lung Disease criteria. Logistic regression was used to examine the correlation between MSDP and COPD, adjusting for age, sex, BMI, educational attainment, place of residence, ethnic background, occupation, childhood passive smoking, residential fine particulate matter, history of childhood pneumonia or bronchitis, average annual household income, and medical history (coronary heart disease, hypertension, and diabetes). Mediation analysis examined TD as a potential mediator in the link between MSDP and COPD risk. The significance of the indirect effect was assessed through 1000 iterations of the “bootstrap” method. Results: The study included 5943 participants (2991 with COPD and 2952 controls). Mothers of the COPD group had higher pregnancy smoking rates (COPD: n=305, 10.20%; controls: n=211, 7.10%; P<.001). TD was more prevalent in the COPD group (COPD: n=582, 40.40%; controls: n=478, 33.90%; P<.001). After adjusting for covariates, MSDP had a significant effect on COPD (β=.097; P<.001). There was an association between MSDP and TD (β=.074; P<.001) as well as between TD and COPD (β=.048; P=.007). Mediation analysis of TD in the MSDP-COPD association showed significant direct and indirect effects (direct: β=.094; P<.001 and indirect: β=.004; P=.03). The indirect effect remains present in the smoking population (direct: β=.120; P<.001 and indirect: β=.002; P=.03). Conclusions: This study highlighted the potential association between MSDP and the risk of COPD in offspring, revealing the mediating role of TD in this association. These findings contribute to a deeper understanding of the impact of prenatal tobacco exposure on lung health, laying the groundwork for the development of relevant prevention and treatment strategies. 
%M 38386387
%R 10.2196/53170
%U https://publichealth.jmir.org/2024/1/e53170
%U https://doi.org/10.2196/53170
%U http://www.ncbi.nlm.nih.gov/pubmed/38386387

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e47408
%T Analyzing Reddit Forums Specific to Abortion That Yield Diverse Dialogues Pertaining to Medical Information Seeking and Personal Worldviews: Data Mining and Natural Language Processing Comparative Study
%A Valdez,Danny
%A Mena-Meléndez,Lucrecia
%A Crawford,Brandon L
%A Jozkowski,Kristen N
%+ Department of Applied Health Science, Indiana University School of Public Health, 1025 E 7th Street, Bloomington, IN, 47403, United States, 1 8128038955, danvald@iu.edu
%K abortion
%K social media
%K Reddit
%K natural language processing
%K NLP
%K neural networks
%D 2024

%7 14.2.2024
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Attitudes toward abortion have historically been characterized via dichotomized labels, yet research suggests that these labels do not appropriately encapsulate beliefs on abortion. Rather, contexts, circumstances, and lived experiences often shape views on abortion into more nuanced and complex perspectives. Qualitative data have also been shown to underpin belief systems regarding abortion. Social media, as a form of qualitative data, could reveal how attitudes toward abortion are communicated publicly in web-based spaces. Furthermore, in some cases, social media can also be leveraged to seek health information. Objective: This study applies natural language processing and social media mining to analyze Reddit (Reddit, Inc) forums specific to abortion, including r/Abortion (the largest subreddit about abortion) and r/AbortionDebate (a subreddit designed to discuss and debate worldviews on abortion). Our analytical pipeline intends to identify potential themes within the data and the affect from each post. Methods: We applied a neural network–based topic modeling pipeline (BERTopic) to uncover themes in the r/Abortion (n=2151) and r/AbortionDebate (n=2815) subreddits. After deriving the optimal number of topics per subreddit using an iterative coherence score calculation, we performed a sentiment analysis using the Valence Aware Dictionary and Sentiment Reasoner to assess positive, neutral, and negative affect and an emotion analysis using the Text2Emotion lexicon to identify potential emotionality per post. Differences in affect and emotion by subreddit were compared. Results: The iterative coherence score calculation revealed 10 topics for both r/Abortion (coherence=0.42) and r/AbortionDebate (coherence=0.35). Topics in the r/Abortion subreddit primarily centered on information sharing or offering a source of social support; in contrast, topics in the r/AbortionDebate subreddit centered on contextualizing shifting or evolving views on abortion across various ethical, moral, and legal domains. The average compound Valence Aware Dictionary and Sentiment Reasoner scores for the r/Abortion and r/AbortionDebate subreddits were 0.01 (SD 0.44) and −0.06 (SD 0.41), respectively. Emotionality scores were consistent across the r/Abortion and r/AbortionDebate subreddits; however, r/Abortion had a marginally higher average fear score of 0.36 (SD 0.39). Conclusions: Our findings suggest that people posting on abortion forums on Reddit are willing to share their beliefs, which manifested in diverse ways, such as sharing abortion stories including how their worldview changed, which critiques the value of dichotomized abortion identity labels, and information seeking. Notably, the style of discourse varied significantly by subreddit. r/Abortion was principally leveraged as an information and outreach source; r/AbortionDebate largely centered on debating across various legal, ethical, and moral abortion domains. Collectively, our findings suggest that abortion remains an opaque yet politically charged issue for people and that social media can be leveraged to understand views and circumstances surrounding abortion. 
%M 38354044
%R 10.2196/47408
%U https://www.jmir.org/2024/1/e47408
%U https://doi.org/10.2196/47408
%U http://www.ncbi.nlm.nih.gov/pubmed/38354044

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 7
%N 
%P e47092
%T Building a Sustainable Learning Health Care System for Pregnant and Lactating People: Interview Study Among Data Access Providers
%A Hollestelle,Marieke J
%A van der Graaf,Rieke
%A Sturkenboom,Miriam C J M
%A Cunnington,Marianne
%A van Delden,Johannes J M
%+ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3508 CA, Netherlands, 31 88755555, m.j.hollestelle-2@umcutrecht.nl
%K ethics
%K learning health care systems
%K pregnancy
%K lactation
%K real-world data
%K governance
%K qualitative research
%D 2024

%7 8.2.2024
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: In many areas of health care, learning health care systems (LHSs) are seen as promising ways to accelerate research and outcomes for patients by reusing health and research data. For example, considering pregnant and lactating people, for whom there is still a poor evidence base for medication safety and efficacy, an LHS presents an interesting way forward. Combining unique data sources across Europe in an LHS could help clarify how medications affect pregnancy outcomes and lactation exposures. In general, a remaining challenge of data-intensive health research, which is at the core of an LHS, has been obtaining meaningful access to data. These unique data sources, also called data access providers (DAPs), are both public and private organizations and are important stakeholders in the development of a sustainable and ethically responsible LHS. Sustainability is often discussed as a challenge in LHS development. Moreover, DAPs are increasingly expected to move beyond regulatory compliance and are seen as moral agents tasked with upholding ethical principles, such as transparency, trustworthiness, responsibility, and community engagement. Objective: This study aims to explore the views of people working for DAPs who participate in a public-private partnership to build a sustainable and ethically responsible LHS. Methods: Using a qualitative interview design, we interviewed 14 people involved in the Innovative Medicines Initiative (IMI) ConcePTION (Continuum of Evidence from Pregnancy Exposures, Reproductive Toxicology and Breastfeeding to Improve Outcomes Now) project, a public-private collaboration with the goal of building an LHS for pregnant and lactating people. The pseudonymized transcripts were analyzed thematically. Results: A total of 3 themes were identified: opportunities and responsibilities, conditions for participation and commitment, and challenges for a knowledge-generating ecosystem. The respondents generally regarded the collaboration as an opportunity for various reasons beyond the primary goal of generating knowledge about medication safety during pregnancy and lactation. Respondents had different interpretations of responsibility in the context of data-intensive research in a public-private network. Respondents explained that resources (financial and other), scientific output, motivation, agreements collaboration with the pharmaceutical industry, trust, and transparency are important conditions for participating in and committing to the ConcePTION LHS. Respondents also discussed the challenges of an LHS, including the limitations to (real-world) data analyses and governance procedures. Conclusions: Our respondents were motivated by diverse opportunities to contribute to an LHS for pregnant and lactating people, primarily centered on advancing knowledge on medication safety. Although a shared responsibility for enabling real-world data analyses is acknowledged, their focus remains on their work and contribution to the project rather than on safeguarding ethical data handling. The results of our interviews underline the importance of a transparent governance structure, emphasizing the trust between DAPs and the public for the success and sustainability of an LHS. 
%M 38329780
%R 10.2196/47092
%U https://pediatrics.jmir.org/2024/1/e47092
%U https://doi.org/10.2196/47092
%U http://www.ncbi.nlm.nih.gov/pubmed/38329780

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 7
%N 
%P e46973
%T Exploring Maternal and Infant Health App Development and Effectiveness Research: Scoping Review
%A Phillips,J Craig
%A Alfano,Alliete R
%A Barfield,Latisha C
%A Cain,Lisa
%A Sadjadi,Masoud
%A Morales,Eduardo
%A Phillips-Beck,Wanda
%A Galarza,M Grisel
%A Torres,Maritza
%A Zindani,Sadaf
%A Rayani,Ahmad
%A Edwards,Khalee
%A Jones,Sande Gracia
%A Hannan,Jean
%+ School of Nursing, University of Ottawa, 308-29 Main St, Ottawa, ON, K1S 1B1, Canada, 1 613 562 5800 ext 8612, craig.phillips@uottawa.ca
%K maternal and child health
%K smartphone
%K mobile health
%K mHealth
%K eHealth
%K app development
%K app evaluation
%K app effectiveness
%K maternal and infant app
%K pregnancy, postpartum
%K mothers
%K mobile phone
%K artificial intelligence
%K AI
%D 2024

%7 26.1.2024
%9 Review
%J JMIR Pediatr Parent
%G English
                
%X Background: Globally, high rates of maternal and infant mortality call for interventions during the perinatal period to engage pregnant people as well as their loved ones in care. Mobile health technologies have become ubiquitous in our lives and in health care settings. However, there is a need to further explore their safety and effectiveness to support and improve health outcomes locally and globally. Objective: The aim of this study was to review and synthesize published literature that described the development process or effectiveness evaluations of maternal and infant apps. Methods: We applied a methodological framework for scoping reviews as well as the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines; in addition, the systematic review platform Covidence (Veritas Health Innovation Ltd) was used to facilitate the review of included studies. Search terms were developed collaboratively, and health sciences–associated databases were searched for studies conducted between January 1, 2000, and February 4, 2022. We excluded studies about apps that only gathered or tracked data or targeted care providers. Results: A total of 1027 articles were included for title and abstract screening, of which 87 (8.47%) were chosen for full-text screening. Of these 87 articles, 74 (85%) were excluded with reasons, and 19 (22%) were included. Four articles were added at data extraction from hand searching and 2 others were excluded. Thus, we reviewed and synthesized data from 11 unique studies reported in 21 articles published between 2017 and 2021. The included studies represented 8 different countries. Most of the apps (8/11, 73%) were in English, although apps were also developed in Arabic, Bahasa Indonesia, and Nepali. The articles reviewed revealed the early stage of development of the field of maternal and infant health apps, with modest evidence of app use and achievement of study outcomes. Only 1 (9%) of the 11 apps was endorsed by an independent health care provider society. App development and evaluation processes emerged, and specific app features were identified as vital for well-functioning apps. End-user engagement occurred in some, but not all, parts of app research and development. Conclusions: Apps to improve maternal and infant health are being developed and launched in enormous numbers, with many of them not developed with mothers’ needs in mind. There are concerns about privacy, safety, and the standardization of current apps as well as a need for professional or institution-specific guidelines or best practices. Despite challenges inherent in currently available apps and their design processes, maternal and infant app technology holds promise for achieving health equity goals and improving maternal and child health outcomes. Finally, we propose recommendations for advancing the knowledge base for maternal and infant apps. 
%M 38055330
%R 10.2196/46973
%U https://pediatrics.jmir.org/2024/1/e46973
%U https://doi.org/10.2196/46973
%U http://www.ncbi.nlm.nih.gov/pubmed/38055330

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 12
%N 
%P e49373
%T Effects of mHealth-Based Lifestyle Interventions on Gestational Diabetes Mellitus in Pregnant Women With Overweight and Obesity: Systematic Review and Meta-Analysis
%A He,Yirong
%A Huang,Chuanya
%A He,Qiuyang
%A Liao,Shujuan
%A Luo,Biru
%+ Department of Nursing, West China Second University Hospital, Sichuan University, #No. 20, Section 3, People’s South Road, Chengdu, Sichuan, 610041, China, 86 88570307, luomr@scu.edu.cn
%K mobile health
%K mHealth
%K lifestyle intervention
%K gestational diabetes mellitus
%K meta-analysis
%K mobile phone
%D 2024

%7 17.1.2024
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The increasing incidence of gestational diabetes mellitus (GDM) is a global health problem that is more likely to occur in pregnant women with overweight or obesity. Adhering to a healthy lifestyle is associated with a reduced risk of GDM. With the development of IT, mobile health (mHealth) interventions have become widely available in health care. However, there are no definitive conclusions on the effectiveness of mHealth-based lifestyle interventions in preventing GDM. Objective: This study aims to evaluate the impact of mHealth-based lifestyle interventions on GDM and other pregnancy outcomes in pregnant women with overweight or obesity. Methods: A systematic literature search was conducted in 5 English databases (MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL) and 4 Chinese databases (CBM, CNKI, Vip, and Wanfang) to identify randomized controlled trials (RCTs) on the effectiveness of mHealth-based interventions for GDM from inception to January 10, 2023. In total, 2 authors independently screened the studies and extracted the data. The quality of the included studies was examined using the Cochrane risk-of-bias tool. Data synthesis was conducted using Review Manager (version 5.4; The Cochrane Collaboration). Results: A total of 16 RCTs with 7351 participants were included in this study. The included studies were published between 2014 and 2021 and were conducted in China, the United States, Australia, New Zealand, the United Kingdom, Ireland, and Norway. The sample sizes of the studies ranged from 75 to 2202, and the duration of the mHealth-based lifestyle interventions ranged from 4 to 28 weeks. Compared with usual care, mHealth-based lifestyle interventions significantly reduced the incidence of GDM (odds ratio [OR] 0.74, 95% CI 0.56-0.96; P=.03; I2=65%), preterm birth (OR 0.65, 95% CI 0.48-0.87; P=.004; I2=25%), macrosomia (OR 0.59, 95% CI 0.40-0.87; P=.008; I2=59%), and gestational weight gain (mean difference=−1.12 kg, 95% CI −1.44 to −0.80; P<.001; I2=43%). The subgroup analysis showed that interventions delivered via apps (OR 0.55, 95% CI 0.37-0.83; P=.004; I2=44%), provided by obstetricians (OR 0.69, 95% CI 0.51-0.93; P=.02; I2=60%), and targeted at Asian populations (OR 0.44, 95% CI 0.34-0.58; P<.001; I2=0%) and that used the International Association of Diabetes and Pregnancy Study Groups diagnostic criteria (OR 0.58, 95% CI 0.39-0.86; P=.007; I2=69%) showed a statistically significant reduction in the risk of GDM. Conclusions: mHealth-based lifestyle interventions had a favorable impact on the prevention of GDM in pregnant women with overweight and obesity. Future studies need to further explore the potential of mHealth-based interventions for GDM through better design and more rigorous large-scale RCTs. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021286995; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=286995 
%M 38231555
%R 10.2196/49373
%U https://mhealth.jmir.org/2024/1/e49373
%U https://doi.org/10.2196/49373
%U http://www.ncbi.nlm.nih.gov/pubmed/38231555

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e48960
%T Digital Health Needs and Preferences During Pregnancy and the Postpartum Period: Mixed Methods Study
%A Henrich,Natalie
%A Brinson,Alison
%A Arnold,Alyssa
%A Jahnke,Hannah R
%+ Maven Clinic, 160 Varick St, New York, NY, 10013, United States, 1 212 457 1790, natalie.henrich@mavenclinic.com
%K digital health
%K perinatal
%K pregnancy
%K postpartum
%K interviews
%K survey
%K user needs
%K patient centered
%K mixed methods
%D 2024

%7 12.1.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Digital health is increasingly used to meet the needs of perinatal people, with estimates of pregnancy-related internet use ranging from 90% to 97% of pregnant people. As digital health takes on greater importance during the perinatal period, it is essential that providers and developers of digital health content understand why perinatal people use these resources and the features that enhance their experience. However, gaps remain in understanding the content that is most helpful and how the platforms are navigated. Learning directly from perinatal people about their needs will help ensure alignment between perinatal needs and available content. Objective: This formative study aims to identify the reasons why perinatal people use digital health resources; the features of the digital health platforms that are of greatest importance to them; and how these differ by perinatal stage (pregnancy vs post partum), mental health conditions, parity, and demographics (race and ethnicity). Methods: This mixed methods study used interviews; surveys; and secondary data on demographic, health, and pregnancy characteristics to identify the digital health needs and preferences of pregnant and postpartum people who used the Maven digital health platform in the United States during their pregnancy or postpartum period. The interviews informed the content of the surveys and provided additional insights and examples for interpreting the survey results. The surveys were used to collect data from a sample of Maven users, and the results were linked to the secondary data set. The interviews were thematically analyzed, and survey data were analyzed using descriptive statistics and stratified by parity, race, and mental health status. Results: Overall, 13 people were interviewed (including n=4, 31% pilot interviews), and 147 pregnancy and 110 postpartum survey respondents completed the surveys and had linkable secondary data. Top reasons for using digital health resources during pregnancy were to (1) know what is normal or typical during pregnancy, (2) have access to a health care provider when needed, and (3) know how the baby is developing. Top reasons for postpartum use were to (1) help with breastfeeding, (2) know what normal baby development is, and (3) help with the baby’s health issues. Top platform features during pregnancy and the postpartum period were (1) credible and trustworthy information and providers, (2) nonjudgmental information and support, and (3) no cost to the user. In general, more reasons for using digital resources were identified as extremely important during pregnancy compared with post partum. The results showed minor variations across strata. Conclusions: This formative research found minor differences in digital resource needs and preferences across user characteristics among perinatal people in the United States. Future work should examine whether there are variations in interests within topics by user characteristics, which may provide additional opportunities to better meet user needs. 
%M 38214971
%R 10.2196/48960
%U https://formative.jmir.org/2024/1/e48960
%U https://doi.org/10.2196/48960
%U http://www.ncbi.nlm.nih.gov/pubmed/38214971

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 7
%N 
%P e50512
%T Chinese Women’s Concept of Childbirth Based on the Social Media Topic “What Does Childbirth Mean to a Woman”: Content and Thematic Analysis
%A Yang,Ting
%A Wu,Yihan
%A Han,Nuo
%A Liu,Tianli
%+ Institute of Population Research, Peking University, Room 230, School of Economics Building, Beijing, 100871, China, 86 010 62751974, tianli.liu@pku.edu.cn
%K childbirth willingness
%K social media
%K risk perception
%K childbirth cost
%K childbirth benefit
%D 2024

%7 5.1.2024
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: In recent years, women’s fertility desire has attracted increasing attention in China. Objective: This study aims to detect attitudes toward giving birth among young female users on Douban, a very popular Chinese social media platform. Methods: A total of 2634 valid posts from 2489 users discussing the topic “What does childbirth mean to a woman” on Douban were crawled and retained for analysis. We utilized content and thematic analysis methods to capture users’ concepts of childbirth. Results: The findings reveal that a significant majority of users conveyed generally neutral (1060/2634, 40.24%) or negative (1051/2634, 39.90%) attitudes toward childbirth, while only about one-fifth of users expressed positive (523/2634, 19.86%) sentiments. Notably, posts with negative attitudes garnered more replies and likes, and the proportion of posts expressing negativity exhibited fluctuations over time. Health risk (339/2634, 12.87%) emerged as the most frequently cited aspect of childbirth cost, with subjective happiness and the fulfillment of mental needs identified as primary benefits. Surprisingly, only a minimal number of posts (10/2634, 0.38%) touched upon the traditional objective benefits of raising children for old-age care. Thematic analysis results suggest that discussions about fertility on social media platforms might contribute to an exaggerated perception of health risks among women. Additionally, a lack of knowledge about childbirth was observed, partially attributable to longstanding neglect and avoidance of communication on these matters, likely influenced by traditional cultural biases. Moreover, there is a prevailing assumption that women should naturally sacrifice themselves for childbirth and childcare, influenced by the idealization of the female figure. Consequently, women may harbor hesitations about having a baby, fearing the potential loss of their own identity in the process. Conclusions: The results indicate a shift in the perception of childbirth among modern Chinese women over time, influenced by their increasing social status and the pursuit of self-realization. Implementing strategies such as public education on the health risks associated with pregnancy and delivery, safeguarding women’s rights, and creating a supportive environment for mothers may enhance women’s willingness to undergo childbirth. International Registered Report Identifier (IRRID): RR2-10.2196/preprints.50468 
%M 38180784
%R 10.2196/50512
%U https://pediatrics.jmir.org/2024/1/e50512
%U https://doi.org/10.2196/50512
%U http://www.ncbi.nlm.nih.gov/pubmed/38180784

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 6
%N 
%P e53933
%T Evaluating the Impact of an App-Delivered Mindfulness Meditation Program to Reduce Stress and Anxiety During Pregnancy: Pilot Longitudinal Study
%A Balsam,Donna
%A Bounds,Dawn T
%A Rahmani,Amir M
%A Nyamathi,Adeline
%+ School of Nursing, San Diego State University, 5500 Campanile Mall, San Diego, CA, 92182, United States, 1 6195942540, dbalsam@sdsu.edu
%K mindfulness app
%K pregnancy
%K pregnant
%K maternal
%K obstetric
%K obstetrics
%K stress
%K anxiety
%K heart rate variability
%K mindfulness
%K mHealth
%K mobile health
%K app
%K apps
%K applications
%K mental health
%K meditation
%K mind-body
%K complementary
%K alternative
%K heart rate
%K sleep
%K mobile phone
%D 2023

%7 25.12.2023
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Stress and anxiety during pregnancy are extremely prevalent and are associated with numerous poor outcomes, among the most serious of which are increased rates of preterm birth and low birth weight infants. Research supports that while in-person mindfulness training is effective in reducing pregnancy stress and anxiety, there are barriers limiting accessibility. Objective: The aim of this paper is to determine if mindfulness meditation training with the Headspace app is effective for stress and anxiety reduction during pregnancy. Methods: A longitudinal, single-arm trial was implemented with 20 pregnant women who were instructed to practice meditation via the Headspace app twice per day during the month-long trial. Validated scales were used to measure participant’s levels of stress and anxiety pre- and postintervention. Physiological measures reflective of stress (heart rate variability and sleep) were collected via the Oura Ring. Results: Statistically significant reductions were found in self-reported levels of stress (P=.005), anxiety (P=.01), and pregnancy anxiety (P<.0001). Hierarchical linear modeling revealed a statistically significant reduction in the physiological data reflective of stress in 1 of 6 heart rate variability metrics, the low-frequency power band, which decreased by 13% (P=.006). A total of 65%  of study participants (n=13) reported their sleep improved during the trial, and 95% (n=19) stated that learning mindfulness helped with other aspects of their lives. Participant retention was 100%, with 65% of participants (n=13) completing about two-thirds of the intervention, and 50% of participants (n=10) completing ≥95%. Conclusions: This study found evidence to support the Headspace app as an effective intervention to aid in stress and anxiety reduction during pregnancy. 
%M 38145479
%R 10.2196/53933
%U https://pediatrics.jmir.org/2023/1/e53933
%U https://doi.org/10.2196/53933
%U http://www.ncbi.nlm.nih.gov/pubmed/38145479

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e44912
%T Evaluating Messaging on Prenatal Health Behaviors Using Social Media Data: Systematic Review
%A Frennesson,Nessie Felicia
%A McQuire,Cheryl
%A Aijaz Khan,Saher
%A Barnett,Julie
%A Zuccolo,Luisa
%+ Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, United Kingdom, 44 1173746633, felicia.frennesson@bristol.ac.uk
%K acceptability
%K design
%K development
%K effectiveness
%K health behavior
%K health messaging
%K messaging
%K prenatal health
%K prenatal
%K social media data
%K social media
%K tool
%D 2023

%7 20.12.2023
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Social media platforms are increasingly being used to disseminate messages about prenatal health. However, to date, we lack a systematic assessment of how to evaluate the impact of official prenatal health messaging and campaigns using social media data. Objective: This study aims to review both the published and gray literature on how official prenatal health messaging and campaigns have been evaluated to date in terms of impact, acceptability, effectiveness, and unintended consequences, using social media data. Methods: A total of 6 electronic databases were searched and supplemented with the hand-searching of reference lists. Both published and gray literature were eligible for review. Data were analyzed using content analysis for descriptive data and a thematic synthesis approach to summarize qualitative evidence. A quality appraisal tool, designed especially for use with social media data, was used to assess the quality of the included articles. Results: A total of 11 studies were eligible for the review. The results showed that the most common prenatal health behavior targeted was alcohol consumption, and Facebook was the most commonly used source of social media data. The majority (n=6) of articles used social media data for descriptive purposes only. The results also showed that there was a lack of evaluation of the effectiveness, acceptability, and unintended consequences of the prenatal health message or campaign. Conclusions: Social media is a widely used and potentially valuable resource for communicating and evaluating prenatal health messaging. However, this review suggests that there is a need to develop and adopt sound methodology on how to evaluate prenatal health messaging using social media data, for the benefit of future research and to inform public health practice. 
%M 38117557
%R 10.2196/44912
%U https://www.jmir.org/2023/1/e44912
%U https://doi.org/10.2196/44912
%U http://www.ncbi.nlm.nih.gov/pubmed/38117557

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 11
%N 
%P e46910
%T Mobile Prenatal Education and Its Impact on Reducing Adverse Pregnancy Outcomes: Retrospective Real-World Study
%A Hao,Jie
%A Yang,Lin
%A Wang,Yaxin
%A Lan,Yushan
%A Xu,Xiaowei
%A Wang,Ziyang
%A Li,Zanmei
%A Ma,Liangkun
%A Li,Jiao
%A Zhang,Suhan
%A Sun,Yin
%+ Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, China, 86 10 69151305, goldhill@163.com
%K adverse pregnancy outcome
%K mobile prenatal education
%K pregnancy
%K real-world study
%K retrospective study
%D 2023

%7 20.12.2023
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Pregnancy is a pivotal phase in a woman’s life, demanding special attention to ensure maternal and fetal health. Prenatal education plays a vital role in promoting healthy pregnancies and reducing adverse outcomes for pregnant women. Mobile prenatal education programs have gained traction due to their accessibility and timeliness, especially in light of finite health care resources and the constraints imposed by the COVID-19 pandemic. Objective: This study aims to develop and evaluate the effectiveness of a mobile-based prenatal education program in improving pregnancy outcomes. Methods: We developed a mobile-based prenatal education curriculum in collaboration with a multidisciplinary maternal care team from Peking Union Medical College Hospital (PUMCH) in Beijing, China. Data were retrospectively collected from 1941 pregnant women who had registered for the PUMCH mobile prenatal education program and subsequently delivered at PUMCH between May 2021 and August 2022. The study compared pregnancy outcomes between the completing group, which were pregnant women who had completed at least 1 course, and the noncompleting group. We also analyzed differences among course topics within the completing group and assessed course topic popularity among pregnant women. Results: The PUMCH mobile prenatal education curriculum consists of 436 courses across 9 topics. Out of the participants, a total of 1521 did not complete any courses, while 420 completed at least 1 course. Compared with the noncompleting group, pregnant women who completed courses exhibited a significant reduction in the risk of gestational diabetes mellitus, induced abortion, postpartum infection, fetal intrauterine distress, and neonatal malformation. Among those in the completing group, a total of 86% (361/420) started course completion during the first and second trimesters. Furthermore, completing courses related to topics of pregnancy psychology and pregnancy nutrition was associated with reduced risks of premature rupture of membranes and small for gestational age infants, respectively. Pregnancy psychology and postpartum recovery were the preferred topics among pregnant women. Conclusions: The study demonstrates the potential of mobile-based prenatal education programs in improving pregnancy outcomes and supporting health care providers in delivering effective prenatal education. The rise of mobile prenatal education presents an opportunity to improve maternal and child health outcomes. Further research and broader implementation of such programs are warranted to continually improve maternal and child health. 
%M 38117555
%R 10.2196/46910
%U https://mhealth.jmir.org/2023/1/e46910
%U https://doi.org/10.2196/46910
%U http://www.ncbi.nlm.nih.gov/pubmed/38117555

%0 Journal Article
        
%@ 2561-6722
%I 
%V 6
%N 
%P e50765
%T Usability and Perception of a Wearable-Integrated Digital Maternity Record App in Germany: User Study
%A Nissen,Michael
%A Perez,Carlos A
%A Jaeger,Katharina M
%A Bleher,Hannah
%A Flaucher,Madeleine
%A Huebner,Hanna
%A Danzberger,Nina
%A Titzmann,Adriana
%A Pontones,Constanza A
%A Fasching,Peter A
%A Beckmann,Matthias W
%A Eskofier,Bjoern M
%A Leutheuser,Heike
%K maternity log
%K maternity logbook
%K log
%K logbook
%K experience
%K experiences
%K attitude
%K attitudes
%K opinion
%K opinions
%K perception
%K perceptions
%K perspective
%K perspectives
%K pregnancy record
%K personal health record
%K PHR
%K health records
%K health record
%K feature
%K features
%K develop
%K development
%K maternity record
%K electronic
%K digital
%K paper hand-held record
%K mHealth
%K mobile health
%K app
%K apps
%K application
%K applications
%K smartphone
%K smartphones
%K wearable
%K wearables
%K usability
%K pregnant
%K pregnancy
%K maternal
%K maternity
%K electronic maternity record
%K pregnancy app
%K data sharing
%K privacy
%K online search
%K searching
%K information behavior
%K information behaviour
%K information seeking
%D 2023

%7 15.12.2023
%9 
%J JMIR Pediatr Parent
%G English
                
%X Background: Although digital maternity records (DMRs) have been evaluated in the past, no previous work investigated usability or acceptance through an observational usability study. Objective: The primary objective was to assess the usability and perception of a DMR smartphone app for pregnant women. The secondary objective was to assess personal preferences and habits related to online information searching, wearable data presentation and interpretation, at-home examination, and sharing data for research purposes during pregnancy. Methods: A DMR smartphone app was developed. Key features such as wearable device integration, study functionalities (eg, questionnaires), and common pregnancy app functionalities (eg, mood tracker) were included. Women who had previously given birth were invited to participate. Participants completed 10 tasks while asked to think aloud. Sessions were conducted via Zoom. Video, audio, and the shared screen were recorded for analysis. Task completion times, task success, errors, and self-reported (free text) feedback were evaluated. Usability was measured through the System Usability Scale (SUS) and User Experience Questionnaire (UEQ). Semistructured interviews were conducted to explore the secondary objective. Results: A total of 11 participants (mean age 34.6, SD 2.2 years) were included in the study. A mean SUS score of 79.09 (SD 18.38) was achieved. The app was rated “above average” in 4 of 6 UEQ categories. Sixteen unique features were requested. We found that 5 of 11 participants would only use wearables during pregnancy if requested to by their physician, while 10 of 11 stated they would share their data for research purposes. Conclusions: Pregnant women rely on their medical caregivers for advice, including on the use of mobile and ubiquitous health technology. Clear benefits must be communicated if issuing wearable devices to pregnant women. Participants that experienced pregnancy complications in the past were overall more open toward the use of wearable devices in pregnancy. Pregnant women have different opinions regarding access to, interpretation of, and reactions to alerts based on wearable data. Future work should investigate personalized concepts covering these aspects. 
%R 10.2196/50765
%U https://pediatrics.jmir.org/2023/1/e50765
%U https://doi.org/10.2196/50765

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e49243
%T Phenotypic Environmental Sensitivity and Mental Health During Pregnancy and Post Partum: Protocol for the Experiences of Pregnancy Longitudinal Cohort Study
%A Rioux,Charlie
%A Fulp,Delaney C
%A Haley,Parker N
%A LaBelle,Jenna L
%A Aasted,Mary E
%A Lambert,Kasie K
%A Donohue,Madison T
%A Mafu,Nkatheko T
%+ Department of Psychology, University of Oklahoma, 455 W Lindsey Street, Dale Hall Tower, Room 705, Norman, OK, 73019-2007, United States, 1 405 325 4511, charlie.rioux@ou.edu
%K anxiety
%K biological sensitivity to context
%K depression
%K diathesis-stress
%K highly sensitive person
%K moderation
%K resilience
%K sensory processing reactivity
%K substance use
%K vantage sensitivity
%D 2023

%7 6.12.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Mental health problems during pregnancy and post partum are common and associated with negative short- and long-term impacts on pregnant individuals, obstetric outcomes, and child socioemotional development. Socio-environmental factors are important predictors of perinatal mental health, but the effects of the environment on mental health are heterogeneous. The differential susceptibility theory and the environmental sensitivity framework suggest that individuals differ in their degree of sensitivity to positive and negative environments, which can be captured by individual phenotypes such as temperament and personality. While there is strong evidence for these models in childhood, few studies examined them in adults, and they were not examined in pregnancy. Objective: The primary objective of the Experiences of Pregnancy study is to explore whether childhood and current environments are associated with mental health and well-being in pregnancy and whether these effects depend on individual sensitivity phenotypes (personality). This study also aims to gather important psychosocial and health data for potential secondary data analyses and integrative data analyses. Methods: We will conduct a longitudinal cohort study. The study was not registered elsewhere, other than this protocol. Participants will be recruited through social media advertisements linking to the study website, followed by an eligibility call on Zoom (Zoom Video Communications). Participants must be aged 18 years or older, currently residing in the United States as citizens or permanent residents, and currently planning to continue the pregnancy. A minimum of 512 participants will be recruited based on power analyses for the main objectives. Since the data will also be a resource for secondary analyses, up to 1000 participants will be recruited based on the available budget. Participants will be in their first trimester of pregnancy, and they will be followed at each trimester and once post partum. Data will be obtained through self-reported questionnaires assessing demographic factors; pregnancy-related factors; delivery, labor, and birth outcomes; early infant feeding; individual personality factors; childhood and current environments; mental health and well-being; attachment; and infant temperament. A series of measures were taken to safeguard the study from web robots and fraudulent participants, as well as to reduce legal and social risks for participants following Dobbs v. Jackson. Results: The study received ethics approval in April 2023 from the University of Oklahoma-Norman Campus Institutional Review Board. Recruitment occurred from May to August 2023, with 3 follow-ups occurring over 10 months. Conclusions: The Experiences of Pregnancy study will extend theories of environmental sensitivity, mainly applied in children to the perinatal period. This will help better understand individual sensitivity factors associated with risk, resilience, plasticity, and receptivity to negative and positive environmental influences during pregnancy for pregnant individuals. International Registered Report Identifier (IRRID): PRR1-10.2196/49243 
%M 38055312
%R 10.2196/49243
%U https://www.researchprotocols.org/2023/1/e49243
%U https://doi.org/10.2196/49243
%U http://www.ncbi.nlm.nih.gov/pubmed/38055312

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e50867
%T Self-Reported Medication Use Across Racial and Rural or Urban Subgroups of People Who Are Pregnant in the United States: Decentralized App-Based Cohort Study
%A Ajayi,Toluwalase
%A Pawelek,Jeff
%A Bhargava,Hansa
%A Faksh,Arij
%A Radin,Jennifer
%+ Scripps Research Translational Institute, Scripps Research, 3344 North Torrey Pines Ct., La Jolla, CA, 92037, United States, 1 8587842096, tajayi@scripps.edu
%K prenatal care
%K maternal health
%K digital study
%K underrepresented in biomedical research
%K pregnant
%K pregnancy
%K medications
%K vaccinations
%K vitamins
%D 2023

%7 28.11.2023
%9 Short Paper
%J JMIR Form Res
%G English
                
%X Background: Maternal health outcomes have been underresearched due to people who are pregnant being underrepresented or excluded from studies based on their status as a vulnerable study population. Based on the available evidence, Black people who are pregnant have dramatically higher maternal morbidity and mortality rates compared to other racial and ethnic groups. However, insights into prenatal care—including the use of medications, immunizations, and prenatal vitamins—are not well understood for pregnant populations, particularly those that are underrepresented in biomedical research. Medication use has been particularly understudied in people who are pregnant; even though it has been shown that up to 95% of people who are pregnant take at least 1 or more medications. Understanding gaps in use could help identify ways to reduce maternal disparities and optimize maternal health outcomes. Objective: We aimed to characterize and compare the use of prenatal vitamins, immunizations, and commonly used over-the-counter and prescription medications among people who are pregnant, those self-identifying as Black versus non-Black, and those living in rural versus urban regions in the United States. Methods: We conducted a prospective, decentralized study of 4130 pregnant study participants who answered survey questionnaires using a mobile research app that was only available on iOS (Apple Inc) devices. All people who were pregnant, living in the United States, and comfortable with reading and writing in English were eligible. The study was conducted in a decentralized fashion with the use of a research app to facilitate enrollment using an eConsent and self-reported data collection. Results: Within the study population, the use of prenatal vitamins, antiemetics, antidepressants, and pain medication varied significantly among different subpopulations underrepresented in biomedical research. Black participants reported significantly lower frequencies of prenatal vitamin use compared to non-Black participants (P<.001). The frequency of participants who were currently receiving treatment for anxiety and depression was also lower among Black and rural groups compared to their non-Black and urban counterparts, respectively. There was significantly lower use of antidepressants (P=.002) and antiemetics (P=.02) among Black compared to non-Black participants. While prenatal vitamin use was lower among participants in rural areas, the difference between rural and urban groups did not reach statistical significance (P=.08). There were no significant differences in vaccine uptake for influenza or tetanus-diphtheria-pertussis (TDaP) across race, ethnicity, rural, or urban status. Conclusions: A prospective, decentralized app-based study demonstrated significantly lower use of prenatal vitamins, antiemetics, and antidepressants among Black pregnant participants. Additionally, significantly fewer Black and rural participants reported receiving treatment for anxiety and depression during pregnancy. Future research dedicated to identifying the root mechanisms of these differences can help improve maternal health outcomes, specifically for diverse communities. 
%M 38015604
%R 10.2196/50867
%U https://formative.jmir.org/2023/1/e50867
%U https://doi.org/10.2196/50867
%U http://www.ncbi.nlm.nih.gov/pubmed/38015604

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e51792
%T Efficacy of mHealth Interventions for Improving Maternal and Neonatal Outcomes Among Pregnant Women With Hypertensive Disorders: Protocol for a Systematic Review
%A Noronha,Judith Angelitta
%A Lewis,Mitchelle S
%A Phagdol,Tenzin
%A Nayak,Baby S
%A D,Anupama
%A Shetty,Jyothi
%A N,Ravishankar
%A Nair,Sreekumaran
%+ Department of Fundamentals of Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Madhav Nagar, Manipal, 576104, India, 91 7259693480, lewis.mitchelle@manipal.edu
%K digital health
%K gestational hypertension
%K hypertension
%K hypertensive
%K knowledge synthesis
%K maternal health outcomes
%K maternal
%K mHealth
%K mobile health application
%K mobile health
%K neonatal health outcomes
%K neonatal
%K neonates
%K preeclampsia
%K pregnancy
%K pregnant
%K review methodology
%K review methods
%K SMS
%K systematic
%K telemedicine
%K text messaging
%K sustainable development goal
%D 2023

%7 28.11.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Hypertension is one of the most prevalent medical conditions that arise during pregnancy, resulting in maternal and neonatal complications. Mobile health (mHealth) has emerged as an innovative intervention for delivering maternal and child health care services. The evidence on the effectiveness of mHealth interventions in improving the health outcomes of pregnant women with hypertensive disorders is lacking. Therefore, there is a need for evidence synthesis using systematic review methods to address this evidence gap. Objective: This review aims to determine the efficacy of mHealth interventions in improving maternal and neonatal outcomes among pregnant women with hypertensive disorders. The review will answer the following research questions: (1) What are the types of mHealth interventions used in pregnant women with hypertensive disorders? (2) Are the various mHealth interventions effective in improving maternal and neonatal health outcomes, health behaviors, and their knowledge of the disease? and (3) Are mHealth interventions effective in supporting health care providers to make health care decisions for pregnant women with hypertensive disorders? Methods: This review will include randomized controlled trials, nonrandomized controlled trials, and cohort studies focusing on mHealth interventions for pregnant women with hypertensive disorders. Studies reporting health care providers use of mHealth interventions in caring for pregnant women with hypertensive disorders will be included. The search strategy will be tailored to each database using database-specific search terms. The search will be conducted in PubMed-MEDLINE, ProQuest, CINAHL, Scopus, Web of Science, and CENTRAL. Other literature sources, such as trial registries and bibliographies of relevant studies, will be additionally searched. Studies published in English from January 2000 to January 2023 will be included. A total of 2 review authors will independently perform the data extraction and the quality appraisal. For quality appraisal of randomized controlled trials, the Cochrane Risk of Bias 2 tool will be used. The Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-1) tool will be used for nonrandomized controlled trials, and the Critical Appraisal Skills Programme checklist for cohort studies will be used. Any disagreements between the 2 reviewers will be resolved through discussion and a third reviewer if required. A meta-analysis will be performed based on the availability of the data. Results: As per the protocol, the study methodology was followed, and 2 independent reviewers conducted the search in 6 databases and clinical registries. Currently, the review is in the full-text screening stage. The review will publish the results in the first quarter of 2024. Conclusions: The evidence synthesized from this systematic review will help guide future research, support health care decisions, and inform policy makers on the effectiveness of mHealth interventions in improving the maternal and neonatal outcomes of pregnant women with hypertensive disorders. International Registered Report Identifier (IRRID): PRR1-10.2196/51792 
%M 38015596
%R 10.2196/51792
%U https://www.researchprotocols.org/2023/1/e51792
%U https://doi.org/10.2196/51792
%U http://www.ncbi.nlm.nih.gov/pubmed/38015596

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e48853
%T App-Supported Lifestyle Interventions in Pregnancy to Manage Gestational Weight Gain and Prevent Gestational Diabetes: Scoping Review
%A Raab,Roxana
%A Geyer,Kristina
%A Zagar,Sophia
%A Hauner,Hans
%+ Institute of Nutritional Medicine, Else Kröner Fresenius Centre for Nutritional Medicine, TUM School of Medicine and Health, Technical University of Munich, Georg-Brauchle-Ring 62, Munich, 80992, Germany, 49 892 892 4921, hans.hauner@tum.de
%K mobile health
%K mHealth
%K eHealth
%K mobile app
%K lifestyle intervention
%K pregnancy
%K gestational weight gain
%K gestational diabetes
%K prevention
%K overweight
%K obesity
%K mobile phone
%D 2023

%7 10.11.2023
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) are common pregnancy complications that have been shown to be preventable through the use of lifestyle interventions. However, a significant gap exists between research on pregnancy lifestyle interventions and translation into clinical practice. App-supported interventions might aid in overcoming previous implementation barriers. The current status in this emerging research area is unknown. Objective: This scoping review aims to provide a comprehensive overview of planned, ongoing, and completed studies on eHealth and mobile health (mHealth) app–supported lifestyle interventions in pregnancy to manage GWG and prevent GDM. The review assesses the scope of the literature in the field; describes the population, intervention, control, outcomes, and study design (PICOS) characteristics of included studies as well as the findings on GWG and GDM outcomes; and examines app functionalities. Methods: The scoping review was conducted according to a preregistered protocol and followed established frameworks. Four electronic databases and 2 clinical trial registers were systematically searched. All randomized and quasi-randomized controlled trials (RCTs) of app-supported lifestyle interventions in pregnancy and related qualitative and quantitative research across the different study phases were considered for inclusion. Eligible studies and reports of studies were included until June 2022. Extracted data were compiled in descriptive analyses and reported in narrative, tabular, and graphical formats. Results: This review included 97 reports from 43 lifestyle intervention studies. The number of published reports has steadily increased in recent years; of the 97 included reports, 38 (39%) were trial register entries. Of the 39 identified RCTs, 10 efficacy or effectiveness trials and 8 pilot trials had published results on GWG (18/39, 46%); of these 18 trials, 7 (39%) trials observed significant intervention effects on GWG outcomes. Of all 39 RCTs, 5 (13%) efficacy or effectiveness trials reported GDM results, but none observed significant intervention effects on GDM. The RCTs included in the review were heterogeneous in terms of their PICOS characteristics. Most of the RCTs were conducted in high-income countries, included women with overweight or obesity and from all BMI categories, delivered multicomponent interventions, delivered interventions during pregnancy only, and focused on diet and physical activity. The apps used in the studies were mostly mHealth apps that included features for self-monitoring, feedback, goal setting, prompts, and educational content. Self-monitoring was often supported by wearable activity monitors and Bluetooth-connected weight scales. Conclusions: Research in this field is nascent, and the effectiveness and implementability of app-supported interventions have yet to be determined. The complexity and heterogeneity of intervention approaches pose challenges in identifying the most beneficial app features and intervention components and call for consistent and comprehensive intervention and outcome reporting. 
%M 37948111
%R 10.2196/48853
%U https://www.jmir.org/2023/1/e48853
%U https://doi.org/10.2196/48853
%U http://www.ncbi.nlm.nih.gov/pubmed/37948111

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 9
%N 
%P e45671
%T The Role of Telehealth in Promoting Equitable Abortion Access in the United States: Spatial Analysis
%A Koenig,Leah R
%A Becker,Andréa
%A Ko,Jennifer
%A Upadhyay,Ushma D
%+ Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Suite 1100, 1330 Broadway, San Francisco, CA, 94612, United States, 1 415 353 4626, ushma.upadhyay@ucsf.edu
%K telehealth
%K abortion
%K spatial analysis
%K health equity
%K barriers
%K abortion access
%K legal
%K health equity
%K young people
%K remote
%K rural
%D 2023

%7 7.11.2023
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Even preceding the Supreme Court’s 2022 Dobbs v. Jackson Women’s Health Organization decision, patients in the United States faced exceptional barriers to reach abortion providers. Abortion restrictions disproportionately limited abortion access among people of color, young people, and those living on low incomes. Presently, clinics in states where abortion remains legal are experiencing an influx of out-of-state patients and wait times for in-person appointments are increasing. Direct-to-patient telehealth for abortion care has expanded since its introduction in the United States in 2020. However, the role of this telehealth model in addressing geographic barriers to and inequities in abortion access remains unclear. Objective: We sought to examine the amount of travel that patients averted by using telehealth for abortion care, and the role of telehealth in mitigating inequities in abortion access by race or ethnicity, age, pregnancy duration, socioeconomic status, rural residence, and distance to a facility. Methods: We used geospatial analyses and data from patients in the California Home Abortion by Telehealth Study, residing in 31 states and Washington DC, who obtained telehealth abortion care at 1 of 3 virtual abortion clinics. We used patients’ residential ZIP code data and data from US abortion facility locations to document the round-trip driving distance in miles, driving time, and public transit time to the nearest abortion facility that patients averted by using telehealth abortion services from April 2021 to January 2022, before the Dobbs decision. We used binomial regression to assess whether patients reported that telehealth was more likely to make it possible to access a timely abortion among patients of color, those experiencing food insecurity, younger patients, those with longer pregnancy durations, rural patients, and those residing further from their closest abortion facility. Results: The 6027 patients averted a median of 10 (IQR 5-26) miles and 25 (IQR 14-46) minutes of round-trip driving, and 1 hour 25 minutes (IQR 46 minutes to 2 hours 30 minutes) of round-trip public transit time. Among a subsample of 1586 patients surveyed, 43% (n=683) reported that telehealth made it possible to obtain timely abortion care. Telehealth was most likely to make it possible to have a timely abortion for younger patients (prevalence ratio [PR] 1.4, 95% CI 1.2-1.6) for patients younger than 25 years of age compared to those 35 years of age or older), rural patients (PR 1.4, 95% CI 1.2-1.6), those experiencing food insecurity (PR 1.3, 95% CI 1.1-1.4), and those who averted over 100 miles of driving to their closest abortion facility (PR 1.6, 95% CI 1.3-1.9). Conclusions: These findings support the role of telehealth in reducing abortion-related travel barriers in states where abortion remains legal, especially among patient populations who already face structural barriers to abortion care. Restrictions on telehealth abortion threaten health equity. 
%M 37934583
%R 10.2196/45671
%U https://publichealth.jmir.org/2023/1/e45671
%U https://doi.org/10.2196/45671
%U http://www.ncbi.nlm.nih.gov/pubmed/37934583

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e51824
%T Video-Delivered Family Therapy for Perinatal Women With Depressive Symptoms and Family Conflict: Feasibility, Acceptability, Safety, and Tolerability Results From a Pilot Randomized Trial
%A Cluxton-Keller,Fallon
%A Hegel,Mark T
%A Donnelly,Craig L
%A Bruce,Martha L
%+ Department of Psychiatry, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, United States, 1 603 650 4726, Fallon.P.Cluxton-Keller@dartmouth.edu
%K perinatal depression
%K family conflict
%K family therapy
%K family
%K conflict
%K depression
%K depressive
%K perinatal
%K pregnant
%K pregnancy
%K video
%K videos
%K feasibility
%K safety
%K acceptability
%K tolerability
%K tolerable
%K families
%K satisfaction
%K resilience
%K psychotherapy
%D 2023

%7 3.11.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Although individual-level treatments exist for pregnant and postpartum women with depression, family conflict is a significant factor that can contribute to the development and severity of perinatal depressive symptoms. Yet, there is a lack of research on family therapy for perinatal women with moderate to severe depressive symptoms and family conflict. Further, research is needed on the feasibility, acceptability, safety, and tolerability of family therapies for perinatal depression that are delivered using Health Insurance Portability and Accountability Act–compliant videoconferencing technology (VCT). Objective: This paper describes the feasibility, acceptability, safety, and tolerability of a VCT-based family therapeutic intervention, Resilience Enhancement Skills Training (REST), for perinatal women with moderate to severe depressive symptoms and moderate to high conflict with their family members. Methods: This paper includes data from an ongoing randomized trial that compares an experimental family therapeutic intervention (REST) to standard of care (VCT-based problem-solving individual therapy) for the treatment of moderate to severe depressive symptoms in perinatal women with moderate to high family conflict. Both interventions were delivered by masters-level therapists using VCT. A total of 83 perinatal women and their adult family members (N=166 individuals) were recruited for participation in the study. Feasibility, defined as therapist adherence to ≥80% of REST session content, was assessed in audio-recorded sessions by 2 expert raters. Acceptability was defined as ≥80% of families completing REST, including completion of ≥80% homework assignments and family report of satisfaction with REST. Completion of REST was assessed by review of therapist session notes, and satisfaction was assessed by participant completion of a web-based questionnaire. The Beck Depression Inventory-Second Edition was administered to perinatal women by research assistants (blind to study group assignment) to assess safety, defined as a reduction in depressive symptoms during the treatment phase. The Family Environment Scale-Family Conflict subscale was administered by therapists to participants during the treatment phase to assess tolerability, defined as a reduction in family conflict during the treatment phase. Results: On average, the therapists achieved 90% adherence to REST session content. Of the families who started REST, 84% (32/38) of them completed REST, and on average, they completed 89% (8/9) of the homework assignments. Families reported satisfaction with REST. The results showed that REST is safe for perinatal women with moderate to severe depressive symptoms, and none discontinued due to worsened depressive symptoms. The results showed that REST is well tolerated by families, and no families discontinued due to sustained family conflict. Conclusions: The results show that REST is feasible, acceptable, safe, and tolerable for families. These findings will guide our interpretation of REST’s preliminary effectiveness upon completion of outcome data collection. Trial Registration: ClinicalTrials.gov NCT04741776; https://clinicaltrials.gov/ct2/show/NCT04741776 
%M 37921846
%R 10.2196/51824
%U https://formative.jmir.org/2023/1/e51824
%U https://doi.org/10.2196/51824
%U http://www.ncbi.nlm.nih.gov/pubmed/37921846

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e50145
%T Digital Self-Monitoring Tools for the Management of Gestational Weight Gain: Protocol for a Systematic Review
%A Mooney,Jan
%A Dahl,Alicia A
%+ Department of Public Health Sciences, College of Health and Human Services, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, United States, 1 7046875612, adahl3@charlotte.edu
%K protocol
%K systematic review
%K gestational weight gain
%K self-monitoring
%K digital health
%K review methods
%K review methodology
%K pregnant
%K pregnancy
%K gestational
%K weight
%K maternal
%K mobile phone
%D 2023

%7 26.10.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Gestational weight gain (GWG) exceeding the recommendations of the Institute of Medicine (in the United States) is associated with numerous adverse maternal and infant health outcomes. While many behavioral interventions targeting nutrition and physical activity have been developed to promote GWG within the Institute of Medicine guidelines, engagement and results are variable. Technology-mediated interventions can potentially increase the feasibility, acceptability, and reach of interventions, particularly for pregnant women, for whom integration of interventions into daily life may be critical to retention and adherence. Previous reviews highlight GWG self-monitoring as a common intervention component, and emerging work has begun to integrate digital self-monitoring into technology-mediated interventions. With rapid advances in technology-mediated interventions, a focused synthesis of literature examining the role of digital self-monitoring tools in managing GWG is warranted to guide clinical practice and inform future studies. Objective: The proposed review aims to synthesize the emerging research base evaluating digital GWG self-monitoring interventions, primarily focusing on whether the intervention is effective in managing GWG. Depending on the characteristics of the included research, secondary focus areas will comprise intervention recruitment and retention, feasibility, acceptability, and differences between stand-alone and multicomponent interventions. Methods: This protocol was developed following the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines for systematic review protocols. The proposed review would use a planned and systematic approach to identify, evaluate, and synthesize relevant and recent empirical quantitative studies (reported in English) examining the use of digital weight self-monitoring tools in the context of technology-mediated interventions to manage GWG in pregnant US adults, with at least 2 instances of data collection. Literature eligible for inclusion will have a publication date between January 2010 and July 2020. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies will be used to assess the methodological quality of included studies across various domains, and results will be synthesized and summarized per the synthesis without meta-analysis guidelines. Results: The initial queries of 1150 records have been executed and papers have been screened for inclusion. Data extractions are expected to be finished by December 2023. Results are expected in 2024. The systematic review that will be generated from this protocol will offer evidence for the use of digital self-monitoring tools in the management of GWG. Conclusions: The planned, focused synthesis of relevant literature has the potential to inform the use of digital weight self-monitoring tools in the context of future technology-mediated interventions to manage GWG. In addition, the planned review has the potential to contribute as part of a broader movement in research toward empirically supporting the inclusion of specific components within more extensive, multicomponent interventions to balance parsimony and effectiveness. Trial Registration: PROSPERO CRD42020204820; https://tinyurl.com/ybzt6bvr International Registered Report Identifier (IRRID): PRR1-10.2196/50145 
%M 37883145
%R 10.2196/50145
%U https://www.researchprotocols.org/2023/1/e50145
%U https://doi.org/10.2196/50145
%U http://www.ncbi.nlm.nih.gov/pubmed/37883145

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 6
%N 
%P e48934
%T Understanding the Tensions of “Good Motherhood” Through Women’s Digital Technology Use: Descriptive Qualitative Study
%A Facca,Danica
%A Hall,Jodi
%A Hiebert,Bradley
%A Donelle,Lorie
%+ College of Nursing, University of South Carolina, 1601 Greene Street, Colombia, SC, 29208, United States, 1 803 777 6528, ldonelle@mailbox.sc.edu
%K motherhood
%K parenting
%K digital health
%K apps
%K social media
%K mother
%K parent
%K technology use
%K use
%K computer use
%K interview
%K interviews
%K perspective
%K perspectives
%K mothers
%K mobile phone
%D 2023

%7 25.10.2023
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Research suggests that expectant and new mothers consult and value information gathered from digital technologies, such as pregnancy-specific mobile apps and social media platforms, to support their transition to parenting. Notably, this transitional context can be rich with profound physiological, psychological, and emotional fluctuation for women as they cope with the demands of new parenting and navigate the cultural expectations of “good motherhood.” Given the ways in which digital technologies can both support and hinder women’s perceptions of their parenting abilities, understanding expectant and new mothers’ experiences using digital technologies and the tensions that may arise from such use during the transition to parenting period warrants nuanced exploration. Objective: This study aims to understand mothers’ use of digital technologies during the transition to parenting period. Methods: A descriptive qualitative study was conducted in a predominantly urban region of Southwestern Ontario, Canada. Purposive and snowball sampling strategies were implemented to recruit participants who had become a parent within the previous 24 months. Researchers conducted focus groups using a semistructured interview guide with 26 women. The interviews were audio recorded, transcribed, and thematically analyzed. Results: Participants’ experiences of using digital technologies in the transition to parenting period were captured within the overarching theme “balancing the tensions of digital technology use in the transition to parenting” and 4 subthemes: self-comparison on social media, second-guessing parenting practices, communities of support, and trusting intuition over technology. Although digital technologies purportedly offered “in-the-moment” access to community support and health information, this came at a cost to mothers, as they described feelings of guilt, shame, and self-doubt that provoked them to question and hold in contention whether they were a good mother and using technology in a morally upright manner. Conclusions: These findings raise critical questions concerning the promotion and commercialization of digital technologies and the ways in which they can further push the boundaries of hegemonic parenting practices, provoke feelings of inadequacy, and compromise well-being among expectant and new mothers. 
%M 37878372
%R 10.2196/48934
%U https://pediatrics.jmir.org/2023/1/e48934
%U https://doi.org/10.2196/48934
%U http://www.ncbi.nlm.nih.gov/pubmed/37878372

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 9
%N 
%P e40783
%T Testing for Hepatitis C During Pregnancy Among Persons With Medicaid and Commercial Insurance: Cohort Study
%A Khan,Mohammed A
%A Thompson,William W
%A Osinubi,Ademola
%A Meyer 3rd,William A
%A Kaufman,Harvey W
%A Armstrong,Paige A
%A Foster,Monique A
%A Nelson,Noele P
%A Wester,Carolyn
%+ Division of Viral Hepaitits, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30329, United States, 1 404 718 5807, odt5@cdc.gov
%K hepatitis C
%K testing
%K pregnancy
%K pregnant
%K trend
%K insurance
%K insured
%K HCV
%K hepatitis
%K Medicaid
%K health coverage
%K maternal
%K fetus
%K birth
%K natal
%K maternity
%K liver
%K communicable disease
%K viral infection
%D 2023

%7 27.9.2023
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: The reported incidence of acute hepatitis C virus (HCV) infection is increasing among persons of childbearing age in the United States. Infants born to pregnant persons with HCV infection are at risk for perinatal HCV acquisition. In 2020, the United States Preventive Services Task Force and Centers for Disease Control and Prevention recommended that all pregnant persons be screened during each pregnancy for hepatitis C. However, there are limited data on trends in hepatitis C testing during pregnancy. Objective: We estimated hepatitis C testing rates in a large cohort of patients with Medicaid and commercial insurance who gave birth during 2015-2019 and described demographic and risk-based factors associated with testing. Methods: Medicaid and commercial insurance claims for patients aged 15-44 years and who gave birth between 2015 and 2019 were included. Birth claims were identified using procedure and diagnosis codes for vaginal or cesarean delivery. Hepatitis C testing was defined as an insurance claim during the 42 weeks before delivery. Testing rates were calculated among patients who delivered and among the subset of patients who were continuously enrolled for 42 weeks before delivery. We also compared the timing of testing relative to delivery among patients with commercial or Medicaid insurance. Multivariable logistic regression was used to identify factors associated with testing. Results: Among 1,142,770 Medicaid patients and 1,207,132 commercially insured patients, 175,223 (15.3%) and 221,436 (18.3%) were tested for hepatitis C during pregnancy, respectively. Testing rates were 89,730 (21.8%) and 187,819 (21.9%) among continuously enrolled Medicaid and commercially insured patients, respectively. Rates increased from 2015 through 2019 among Medicaid (from 20,758/108,332, 19.2% to 13,971/52,330, 26.8%) and commercially insured patients (from 38,308/211,555, 18.1% to 39,152/139,972, 28%), respectively. Among Medicaid patients, non-Hispanic Black (odds ratio 0.73, 95% CI 0.71-0.74) and Hispanic (odds ratio 0.53, 95% CI 0.51-0.56) race or ethnicity were associated with lower odds of testing. Opioid use disorder, HIV infection, and high-risk pregnancy were associated with higher odds of testing in both Medicaid and commercially insured patients. Conclusions: Hepatitis C testing during pregnancy increased from 2015 through 2019 among patients with Medicaid and commercial insurance, although tremendous opportunity for improvement remains. Interventions to increase testing among pregnant persons are needed. 
%M 37756048
%R 10.2196/40783
%U https://publichealth.jmir.org/2023/1/e40783
%U https://doi.org/10.2196/40783
%U http://www.ncbi.nlm.nih.gov/pubmed/37756048

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e46663
%T Perceptions and Challenges of Telehealth Obstetric Clinics Among Pregnant Women in Hong Kong: Cross-Sectional Questionnaire Study
%A Cheung,Ka Wang
%A Au,Tiffany Sin-Tung
%A Wai,Joan Kar On
%A Seto,Mimi Tin-Yan
%+ Department of Obstetrics & Gynaecology, The University of Hong Kong, 6/F, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China (Hong Kong), 852 22554517, kelvincheung82@hotmail.com
%K delivery
%K digital
%K portable electronic applications
%K smartphone
%K pregnancy
%K virtual clinics
%K telehealth
%K telemedicine
%D 2023

%7 19.9.2023
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Integrating telehealth in an obstetric care model is important to prepare for possible infection outbreaks that require social distancing and limit in-person consultations. To ensure the successful implementation of obstetric telehealth in Hong Kong, it is essential to understand and address pregnant women’s concerns. Objective: This study aimed to assess pregnant women’s attitudes, concerns, and perceptions regarding telehealth obstetric clinic services in Hong Kong. Methods: We conducted a prospective cross-sectional questionnaire study at Queen Mary Hospital between November 2021 and August 2022. Utilizing a 5-point rating scale, the questionnaire aimed to capture pregnant women’s preferences, expectations, feasibility perceptions, and privacy concerns related to telehealth clinic services. We used statistical analyses, including chi-square tests and multinomial logistic regression, to compare questionnaire responses and investigate the association between advancing gestation and attitudes toward telehealth clinics. Results: The study included 664 participants distributed across different pregnancy stages: 269 (40.5%) before 18 gestational weeks, 198 (29.8%) between 24 and 31 weeks, and 197 (29.7%) after delivery. Among them, 49.8% (329/664) favored face-to-face consultations over telehealth clinics, and only 7.3% (48/664) believed the opposite. Additionally, 24.2% (161/664) agreed that telehealth clinics should be launched for obstetric services. However, the overall preference for telehealth clinics was <20% for routine prenatal checkups (81/664, 12.2%) and addressing pregnancy-related concerns, such as vaginal bleeding (76/664, 11.5%), vaginal discharge (128/664, 19.4%), reduced fetal movement (64/664, 9.7%), uterine contractions (62/664, 9.4%), and suspected leakage of amniotic fluid (54/664, 8.2%). Conversely, 76.4% (507/664) preferred telehealth clinics to in-person visits for prenatal education talks, prenatal and postpartum exercise, and addressing breastfeeding problems. Participants were more comfortable with telehealth clinic tasks for tasks like explaining pregnancy exam results (418/664, 63.1%), self-administering urinary dipsticks at home (373/664, 56.4%), medical history-taking (341/664, 51.5%), and self-monitoring blood pressure using an electronic machine (282/664, 42.8%). %). During the postpartum period, compared to before 18 weeks of gestation, significantly more participants agreed that telehealth clinics could be an option for assessing physical symptoms such as vaginal bleeding (aOR 2.105, 95% CI 1.448-3.059), reduced fetal movement (aOR 1.575, 95% CI 1.058-2.345), uterine contractions (aOR 2.906, 95% CI 1.945-4.342), suspected leakage of amniotic fluid (aOR 2.609, 95% CI 1.721-3.954), fever (aOR 1.526, 95% CI 1.109-2.100), and flu-like symptoms (aOR 1.412, 95% CI 1.030-1.936). They were also more confident with measuring the symphysis-fundal height, arranging further investigations, and making diagnoses with the doctor via the telehealth clinic. The main perceived public health advantage of telehealth clinics was the shorter traveling and waiting time (526/664, 79.2%), while the main concern was legal issues from wrong diagnosis and treatment (511/664, 77.4%). Conclusions: Face-to-face consultation remained the preferred mode of consultation among the participants. However, telehealth clinics could be an alternative for services that do not require physical examination or contact. An increased acceptance of and confidence in telehealth was found with advancing gestation and after delivery. Enforcing stricter laws and guidelines could facilitate the implementation of telehealth clinics and increase confidence in their use among pregnant women for obstetric care. 
%M 37725425
%R 10.2196/46663
%U https://www.jmir.org/2023/1/e46663
%U https://doi.org/10.2196/46663
%U http://www.ncbi.nlm.nih.gov/pubmed/37725425

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e51431
%T A Complex mHealth Coaching Intervention to Prevent Overweight, Obesity, and Diabetes in High-Risk Women in Antenatal Care: Protocol for a Hybrid Type 2 Effectiveness-Implementation Study
%A O'Reilly,Sharleen L
%A Laws,Rachel
%A Maindal,Helle Terkildsen
%A Teede,Helena
%A Harrison,Cheryce
%A McAuliffe,Fionnuala M
%A Geraghty,Aisling
%A Campoy,Cristina
%A Bermúdez,Mercedes G
%A Pirhonen,Laura
%A Burden,Christy
%A Davies,Anna
%A Laursen,Ditte Hjorth
%A Skinner,Timothy
%A ,
%+ School of Agriculture and Food Science, University College Dublin, School of Agriculture and Food Science, University College Dublin, Belfield, Dublin, D4, Ireland, 353 17162157, sharleen.oreilly@ucd.ie
%K hybrid type 2 effectiveness-implementation
%K gestational diabetes
%K obesity
%K mHealth
%K mobile health
%K health behavior change
%K pregnancy
%K postpartum
%K weight management
%K health coaching
%K maternal health
%D 2023

%7 18.9.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Women with overweight and obesity are at higher risk of developing complications in pregnancy such as gestational diabetes and longer-term chronic conditions. Research concerning health behavior change interventions during pregnancy and postpartum shows promising effects, but implementation into routine services is sparsely investigated. Most interventions focus on the antenatal or postpartum life stages, failing to meet the needs of women. IMPACT DIABETES Bump2Baby is a multicenter project across 4 high-income countries developed to test the implementation of an antenatal and postpartum evidence-based mobile health (mHealth) coaching intervention called Bump2Baby and Me (B2B&Me) designed to sit alongside usual care in the perinatal period. Objective: We aim to explore the feasibility and implementation of the B2B&Me intervention and investigate the effectiveness of this intervention in women at risk of gestational diabetes. Methods: IMPACT DIABETES Bump2Baby is a hybrid type 2 effectiveness-implementation study, which integrates an evidence-based mHealth coaching app that includes personalized health behavior change coaching provided by health care professionals alongside antenatal care from the first antenatal visit to 12 months postpartum. The mHealth app offers the possibility of synchronous calls, asynchronous contact (including coach-participant text and video messaging exchanges tailored to the participant’s needs), and ongoing access to an extensive library of bespoke intervention materials. Participants will interact asynchronously with their health coach throughout the intervention via the app. This randomized controlled trial across 4 clinical sites within Ireland, the United Kingdom, Spain, and Australia will recruit 800 women in early pregnancy to evaluate the effectiveness on postpartum weight. The Exploration, Preparation, Implementation, and Sustainment implementation framework is the theoretical underpinning of the study. The implementation evaluation will be assessed at the individual, hospital staff, and broader community levels using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Data sources for the RE-AIM evaluation will include app and platform analytics, screening and training records, participant medical records, key informant interviews, participant and partner exit interviews, cost data, study questionnaires, staff surveys, and blood sample analyses. Results: The study was approved and registered with the Australian New Zealand Clinical Trials Registry on November 19, 2020. Recruitment commenced on February 9, 2021, and data collection is ongoing. Publication of the results is expected in 2024. Conclusions: This is the first hybrid effectiveness-implementation study of an 18-month mHealth coaching intervention in at-risk women that we are aware of. As research aims to move toward real-world implementable solutions, it is critical that hybrid studies are conducted. The data from this large multicenter study will be useful in planning the potential implementation and scale-up of evidence-based perinatal health behavior change interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001240932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380020&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/51431 
%M 37721798
%R 10.2196/51431
%U https://www.researchprotocols.org/2023/1/e51431
%U https://doi.org/10.2196/51431
%U http://www.ncbi.nlm.nih.gov/pubmed/37721798

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e43654
%T A Tailored mHealth Intervention for Improving Antenatal Care Seeking and Health Behavioral Determinants During Pregnancy Among Adolescent Girls and Young Women in South Africa: Development and Protocol for a Pilot Randomized Controlled Trial
%A Sewpaul,Ronel
%A Resnicow,Ken
%A Crutzen,Rik
%A Dukhi,Natisha
%A Ellahebokus,Afzal
%A Reddy,Priscilla
%+ Public Health, Societies and Belonging, Human Sciences Research Council, 134 Pretorius Street, Pretoria, 0002, South Africa, 27 214667912, rsewpaul@hsrc.ac.za
%K antenatal care
%K adolescent girls and young women
%K AGYW
%K adolescent pregnancy
%K mobile health
%K mHealth
%K tailoring
%K motivational interviewing
%K South Africa
%K mobile phone
%D 2023

%7 13.9.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: South Africa, a middle-income country, has an adolescent fertility rate far higher than that of high-income countries. Adolescent girls and young women have an increased risk of pregnancy-related complications and lower antenatal appointment attendance rates than older adult pregnant women. Mobile health (mHealth) interventions to improve health behaviors among pregnant adolescent girls and young women in low- and middle-income countries are scarce. Objective: This paper describes the development and components of an mHealth intervention to improve antenatal appointment attendance and health behavioral determinants among pregnant adolescent girls and young women in South Africa and details the protocol for a pilot randomized controlled trial that evaluated the intervention’s efficacy and user acceptability. Methods: The intervention, Teen MomConnect, sent tailored motivational behavior change and behavioral reinforcement SMS text messages to participants about antenatal appointment keeping and pregnancy behaviors. The delivery methodology of the intervention was adapted from MomConnect, an mHealth education program for pregnant women in South Africa that has nationwide coverage. In addition, participants received a face-to-face motivational interviewing session delivered by a trained research assistant. Pregnant adolescent girls and young women aged 13 to 20 years were recruited from health facilities and community networks. Participants were randomized into the control group that received the standard MomConnect health SMS text messages or the experimental group that received the Teen MomConnect intervention. Participants completed a baseline questionnaire upon enrollment in the study and a follow-up questionnaire after the end of their pregnancy. The questionnaires assessed demographic characteristics, pregnancy behaviors, and the psychosocial determinants of antenatal appointment attendance (knowledge, attitudes, social support, risk perceptions, self-efficacy, intention, and action planning). Feasibility was assessed using descriptive analyses of acceptability, study implementation processes, and perceived satisfaction with the intervention. The number of appointments attended was obtained from the participants’ clinic records. Appointment attendance was compared between the control and experimental groups, as were awareness of HIV status and the psychosocial determinants of antenatal appointment attendance. Results: Participant recruitment was conducted from May 2018 to December 2018, and the questionnaire-based data collection was completed by December 2019. Overall, 412 participants were enrolled. Conclusions: This paper describes the Teen MomConnect intervention to improve antenatal appointment attendance and pregnancy health behaviors among adolescent girls and young women. The results on the intervention’s preliminary efficacy and user acceptability will inform policy makers and health program officers on how tailored, age-appropriate, and motivational health behavior messages can be delivered via mobile phone to pregnant adolescent girls and young women. Trial Registration: Pan African Clinical Trial Registry (PACTR) PACTR201912734889796; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9565 International Registered Report Identifier (IRRID): DERR1-10.2196/43654 
%M 37703092
%R 10.2196/43654
%U https://www.researchprotocols.org/2023/1/e43654
%U https://doi.org/10.2196/43654
%U http://www.ncbi.nlm.nih.gov/pubmed/37703092

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e42686
%T Changes in Intrapersonal Factors of Participants in the Pregnancy Remote Monitoring Study Who Are at Risk for Pregnancy-Induced Hypertension: Descriptive Quantitative Study
%A Lanssens,Dorien
%A Vandenberk,Thijs
%A Storms,Valerie
%A Thijs,Inge
%A Grieten,Lars
%A Bamelis,Lotte
%A Gyselaers,Wilfried
%A Tang,Eileen
%A Luyten,Patrick
%+ Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Hasselt, 3500, Belgium, 32 494919476, dorien.lanssens@uhasselt.be
%K intrapersonal factors
%K peripartum period
%K pregnancy
%K pregnancy-induced hypertension
%K remote monitoring
%D 2023

%7 6.9.2023
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: The peripartum period, defined as the period from the beginning of the gestation until 1 year after the delivery, has long been shown to be potentially associated with increased levels of stress and anxiety with regard to one’s transition to the status of parent and the accompanying parental tasks. Yet, no research to date has investigated changes in intrapersonal factors during the peripartum period in women at risk for pregnancy-induced hypertension (PIH). Objective: The aim of this study is to explore and describe changes in intrapersonal factors in participants at risk for PIH. Methods: We used an explorative design in which 3 questionnaires were sent by email to 110 participants the day following enrollment in the Pregnancy Remote Monitoring program for pregnant women at risk for PIH. Women were invited to complete the questionnaires at the beginning of their participation in the Pregnancy Remote Monitoring project (mostly at 14 weeks of gestation) and after approaching 32 weeks of gestational age (GA). The Generalized Anxiety Disorder-7 Scale (GAD-7) and the Patient Health Questionnaire-9 were used to assess anxiety and depression, and adaptation of the Pain Catastrophizing Scale was used to measure trait pain catastrophizing. Results: Scores were significantly higher at 32 weeks of GA than at the moment of enrollment (GAD-7 score=7, range 4-11 vs 5, range 3-8; P=.01; and Patient Health Questionnaire-9 score=6, range 4-10 vs 4, range 2-7; P<.001). The subscale scores of the Pain Catastrophizing Scale were all lower at 32 weeks of GA compared with 14 weeks of GA (rumination: 4, range 1-6 vs 5, range 2-9.5; P=.11; magnification: 3, range 1-5.5 vs 4, range 3-7; P=.04; and helplessness: 5, range 2-9 vs 6, range 3.5-12; P=.06). The proportion of women with a risk for depression (GAD-7 score >10) was 13.3% (10/75) at enrollment and had increased to 35.6% (26/75) at 32 weeks of GA. Conclusions: This study shows that pregnant women at risk for PIH have higher levels of stress and anxiety at 32 weeks of GA than at the moment of enrollment. Further research is recommended to investigate potential strategies to help pregnant women at risk for PIH manage feelings of stress and anxiety. Trial Registration: ClinicalTrials.gov NCT03246737; https://clinicaltrials.gov/study/NCT03246737 
%M 37672324
%R 10.2196/42686
%U https://www.jmir.org/2023/1/e42686
%U https://doi.org/10.2196/42686
%U http://www.ncbi.nlm.nih.gov/pubmed/37672324

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e42559
%T Telephone-Based Intervention to Improve Family Planning Care in Pregnancies of Unknown Location: Retrospective Pre-Post Study
%A Flynn,Anne Nichols
%A Koelper,Nathanael C
%A Sonalkar,Sarita
%+ University of California, Davis, 4860 Y St, Sacramento, CA, 95817, United States, 1 916 734 6900, aenflynn@ucdavis.edu
%K contraception
%K electronic medical record
%K family planning
%K pregnancy intendedness
%K pregnancy of unknown location
%K pre-post study
%K telephone-based intervention
%D 2023

%7 28.8.2023
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Patients followed for a pregnancy of unknown location are generally followed by a team of clinicians through telephone calls, and their contraceptive needs at the time of pregnancy resolution may not be addressed. Objective: This study aimed to assess contraceptive counseling and contraceptive uptake before and after a telephone-based intervention. Methods: This was a retrospective pre-post study assessing pregnancy intendedness in patients with a pregnancy of unknown location and the proportion of patients who received contraceptive counseling and a contraceptive prescription before and after the initiation of a telephone-based intervention. We reviewed medical records 1 year before and 1 year after implementation of our intervention for demographic characteristics, pregnancy intendedness, pregnancy outcome, contraceptive counseling documentation, receipt of contraception, and repeat pregnancy within 6 months. We assessed the effects of an implementation strategy to address family planning needs once pregnancy was resolved by comparing the proportions of patients who were counseled and received contraception before and after our intervention was implemented. We performed logistic regression to identify associations between covariates and the outcomes of contraceptive counseling documentation and receipt of contraception. Results: Of the 220 patients in the combined cohort, the majority were Black (161/220, 73%) and ultimately had a resolved pregnancy of unknown location (162/220, 74%), and the proportion of pregnancies documented as unintended was 60% (132/220). Before our intervention, 27 of 100 (27%) patients received contraceptive counseling, compared with 94 of 120 (78%) patients after the intervention (odds ratio [OR] 9.77, 95% CI 5.26-18.16). Before the intervention, 17 of 90 (19%) patients who did not desire repeat pregnancy received contraception, compared with 32 of 86 (37%) patients after the intervention (OR 2.54, 95% CI 1.28-5.05). Our postintervention cohort had an increased odds of receiving contraceptive counseling (OR 9.77, 95% CI 5.26-18.16) and of receiving a contraceptive prescription (OR 2.54, 95% CI 1.28-5.05) compared with our preintervention cohort. Conclusions: We found that over half of patients with a pregnancy of unknown location have an unintended pregnancy, and standardization of care through a telephone-based intervention improves contraceptive counseling and prescribing in patients with a resolved pregnancy of unknown location. This intervention could be used at any institution that follows patients with a pregnancy of unknown location remotely to improve care. 
%M 37639302
%R 10.2196/42559
%U https://www.jmir.org/2023/1/e42559
%U https://doi.org/10.2196/42559
%U http://www.ncbi.nlm.nih.gov/pubmed/37639302

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 6
%N 
%P e44701
%T Comparing the Effectiveness of a Web-Based Application With a Digital Live Seminar to Improve Safe Communication for Pregnant Women: 3-Group Partially Randomized Controlled Trial
%A Kötting,Lukas
%A Derksen,Christina
%A Keller,Franziska Maria
%A Lippke,Sonia
%+ Psychology & Methods, Constructor University, Campus Ring 1, Bremen, 28759, Germany, 49 421 200 4721, l.koetting@jacobs-university.de
%K Health Action Process Approach
%K HAPA
%K intention
%K safe communication behavior
%K patient safety
%K obstetric patients
%K digital intervention
%K web-based app
%D 2023

%7 24.7.2023
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Medical internet interventions such as asynchronous apps and synchronous digital live seminars can be effective behavior change interventions. The research question of this study was whether digital interventions based on the Health Action Process Approach can improve pregnant women’s safe communication and patient safety in obstetric care. Objective: This study aims to compare a digital live seminar with a web-based application intervention and a passive control group and to identify which social cognitive variables determine safe communication behavior and patient safety. Methods: In total, 657 pregnant women were recruited, and hereof, 367 expectant mothers from 2 German university hospitals participated in the pre-post study (live seminar: n=142; web-based app: n=81; passive control group: n=144). All interventions targeted intention, planning, self-efficacy, and communication of personal preferences. The 2.5-hour midwife-assisted live seminar included exercises on empathy and clear communication. The fully automated web-based application consisted of 9 consecutive training lessons with the same content as that of the live seminar. Results: Controlled for sociodemographic characteristics, repeated measures analyses of covariance revealed that pregnant women significantly improved their self-reported communication behavior in all groups. The improvement was more pronounced after the digital live seminar than after the web-based application (P<.001; ηp2=0.043). Perceived patient safety improved more for pregnant women participating in the live seminar than for those participating in the web-based application group (P=.03 ηp2=0.015). A regression analysis revealed that social cognitive variables predicted safe communication behavior. Conclusions: Overall, the web-based application intervention appeared to be less effective than the digital live training in terms of communication behavior. Application interventions addressing communication behaviors might require more face-to-face elements. Improving intention, coping planning, and coping self-efficacy appeared to be key drivers in developing safe communication behavior in pregnant women. Future research should include social learning aspects and focus on the practical application of medical internet interventions when aiming to improve pregnant women’s communication and patient safety in obstetrics. Trial Registration: ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735 
%M 37486755
%R 10.2196/44701
%U https://pediatrics.jmir.org/2023/1/e44701
%U https://doi.org/10.2196/44701
%U http://www.ncbi.nlm.nih.gov/pubmed/37486755

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e44362
%T A Mobile Clinical Decision Support System for High-Risk Pregnant Women in Rural India (SMARThealth Pregnancy): Pilot Cluster Randomized Controlled Trial
%A Nagraj,Shobhana
%A Kennedy,Stephen
%A Jha,Vivekananda
%A Norton,Robyn
%A Hinton,Lisa
%A Billot,Laurent
%A Rajan,Eldho
%A Mohammed Abdul,Ameer
%A Phalswal,Anita
%A Arora,Varun
%A Praveen,Devarsetty
%A Hirst,Jane
%+ Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, The Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, United Kingdom, 44 1865 281231, shobhana.nagraj@ndm.ox.ac.uk
%K decision support systems
%K clinical
%K telemedicine
%K community health workers
%K pregnancy
%K high risk
%K diabetes
%K gestational
%K cardiovascular diseases
%D 2023

%7 20.7.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Cardiovascular disease (CVD) is the leading cause of death in women in India. Early identification is crucial to reducing deaths. Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) carry independent risks for future CVD, and antenatal care is a window to screen and counsel high-risk women. In rural India, community health workers (CHWs) deliver antenatal and postnatal care. We developed a complex intervention (SMARThealth Pregnancy) involving mobile clinical decision support for CHWs and evaluated it in a pilot cluster randomized controlled trial (cRCT). Objective: The aim of the study is to co-design a theory-informed intervention for CHWs to screen, refer, and counsel pregnant women at high risk of future CVD in rural India and evaluate its feasibility and acceptability. Methods: In phase 1, we used qualitative methods to explore community priorities for high-risk pregnant women in rural areas of 2 diverse states in India. In phase 2, informed by behavior change theory and human-centered design, we used these qualitative data to develop the intervention components and implementation strategies for SMARThealth Pregnancy in an iterative process with end users. In phase 3, using mixed methods, we evaluated the intervention in a cRCT with an embedded qualitative substudy across 4 primary health centres: 2 in Jhajjar district, Haryana, and 2 in Guntur district, Andhra Pradesh. Results: SMARThealth Pregnancy embedded a total of 15 behavior change techniques and included (1) community awareness programs; (2) targeted training, including point-of-care blood pressure and hemoglobin measurement; and (3) mobile clinical decision support for CHWs to screen women in their homes. The intervention focused on 3 priority conditions: anemia, HDP, and GDM. The evaluation involved a total of 200 pregnant women, equally randomized to intervention or enhanced standard care (control). Recruitment was completed within 5 months, with minimal loss to follow-up (4/200, 2%) at 6 weeks postpartum. A total of 4 primary care doctors and 54 CHWs in the intervention clusters took part in the study. Fidelity to intervention practices was 100% prepandemic. Over half the study population was affected by moderate to severe anemia at baseline. The prevalence of HDP (2.5%) and GDM (2%) was low in our study population. Results suggest a possible improvement in mean hemoglobin (anemia) in the intervention group, although an adequately powered trial is needed. The model of home-based care was feasible and acceptable for pregnant or postpartum women and CHWs, who perceived improvements in quality of care, self-efficacy, and professional recognition. Conclusions: SMARThealth Pregnancy is an innovative model of home-based care for high-risk pregnant women during the transitions between antenatal and postnatal care and adult health services. The use of theory and co-design during intervention development facilitated acceptability of the intervention and implementation strategies. Our experience has informed the decision to initiate a larger-scale cRCT. Trial Registration: ClinicalTrials.gov NCT03968952; https://clinicaltrials.gov/ct2/show/NCT03968952 International Registered Report Identifier (IRRID): RR2-10.3389/fgwh.2021.620759 
%M 37471135
%R 10.2196/44362
%U https://formative.jmir.org/2023/1/e44362
%U https://doi.org/10.2196/44362
%U http://www.ncbi.nlm.nih.gov/pubmed/37471135

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e46395
%T Web-Based Survey Piloting Process as a Model for Developing and Testing Past Contraceptive Use and Pregnancy History: Cystic Fibrosis Case Study
%A Godfrey,Emily M
%A Schwartz,Malaika  R
%A Stukovsky,Karen D Hinckley
%A Woodward,Danielle
%A Magaret,Amalia S
%A Aitken,Moira L
%+ Departments of Family Medicine and Obstetrics and Gynecology, University of Washington, 4311 11th Ave, NE, Box 354982, Seattle, WA, 98103, United States, 1 206 685 4895, godfreye@uw.edu
%K contraception
%K chronic disease
%K genetic disease
%K questionnaire reliability
%K surveys and questionnaires
%K contraceptive
%K birth control
%K cystic fibrosis
%K reproductive health
%K pregnancy
%K electronic survey
%K obstetrical history
%D 2023

%7 18.7.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Individuals with complex, chronic diseases are now living longer, making reproductive health an important topic to address in the health care setting. Self-respondent surveys are a feasible way to collect past contraceptive use and pregnancy history to assess contraceptive safety and effectiveness. Because sensitive topics, such as contraception and pregnancy outcomes, can vary across social groups or cultures, piloting questions and evaluating survey administration procedures in the target population are necessary for precise and reliable responses before wide distribution. Objective: This study aimed to develop a precise and reliable survey instrument and related procedures among individuals with cystic fibrosis regarding contraceptive use and obstetrical history. Methods: We piloted and tested web-based questions related to contraceptive use and pregnancy history among 50 participants with and those without cystic fibrosis aged 18 to 45 years using a 3-tier process. Findings from each tier informed changes to the questionnaire before testing in the subsequent tier. Tier 1 used cognitive pretesting to assess question understanding and the need for memory prompts. In tier 2, we used test-retest self- and interviewer-administered approaches to assess question reliability, evaluate response missingness, and determine confidence between 2 types of survey administration approaches. In tier 3, we tested the questionnaire for clarity, time to complete, and whether additional prompts were necessary. Results: In tier 1, respondents suggested improvements to the web-based survey questions and to the written and visual prompts for better recall regarding past contraceptive use. In tier 2, the test-retest reliability between self- and interviewer-administrative procedures of “ever use” contraceptive method questions was similar, with percent absolute agreement ranging between 84% and 100%. When the survey was self-administered, the percentage of missing responses was higher and respondent confidence about month and year when contraceptive methods were used was lower. Most respondents reported that they preferred the self-administered survey because it was more convenient and faster to complete. Conclusions: Our 3-tier process to pilot web-based survey questions related to contraceptive and obstetrical history in our complex disease population helped us tailor content and format questions before wide dissemination to our target population. Results from this pilot study informed the subsequent larger study design to include a 10% respondent test-retest self- and interviewer-administered quality control component to better inform imputation procedures of missing data. 
%M 37463015
%R 10.2196/46395
%U https://formative.jmir.org/2023/1/e46395
%U https://doi.org/10.2196/46395
%U http://www.ncbi.nlm.nih.gov/pubmed/37463015

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e45983
%T Indigenous Women and Their Nutrition During Pregnancy (the Mums and Bubs Deadly Diets Project): Protocol for a Co-designed mHealth Resource Development Study
%A Gilbert,Stephanie
%A Irvine,Rachel
%A D'or,Melissa
%A Adam,Marc T P
%A Collins,Clare E
%A Marriott,Rhonda
%A Rollo,Megan
%A Walker,Roz
%A Rae,Kym
%+ Mater Research Institute, Aubigny Place, 1 Raymond Terrace, Brisbane, 4101, Australia, 61 0431379872, kym.rae@uq.edu.au
%K co-design
%K community-based participatory research
%K mHealth
%K Aboriginal and Torres Strait Islander
%K maternal health
%K pregnancy
%K nutrition
%K Indigenous women
%K diet
%K health literacy
%K Indigenous
%K Indigenous people
%K mobile phone
%D 2023

%7 6.7.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Nutrition in pregnancy is pivotal to optimizing infant growth and maternal well-being. The factors affecting Indigenous people’s food and nutrition intake are complex with a history of colonization impacting the disproportionate effect of social determinants to this day. Literature regarding the dietary intake or dietary priorities of Indigenous women in Australia is scarce, with supportive, culturally appropriate resources developed for and with this group rare. Research suggests mobile health (mHealth) tools are effective in supporting health knowledge of Indigenous people and positive health behavior changes when designed and developed with the expertise of Indigenous communities. Objective: This study seeks to build the body of knowledge related to nutrition needs and priorities for Indigenous women in Australia during pregnancy. Further, this project team and its participants will co-design an mHealth digital tool to support these nutrition needs. Methods: The Mums and Bubs Deadly Diets study recruits Indigenous women and health care professionals who support Indigenous women during pregnancy into 2 phases. Phase 1 (predesign) uses a mixed methods convergent design using a biographical questionnaire and social or focus groups to inform phase 2 (generative). Phase 2 will use a participatory action research process during co-design workshops to iteratively develop the digital tool; the exact actions within a workshop will evolve according to the participant group decisions. Results: To date, this project has undertaken phase 1 focus groups at all Queensland sites, with New South Wales and Western Australia to begin in early to mid-2023. We have recruited 12 participants from Galangoor Duwalami, 18 participants from Carbal in Toowoomba, and 18 participants from Carbal in Warwick. We are expecting similar numbers of recruits in Western Australia and New South Wales. Participants have been both community members and health care professionals. Conclusions: This study is an iterative and adaptive research program that endeavors to develop real-world, impactful resources to support the nutrition needs and priorities of pregnant Indigenous women in Australia. This comprehensive project requires a combination of methods and methodologies to ensure Indigenous voices are heard at each stage and in all aspects of research output. The development of an mHealth resource for this cohort will provide a necessary bridge where there is often a gap in access to nutrition resources for women in pregnancy in Indigenous communities. International Registered Report Identifier (IRRID): DERR1-10.2196/45983 
%M 37147188
%R 10.2196/45983
%U https://www.researchprotocols.org/2023/1/e45983
%U https://doi.org/10.2196/45983
%U http://www.ncbi.nlm.nih.gov/pubmed/37147188

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e43528
%T Effect of a Mobile App–Based Urinary Incontinence Self-Management Intervention Among Pregnant Women in China: Pragmatic Randomized Controlled Trial
%A Chen,Ling
%A Zhang,Danli
%A Li,Tiantian
%A Liu,Sha
%A Hua,Jie
%A Cai,Wenzhi
%+ Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoán District Shenzhen, Guangdong, Shenzhen, 518101, China, 86 13078484316, caiwzh@smu.edu.cn
%K mobile health
%K mHealth
%K mobile apps
%K urinary incontinence
%K pregnancy
%K pragmatic randomized controlled trial
%K mobile phone
%D 2023

%7 27.6.2023
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Urinary incontinence (UI) is a highly prevalent health concern commonly observed during and after pregnancy that can substantially impact women’s physical and psychological well-being and quality of life. Owing to its numerous advantages, mobile health may be a promising solution; however, it is unclear whether the app-based intervention can effectively improve UI symptoms during and after pregnancy. Objective: This study aimed to evaluate the effectiveness of the Urinary Incontinence for Women (UIW) app–based intervention for UI symptom improvement among pregnant women in China. Methods: Singleton pregnant women without incontinence before pregnancy who were aged ≥18 years and between 24 and 28 weeks of gestation were recruited from a tertiary public hospital in China and were randomly allocated (1:1) to either an experimental group (n=63) or a control group (n=63). The experimental group received the UIW app intervention and oral pelvic floor muscle training (PFMT) instructions, whereas the control group received oral PFMT instructions alone. Neither the participants nor the researchers were blinded to the intervention. The primary outcome was UI severity. The secondary outcomes included quality of life, self-efficacy with PFMT, and knowledge of UI. All data were collected at baseline, 2 months after randomization, and 6 weeks post partum through electronic questionnaires or by checking the electronic medical record system. Data analysis followed the intention-to-treat principle. A linear mixed model was used to examine the intervention effect on primary and secondary outcomes. Results: Participants in the experimental and control groups were comparable at baseline. Of the 126 overall participants, 117 (92.9%) and 103 (81.7%) women completed follow-up visits at 2 months after randomization and 6 weeks after delivery, respectively. A statistically significant difference in UI symptom severity was observed between the experimental group and control group (2 months after randomization: mean difference −2.86, 95% CI −4.09 to −1.64, P<.001; 6 weeks post partum: mean difference −2.68, 95% CI −3.87 to −1.49, P<.001). For the secondary outcomes, a statistically significant intervention effect on the quality of life, self-efficacy, and UI knowledge was found at the 2-month follow-up (all P<.05) and 6 weeks post partum (all P<.001). Conclusions: The app-based UI self-management intervention (UIW) effectively improved UI symptom severity, quality of life, self-efficacy with PFMT, and knowledge of UI during the late pregnancy and early postnatal periods. Larger multicenter studies with a longer postpartum follow-up are required to further extend these findings. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800016171; http://www.chictr.org.cn/showproj.aspx?proj=27455 International Registered Report Identifier (IRRID): RR2-10.2196/22771 
%M 37368465
%R 10.2196/43528
%U https://www.jmir.org/2023/1/e43528
%U https://doi.org/10.2196/43528
%U http://www.ncbi.nlm.nih.gov/pubmed/37368465

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e48228
%T Rationale, Design, and Methods for the Sedentary Behavior Reduction in Pregnancy Intervention (SPRING): Protocol for a Pilot and Feasibility Randomized Controlled Trial
%A Barone Gibbs,Bethany
%A Kozai,Andrea C
%A McAdoo,Shannon N
%A Bastyr,Meghan C
%A Davis,Kelliann D
%A Hauspurg,Alisse
%A Catov,Janet M
%+ Department of Epidemiology and Biostatistics, West Virginia University School of Public Health, 64 Medical Center Drive, PO Box 9190, Morgantown, WV, 26506, United States, 1 4123105988, bethany.gibbs@hsc.wvu.edu
%K pregnancy
%K behavioral intervention
%K pilot and feasibility trial
%K sedentary behavior
%K physical activity
%K mobile phone
%D 2023

%7 14.6.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Adverse pregnancy outcomes (APOs) identify cardiovascular disease risk, but few effective interventions are available. High sedentary behavior (SED) has recently been associated with APOs, but very few randomized controlled trials (RCTs) have tested SED reduction in pregnancy. Objective: The Sedentary Behavior Reduction in Pregnancy Intervention (SPRING) pilot and feasibility RCT addresses this gap by testing the feasibility, acceptability, and preliminary pregnancy health effects of an intervention to reduce SED in pregnant women. The objective of this manuscript is to describe the rationale and design of SPRING. Methods: Pregnant participants (n=53) in their first trimester, who are at risk for high SED and APO and without contraindications, are randomized in a 2:1 ratio to an intervention or control group. SED (primary outcome) and standing durations, and steps per day, are measured objectively in each trimester for 1 week with a thigh-mounted activPAL3 accelerometer. SPRING also seeks to demonstrate feasibility and acceptability while estimating preliminary effects on maternal-fetal health outcomes assessed during study visits and abstracted from medical records. The pregnancy-customized intervention promotes daily behavioral targets of less than 9 hours of SED and at least 7500 steps, achieved via increased standing and incorporating light-intensity movement breaks each hour. The multicomponent intervention provides a height-adjustable workstation, a wearable activity monitor, behavioral counseling every 2 weeks (through videoconference), and membership in a private social media group. Herein, we review the rationale, describe recruitment and screening processes, and detail the intervention, assessment protocols, and planned statistical analyses. Results: This study was funded by the American Heart Association (20TPA3549099), with a funding period of January 1, 2021, and until December 31, 2023. Institutional review board approval was obtained on February 24, 2021. Participants were randomized between October 2021 and September 2022, with final data collection planned for May 2023. Analyses and submission of results are expected for winter of 2023. Conclusions: The SPRING RCT will provide initial evidence on the feasibility and acceptability of an SED-reduction intervention to decrease SED in pregnant women. These data will inform the design of a large clinical trial testing SED reduction as a strategy to reduce APO risk. Trial Registration: ClincialTrials.gov NCT05093842; https://clinicaltrials.gov/ct2/show/NCT05093842 International Registered Report Identifier (IRRID): DERR1-10.2196/48228 
%M 37314845
%R 10.2196/48228
%U https://www.researchprotocols.org/2023/1/e48228
%U https://doi.org/10.2196/48228
%U http://www.ncbi.nlm.nih.gov/pubmed/37314845

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e44500
%T Acceptability of an mHealth App for Monitoring Perinatal and Postpartum Mental Health: Qualitative Study With Women and Providers
%A Varma,Deepthi S
%A Mualem,Maya
%A Goodin,Amie
%A Gurka,Kelly K
%A Wen,Tony Soo-Tung
%A Gurka,Matthew J
%A Roussos-Ross,Kay
%+ Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610, United States, 1 352 294 5941, dvarma@ufl.edu
%K perinatal mental health
%K mobile health
%K mHealth
%K mobile apps
%K ecological momentary assessment
%K EMA
%K mobile phone
%D 2023

%7 7.6.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Up to 15% of pregnant and postpartum women commonly experience undiagnosed and untreated mental health conditions, such as depression and anxiety, which may result in serious health complications. Mobile health (mHealth) apps related to mental health have been previously used for early diagnosis and intervention but not among pregnant and postpartum women. Objective: This study aims to assess the acceptability of using mHealth to monitor and assess perinatal and postpartum depression and anxiety. Methods: Focus group discussions with pregnant and postpartum women (n=20) and individual interviews with health care providers (n=8) were conducted to inform the acceptability of mHealth and determine its utility for assessing perinatal and postpartum mood symptoms. Participants were recruited via purposive sampling from obstetric clinics and the surrounding community. A semistructured interview guide was developed by an epidemiologist with qualitative research training in consultation with an obstetrician. The first author conducted all focus group discussions and provider interviews either in person or via Zoom (Zoom Video Communications, Inc) depending on the COVID-19 protocol that was in place during the study period. All interviews were audio recorded with consent; transcribed; and uploaded for coding to ATLAS.ti 8 (ATLAS.ti Scientific Software Development Gmb H), a qualitative data analysis and retrieval software. Data were analyzed using the deductive content analysis method using a set of a priori codes developed based on the interview guide. Methodological rigor and quality were ensured by adopting a systematic approach during the implementation, data collection, data analysis, and reporting of the data. Results: Almost all women and providers had downloaded and used at least 1 health app. The respondents suggested offering short questions in layperson language that could be understood by women of all educational levels and offering no more than 2 to 3 assessments per day at preferred timings decided by the women themselves. They also suggested that the women themselves receive the alerts first, with other options being family members, spouses, or friends if the women themselves did not respond within 24 to 72 hours. Customization and snooze features were strongly endorsed by women and providers to improve acceptability and utility. Women mentioned competing demands on their time during the postpartum period, fatigue, privacy, and the security of mental health data as concerns. Health care professionals highlighted the long-term sustainability of app-based mood assessment and monitoring as an important challenge. Conclusions: The findings from this study show that mHealth would be acceptable to pregnant and postpartum women for monitoring mood symptoms. This could inform the development of clinically meaningful and inexpensive tools for facilitating the continuous monitoring of, the early diagnosis of, and an early intervention for mood disorders in this vulnerable population. 
%M 37285185
%R 10.2196/44500
%U https://formative.jmir.org/2023/1/e44500
%U https://doi.org/10.2196/44500
%U http://www.ncbi.nlm.nih.gov/pubmed/37285185

%0 Journal Article
        
%@ 1929-073X
%I JMIR Publications
%V 12
%N 
%P e44430
%T Heart Rate Variability and Pregnancy Complications: Systematic Review
%A Sharifi-Heris,Zahra
%A Rahmani,Amir M
%A Axelin,Anna
%A Rasouli,Mahkameh
%A Bender,Miriam
%+ University of California Irvine, 8420 Palo Verde, Irvine, CA, 92697, United States, 1 6506805432, sharifiz@uci.edu
%K autonomic nervous system
%K heart rate variability
%K pregnancy complication
%K pregnancy
%K maternal
%K hypertensive disorder
%K fetal growth
%K global developmental delay
%K hypertension
%D 2023

%7 5.6.2023
%9 Review
%J Interact J Med Res
%G English
                
%X Background: The autonomic nervous system (ANS) is known as a critical regulatory system for pregnancy-induced adaptations. If it fails to function, life-threatening pregnancy complications could occur. Hence, understanding and monitoring the underlying mechanism of action for these complications are necessary. Objective: We aimed to systematically review the literature concerned with the associations between heart rate variability (HRV), as an ANS biomarker, and pregnancy complications. Methods: We performed a comprehensive search in the PubMed, Medline Completion, CINAHL Completion, Web of Science Core Collection Classic, Cochrane Library, and SCOPUS databases in February 2022 with no time span limitation. We included studies concerned with the association between any pregnancy complications and HRV, with or without a control group. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was used for the review of the studies, and Covidence software was used for the study selection process. For data synthesis, we used the guideline by Popay et al. Results: Finally, 12 studies with 6656 participants were included. Despite the methodological divergency that hindered a comprehensive comparison, our findings suggest that ANS is linked with some common pregnancy complications including fetal growth. However, existing studies do not support an association between ANS and gestational diabetes mellitus. Studies that linked pulmonary and central nervous system disorders with ANS function did not provide enough evidence to draw conclusions. Conclusions: This review highlights the importance of understanding and monitoring the underlying mechanism of ANS in pregnancy-induced adaptations and the need for further research with robust methodology in this area. 
%M 37276013
%R 10.2196/44430
%U https://www.i-jmr.org/2023/1/e44430
%U https://doi.org/10.2196/44430
%U http://www.ncbi.nlm.nih.gov/pubmed/37276013

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e44082
%T Using the Person-Based Approach to Develop a Digital Intervention Targeting Diet and Physical Activity in Pregnancy: Development Study
%A Rhodes,Alexandra
%A Pimprikar,Arya
%A Baum,Alison
%A Smith,Andrea D
%A Llewellyn,Clare H
%+ Research Department of Behavioural Science and Health, Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 2076791720, alexandra.rhodes.15@ucl.ac.uk
%K digital
%K app
%K dietary
%K physical activity
%K lifestyle
%K pregnancy
%K prenatal
%K person-based approach
%K behavior change habit formation
%K intervention
%D 2023

%7 26.5.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: In pregnancy, eating well, keeping active, and avoiding excessive weight gain are associated with better maternal and fetal health outcomes. Dietary and physical activity (PA) interventions can be effective in changing behaviors and managing weight gain. The comparatively lower cost and greater accessibility of digital interventions make them an attractive alternative to in-person interventions. Baby Buddy is a free pregnancy and parenting app from the charity Best Beginnings. Designed to support parents, improve health outcomes, and reduce inequalities, the app is actively used within the UK National Health Service. It offers an ideal platform for delivering and evaluating a new prenatal dietary and PA intervention. Objective: The aim of this study was to create a theory-based intervention within Baby Buddy to empower, encourage, and support expectant parents to develop healthier dietary and PA habits for pregnancy and parenthood. Methods: The intervention’s development process was guided by the Behavior Change Wheel, with the person-based approach used to create and test its design. Three stages of qualitative research with pregnant and recently pregnant parents guided the intervention design. Study 1 (n=30), comprising 4 web-based focus groups and 12 telephone interviews, gauged response to the rudimentary concept and generated ideas for its development. Results were analyzed thematically. At this stage, the guiding principles for the intervention development were established, and regular team meetings ensured that the intervention design remained aligned with Best Beginnings’ objectives, evidence-based approach, and feasibility criteria. Study 2 (n=29), comprising web-based individual and couple interviews, explored design ideas using wireframes and scripts and generated iterative feedback on the intervention content, branding, and tone. A table of changes analysis tracked design amendments. Study 3 (n=19) tested an app prototype using think-aloud interviews with current Baby Buddy users. A patient and public involvement and engagement activity (n=18) and other expert contributors (n=14) provided ad hoc input into the research process and design development. Results: Study 1 confirmed the appeal and relevance of the intervention concept and its novel approach of including partners. The identified themes underpinned the development of the intervention design. Iterative feedback from study 2, in conjunction with patient and public involvement and engagement and expert contributor input, helped refine the intervention design and ensure its relevance and appeal to a diverse target user group. Study 3 highlighted functionality, content, and design issues with the app prototype and identified ways of improving the user experience. Conclusions: This study illustrates the value of combining a theoretical method for intervention development with the person-based approach to create a theory-based intervention that is also user-friendly, appealing, and engaging for its target audience. Further research is needed to evaluate the effectiveness of the intervention in improving diet, PA, and weight management in pregnancy. 
%M 37234026
%R 10.2196/44082
%U https://formative.jmir.org/2023/1/e44082
%U https://doi.org/10.2196/44082
%U http://www.ncbi.nlm.nih.gov/pubmed/37234026

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 6
%N 
%P e40561
%T Improving Knowledge About Pregnancy for Deaf South African Women of Reproductive Age Through a Text Messaging–Based Information Campaign: Mixed Methods Study
%A Haricharan,Hanne Jensen
%A Hacking,Damian
%A Lau,Yan Kwan
%A Heap,Marion
%+ School of Public Health, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa, 27 829656103, hanne.haricharan@uct.ac.za
%K SMS text messages
%K cell phones
%K mobile health
%K mHealth
%K health information
%K health literacy
%K healthy behavior
%K maternal health
%K antenatal care
%K Deaf
%K South Africa
%D 2023

%7 22.5.2023
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Signing Deaf South Africans have limited access to health information and, consequently, limited knowledge about health. Maternal and neonatal mortality rates are high. Cell phone use is high, making it a potentially effective way of communicating about maternal and child health. Objective: The primary aim of this study was to assess whether an SMS text messaging–based health information campaign could improve knowledge about pregnancy, antenatal care, and healthy living during pregnancy for signing Deaf South African women of reproductive age. The secondary aim was to evaluate the acceptability of such an intervention. Methods: This study was designed as a pretest-posttest study. A baseline questionnaire assessed participants’ knowledge about pregnancy, antenatal care, and healthy living during pregnancy before an SMS text messaging–based information campaign was conducted. After the campaign, an exit questionnaire was administered containing the same questions as the baseline questionnaire with additional questions on general acceptability and communication preferences. The results were compared between baseline and exit using the McNemar and Wilcoxon signed rank tests. A focus group aimed to obtain further information on the impact and acceptability of SMS text messages. The focus group was analyzed inductively. Results: The study showed a statistically significant improvement in overall health knowledge among participants. Despite this, some participants found the medical terminology challenging to understand. Several ways of improving SMS text messaging campaigns for the Deaf were identified, including using Multimedia Messaging Services with a person signing messages and linking information campaigns to a communication service that would enable Deaf people to pose questions. The focus group also suggested that SMS text messages might play a role in motivating healthy behaviors during pregnancy. Conclusions: The SMS text messaging campaign effectively improved Deaf women’s knowledge about pregnancy, antenatal care, and healthy living during pregnancy and has the potential to affect health behavior. This contrasts with a similar study on hearing pregnant women. This suggests that SMS text messages may be particularly effective in improving Deaf people’s health knowledge. However, attention should be paid to Deaf participants’ specific needs and communication preferences to optimize impact. The potential of using SMS text messaging campaigns to affect behavior should be studied. Trial Registration: Pan-African Clinical Trials Registry (PACTR) PACTR201512001352180; https://tinyurl.com/3rxvsrbe 
%M 37213174
%R 10.2196/40561
%U https://pediatrics.jmir.org/2023/1/e40561
%U https://doi.org/10.2196/40561
%U http://www.ncbi.nlm.nih.gov/pubmed/37213174

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e38938
%T Introduction of a Single Electronic Health Record for Maternity Units in Ireland: Outline of the Experiences of the Project Management Team
%A Sheehan,Orla Maria
%A Greene,Richard Anthony
%A McKernan,Joye
%A Murphy,Brendan
%A Cahill,Caroline
%A Cleary,Brian
%A Lawlor,Fiona
%A Robson,Michael
%A ,
%+ Department of Obstetrics and Gynaecology, University College Cork, 5th Floor, Cork University Maternity Hospital, Cork, T12 YE02, Ireland, 353 873385218, orla.sheehan1@hse.ie
%K baby
%K babies
%K data management
%K data quality
%K electronic health record
%K health management
%K implementation
%K information management
%K Ireland
%K lessons learned
%K management system
%K maternity
%K maternal
%K mother
%K newborn
%K optimization
%K planning
%K pregnant
%K pregnancy
%K project management
%D 2023

%7 12.5.2023
%9 Viewpoint
%J JMIR Form Res
%G English
                
%X Electronic health records (EHRs) are being introduced worldwide. The change from paper to electronic records has not always been a seamless or quick process; however, EHRs are viewed as central to updating modern health care, especially organization structures and delivery of sustainable care with the potential for joint decision-making with the patient. The objective of this viewpoint paper is to outline how an EHR is being developed in Ireland. The focus of the Maternal & Newborn Clinical Management System project is the design and implementation of an EHR for all women and babies in the maternity services in the Republic of Ireland. The paper also outlines the lessons learned from the planning to the optimization stage of the project. The paper was developed through discussions with the project management team and their completed reports that outline the lessons they acquired from each project stage. Key lessons learned from each stage of the project are highlighted. This viewpoint paper explains how the national project management team is implementing the EHR and outlines the experiences and lessons learned and the challenges ahead following the phase one introduction. The Maternal & Newborn Clinical Management System is an example of a clinician-led, patient-focused, change management project from its inception to implementation. The introduction of EHRs is essential in modernizing health care and optimizing patient outcomes through the accurate and appropriate use of data.
%M 37171841
%R 10.2196/38938
%U https://formative.jmir.org/2023/1/e38938
%U https://doi.org/10.2196/38938
%U http://www.ncbi.nlm.nih.gov/pubmed/37171841

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e42582
%T The Next Infodemic: Abortion Misinformation
%A Pagoto,Sherry L
%A Palmer,Lindsay
%A Horwitz-Willis,Nate
%+ UConn Center for mHealth and Social Media, UConn Institute for Collaboration in Health, Interventions, and Policy, University of Connecticut, 2006 Hillside Road, Unit 1248, Room 22, Storrs, CT, 06268, United States, 1 6178779023, sherry.pagoto@uconn.edu
%K abortion
%K reproductive health
%K misinformation
%K online
%K infodemic
%K misleading information
%K online health information
%K health authority
%K public health
%K abortion
%K women's health
%D 2023

%7 4.5.2023
%9 Viewpoint
%J J Med Internet Res
%G English
                
%X The World Health Organization (WHO) defines an infodemic as the proliferation of false or misleading information that leads to confusion, mistrust in health authorities, and the rejection of public health recommendations. The devastating impacts of an infodemic on public health were felt during the COVID-19 pandemic. We are now on the precipice of another infodemic, this one regarding abortion. On June 24, 2022, the Supreme Court of the United States (SCOTUS) decision in Dobbs v. Jackson Women’s Health Organization resulted in the reversal of Roe v. Wade, which had protected a woman’s right to have an abortion for nearly 50 years. The reversal of Roe v. Wade has given way to an abortion infodemic that is being exacerbated by a confusing and rapidly changing legislative landscape, the proliferation of abortion disinformants on the web, lax efforts by social media companies to abate abortion misinformation, and proposed legislation that threatens to prohibit the distribution of evidence-based abortion information. The abortion infodemic threatens to worsen the detrimental effects of the Roe v. Wade reversal on maternal morbidity and mortality. It also comes with unique barriers to traditional abatement efforts. In this piece, we lay out these challenges and urgently call for a public health research agenda on the abortion infodemic to stimulate the development of evidence-based public health efforts to mitigate the impact of misinformation on the increased maternal morbidity and mortality that is expected to result from abortion restrictions, particularly among marginalized populations.
%M 37140975
%R 10.2196/42582
%U https://www.jmir.org/2023/1/e42582
%U https://doi.org/10.2196/42582
%U http://www.ncbi.nlm.nih.gov/pubmed/37140975

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 6
%N 
%P e37359
%T The Effectiveness of Interactive Text Messaging and Structured Psychosocial Support Groups on Developmental Milestones of Children From Adolescent Pregnancies in Kenya: Quasi-Experimental Study
%A Mwenda,Valerian
%A Makena,Ireen
%A Ogweno,Vincent
%A Obonyo,James
%A Were,Vincent
%+ Department of Non-communicable Diseases, Ministry of Health, PO Box 30016, Nairobi, 00100, Kenya, 254 723992573, valmwenda@gmail.com
%K text messages
%K adolescent pregnancy
%K milestones
%K mHealth
%K psychosocial support
%K Kenya
%K nurturing care
%D 2023

%7 1.5.2023
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: In sub-Saharan Africa, one-quarter of all pregnancies occur in adolescents. Children born to adolescent mothers have poorer physical and socio-cognitive development. One reason may be inadequate knowledge on childcare and psychosocial support during pregnancy and post partum, since adolescent mothers have less antenatal care attendance and overall interaction with the health care system. Mobile health technology has been used to relay health information to special groups; however, psychosocial support commonly requires physical interaction. Objective: We aimed to assess the efficacy of an interactive mobile text messaging platform and support groups in improving adolescent mothers’ knowledge and practices as well as infant growth and development. Methods: This was a quasi-experimental study, conducted among adolescent mothers with infants younger than 3 months, in Homa Bay County, Kenya. Five of the 8 subcounties in Homa Bay County were purposively selected as study clusters. Four subcounties were assigned as intervention clusters and 1 as a control cluster. Adolescent mothers from 2 intervention subcounties received interactive text messaging only (limited package), whereas those from the other 2 subcounties received text messaging and weekly support groups, moderated by a community health extension worker and a counselor (full package); the control cluster only received the end-line evaluation (posttest-only control). The follow-up period was 9 months. Key outcomes were maternal knowledge on childcare and infant development milestones assessed using the Developmental Milestones Checklist (DMC III). Knowledge and DMC III scores were compared between the intervention and control groups, as well as between the 2 intervention groups. Results: We recruited 791 mother-infant pairs into the intervention groups (full package: n=375; limited package: n=416) at baseline and 220 controls at end line. Attrition from the intervention groups was 15.8% (125/791). Compared with the control group, adolescent mothers receiving the full package had a higher knowledge score on infant care and development (9.02 vs 8.01; P<.001) and higher exclusive breastfeeding rates (238/375, 63.5% vs 112/220, 50.9%; P=.004), and their infants had higher average DMC III scores (53.09 vs 48.59; P=.01). The limited package group also had higher knowledge score than the control group (8.73 vs 8.01; P<.001); this group performed better than the full package group on exclusive breastfeeding (297/416, 71.4% vs 112/220, 50.9%; P<.001) and DMC III scores (58.29 vs 48.59; P<.001) when compared with the control group. We found a marginal difference in knowledge scores between full and limited package groups (9.02 vs 8.73; P=.048) but no difference in DMC III scores between the 2 groups (53.09 vs 58.29; P>.99). Conclusions: An interactive text messaging platform improved adolescent mothers’ knowledge on nurturing infant care and the development of their children, even without physical support groups. Such platforms offer a convenient avenue for providing reproductive health information to adolescents. Trial Registration: Pan African Clinical Trials Registry PACTR201806003369302; https://tinyurl.com/kkxvzjse 
%M 37126373
%R 10.2196/37359
%U https://pediatrics.jmir.org/2023/1/e37359
%U https://doi.org/10.2196/37359
%U http://www.ncbi.nlm.nih.gov/pubmed/37126373

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 11
%N 
%P e41545
%T Delivering a Postpartum Weight Loss Intervention via Facebook or In-Person Groups: Results From a Randomized Pilot Feasibility Trial
%A Waring,Molly E
%A Pagoto,Sherry L
%A Moore Simas,Tiffany A
%A Blackman Carr,Loneke T
%A Eamiello,Madison L
%A Libby,Brooke A
%A Rudin,Lauren R
%A Heersping,Grace E
%+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Rd, Unit 1101, Storrs, CT, 06269, United States, 1 8604861446, molly.waring@uconn.edu
%K postpartum weight loss
%K Facebook
%K social media
%K pilot study
%K feasibility
%K mobile phone
%D 2023

%7 27.4.2023
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Postpartum weight retention contributes to weight gain and obesity. Remotely delivered lifestyle interventions may be able to overcome barriers to attending in-person programs during this life phase. Objective: This study aimed to conduct a randomized feasibility pilot trial of a 6-month postpartum weight loss intervention delivered via Facebook or in-person groups. Feasibility outcomes were recruitment, sustained participation, contamination, retention, and feasibility of study procedures. Percent weight loss at 6 and 12 months were exploratory outcomes. Methods: Women with overweight or obesity who were 8 weeks to 12 months post partum were randomized to receive a 6-month behavioral weight loss intervention based on the Diabetes Prevention Program lifestyle intervention via Facebook or in-person groups. Participants completed assessments at baseline, 6 months, and 12 months. Sustained participation was defined by intervention meeting attendance or visible engagement in the Facebook group. We calculated percent weight change for participants who provided weight at each follow-up. Results: Among individuals not interested in the study, 68.6% (72/105) were not interested in or could not attend in-person meetings and 2.9% (3/105) were not interested in the Facebook condition. Among individuals excluded at screening, 18.5% (36/195) were ineligible owing to reasons related to the in-person condition, 12.3% (24/195) related to the Facebook condition, and 2.6% (5/195) were unwilling to be randomized. Randomized participants (n=62) were a median of 6.1 (IQR 3.1-8.3) months post partum, with a median BMI of 31.7 (IQR 28.2-37.4) kg/m2. Retention was 92% (57/62) at 6 months and 94% (58/62) at 12 months. The majority (21/30, 70%) of Facebook and 31% (10/32) of in-person participants participated in the last intervention module. Half (13/26, 50%) of Facebook and 58% (15/26) of in-person participants would be likely or very likely to participate again if they had another baby, and 54% (14/26) and 70% (19/27), respectively, would be likely or very likely to recommend the program to a friend. In total, 96% (25/26) of Facebook participants reported that it was convenient or very convenient to log into the Facebook group daily compared with 7% (2/27) of in-person participants who said it was convenient or very convenient to attend group meetings each week. Average weight loss was 3.0% (SD 7.2%) in the Facebook condition and 5.4% (SD 6.8%) in the in-person condition at 6 months, and 2.8% (SD 7.4%) in the Facebook condition and 4.8% (SD 7.6%) in the in-person condition at 12 months. Conclusions: Barriers to attending in-person meetings hampered recruitment efforts and intervention participation. Although women found the Facebook group convenient and stayed engaged in the group, weight loss appeared lower. Research is needed to further develop care models for postpartum weight loss that balance accessibility with efficacy. Trial Registration: ClinicalTrials.gov, NCT03700736; https://clinicaltrials.gov/ct2/show/NCT03700736 
%M 37103991
%R 10.2196/41545
%U https://mhealth.jmir.org/2023/1/e41545
%U https://doi.org/10.2196/41545
%U http://www.ncbi.nlm.nih.gov/pubmed/37103991

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 11
%N 
%P e40427
%T Characterization of Self-reported Improvements in Knowledge and Health Among Users of Flo Period Tracking App: Cross-sectional Survey
%A Zhaunova,Liudmila
%A Bamford,Ryan
%A Radovic,Tara
%A Wickham,Aidan
%A Peven,Kimberly
%A Croft,Jazz
%A Klepchukova,Anna
%A Ponzo,Sonia
%+ Flo Health LTU, Saltoniškių g. 2, Vilnius, LT-01109, Lithuania, 370 60396823, l_zhaunova@flo.health
%K health knowledge
%K menstrual cycle
%K pregnancy
%K period-tracking app
%K digital health
%K women’s health
%D 2023

%7 26.4.2023
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Research shows that poor knowledge and awareness of menstrual and pregnancy health among women are associated with adverse reproductive health and pregnancy outcomes. Menstrual cycle– and pregnancy-tracking mobile apps are promising tools for improving women’s awareness of and attitudes toward their reproductive health; however, there is little information about subscribers’ perceptions of app functionality and its impact on their knowledge and health. Objective: This study aimed to explore knowledge and health improvements related to menstrual cycle and pregnancy, as well as improvements in general health among Flo app users. We also investigated what components of the Flo app were associated with the abovementioned improvements and evaluated whether those improvements differed based on education level, country of residence (low- and middle-income vs high-income countries), free or premium subscription to the app, short- or long-term use of the app, and frequency of use. Methods: Flo subscribers who had been using the app for no less than 30 days, completed a web-based survey. A total of 2212 complete survey responses were collected. The survey included demographic questions and questions about motivations guiding the use of the Flo app and which components of the app improved their knowledge and health, as well as to what extent. Results: Most study participants reported improvements in menstrual cycle (1292/1452, 88.98%) and pregnancy (698/824, 84.7%) knowledge from Flo app use. Participants with higher levels of education and those from high-income countries reported using the app predominantly for getting pregnant (χ21=4.2, P=.04; χ21=52.3, P<.001, respectively) and pregnancy tracking (χ21=19.3, P<.001; χ21=20.9, P=.001, respectively). Participants with less education reported using the app to avoid pregnancy (χ21=4.2; P=.04) and to learn more about their body (χ21=10.8; P=.001) and sexual health (χ21=6.3; P=.01), while participants from low- and middle-income countries intended to mainly learn more about their sexual health (χ21=18.2; P<.001). Importantly, the intended use of the app across education levels and country income levels matched areas in which they had gained knowledge and achieved their health goals upon use of the Flo app. Period, fertile days, and ovulation predictions as well as symptom tracking were consistently the top 3 components in the app that helped users with their cycle knowledge and general health. Reading articles or watching videos helped with users' education regarding their pregnancy. Finally, the strongest improvements in knowledge and health were observed in premium, frequent, and long-term users. Conclusions: This study suggests that menstrual health apps, such as Flo, could present revolutionary tools to promote consumer health education and empowerment on a global scale. 
%M 37099370
%R 10.2196/40427
%U https://mhealth.jmir.org/2023/1/e40427
%U https://doi.org/10.2196/40427
%U http://www.ncbi.nlm.nih.gov/pubmed/37099370

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e41900
%T Addressing Preconception Behavior Change Through Mobile Phone Apps: Systematic Review and Meta-analysis
%A Musgrave,Loretta
%A Cheney,Kate
%A Dorney,Edwina
%A Homer,Caroline S E
%A Gordon,Adrienne
%+ Centre for Midwifery, Child and Family Health, University of Technology Sydney, 235 Jones St, NSW, Sydney, 2007, Australia, 61 9514 5069, loretta.musgrave@uts.edu.au
%K apps
%K mobile
%K preconception
%K prenatal care
%K perinatal
%K reproductive health
%K reproductive age
%K maternal
%K interconception
%K behavior change
%K mobile phone
%D 2023

%7 19.4.2023
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Positive health behavior changes before pregnancy can optimize perinatal outcomes for mothers, babies, and future generations. Women are often motivated to positively change their behavior in preparation for pregnancy to enhance their health and well-being. Mobile phone apps may provide an opportunity to deliver public health interventions during the preconception period. Objective: This review aimed to synthesize the evidence of the effectiveness of mobile phone apps in promoting positive behavior changes in women of reproductive age before they are pregnant (preconception and interconception periods), which may improve future outcomes for mothers and babies. Methods: Five databases were searched in February 2022 for studies exploring mobile phone apps as a prepregnancy intervention to promote positive behavior change. The identified studies were retrieved and exported to EndNote (Thomson Reuters). Using Covidence (Veritas Health Innovation), a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) study flow diagram was generated to map the number of records identified, included, and excluded. Three independent reviewers assessed the risk of bias and conducted data extraction using the Review Manager software (version 5.4, The Cochrane Collaboration), and the data were then pooled using a random-effects model. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess the certainty of the evidence. Results: Of the 2973 publications identified, 7 (0.24%) were included. The total number of participants across the 7 trials was 3161. Of the 7 studies, 4 (57%) included participants in the interconception period, and 3 (43%) included women in the preconception period. Of the 7 studies, 5 (71%) studies focused on weight reduction, assessing the outcomes of reductions in adiposity and weight. Of the 7 studies, nutrition and dietary outcomes were evaluated in 2 (29%) studies, blood pressure outcomes were compared in 4 (57%) studies, and biochemical and marker outcomes associated with managing disease symptoms were included in 4 (57%) studies. Analysis showed that there were no statistically significant differences in energy intake; weight loss; body fat; and biomarkers such as glycated hemoglobin, total cholesterol, fasting lipid profiles, or blood pressure when compared with standard care. Conclusions: Owing to the limited number of studies and low certainty of the evidence, no firm conclusions can be drawn on the effects of mobile phone app interventions on promoting positive behavior changes in women of reproductive age before they are pregnant (preconception and interconception periods). Trial Registration: PROSPERO CRD42017065903; https://tinyurl.com/2p9dwk4a International Registered Report Identifier (IRRID): RR2-10.1186/s13643-019-0996-6 
%M 37074767
%R 10.2196/41900
%U https://www.jmir.org/2023/1/e41900
%U https://doi.org/10.2196/41900
%U http://www.ncbi.nlm.nih.gov/pubmed/37074767

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e44661
%T Expectant Parents’ Preferences for Teaching by Texting: Development and Usability Study of SmartMom
%A Murray,Jennifer B
%A Sharp,Alexander
%A Munro,Sarah
%A Janssen,Patricia A
%+ School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 822 2772, jennifer.murray@ubc.ca
%K pregnancy
%K pregnant
%K prenatal
%K patient education
%K text message
%K SMS text messaging
%K prenatal education
%K mHealth
%K evidence-based health care
%K mobile app
%K Canada
%K mobile health
%K preference
%K focus group
%K information need
%K user need
%D 2023

%7 18.4.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Prenatal education encourages healthy behavioral choices and reduces rates of adverse birth outcomes. The use of mobile health (mHealth) technologies during pregnancy is increasing and changing how pregnant people acquire prenatal education. SmartMom is an evidence-based prenatal education SMS text messaging program that overcomes barriers to prenatal class attendance, including rural or remote location, cost, stigma among participants, lack of instructors, and cessation of classes during the COVID-19 pandemic. Objective: We sought to explore perceived information needs and preferences for the content and structure of prenatal education mHealth programs among persons enrolled in or eligible to enroll in SmartMom. Methods: This was a qualitative focus group study conducted as part of a development and usability study of the SmartMom program. Participants were older than 19 years of age, Canadian residents, fluent in English, and either currently pregnant or pregnant within the last year. We asked open-ended questions about information-seeking behaviors during pregnancy, the nature of the information that participants were seeking, how they wanted to receive information, and if SmartMom was meeting these needs. Focus groups took place via videoconference technology (Zoom) between August and December 2020. We used reflexive thematic analysis to identify themes that emerged from the data and the constant comparison method to compare initial coding to emerging themes. Results: We conducted 6 semistructured focus groups with 16 participants. All participants reported living with a partner and owning a cell phone. The majority (n=13, 81%) used at least 1 app for prenatal education. Our analysis revealed that “having reliable information is the most important thing” (theme 1); pregnant people value inclusive, local, and strength-based information (theme 2); and SMS text messages are a simple, easy, and timely modality (“It was nice to have that [information] fed to you”; theme 3). Participants perceived that SmartMom SMS text messages met their needs for prenatal education and were more convenient than using apps. SmartMom’s opt-in supplemental message streams, which allowed users to tailor the program to their needs, were viewed favorably. Participants also identified that prenatal education programs were not meeting the needs of diverse populations, such as Indigenous people and LGBTQIA2S+ (lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, Two-Spirit plus) communities. Conclusions: The shift toward digital prenatal education, accelerated by the COVID-19 pandemic, has resulted in a plethora of web- or mobile technology–based programs, but few of these have been evaluated. Participants in our focus groups revealed concerns about the reliability and comprehensiveness of digital resources for prenatal education. The SmartMom SMS text messaging program was viewed as being evidence-based, providing comprehensive content without searching, and permitting tailoring to individual needs through opt-in message streams. Prenatal education must also meet the needs of diverse populations. 
%M 37071451
%R 10.2196/44661
%U https://formative.jmir.org/2023/1/e44661
%U https://doi.org/10.2196/44661
%U http://www.ncbi.nlm.nih.gov/pubmed/37071451

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e43193
%T Biological Mechanisms in Pregnant Women With Anxiety (Happy Mother-Healthy Baby Supplement Study): Protocol for a Longitudinal Mixed Methods Observational Study
%A Sherer,Morgan L
%A Malik,Abid
%A Osborne,Lauren M
%A Rowther,Armaan A
%A Zaidi,Ahmed
%A Atif,Najia
%A Rahman,Atif
%A Kahloon,Lubna E
%A Salman,Muhammad
%A Yenokyan,Gayane
%A Surkan,Pamela J
%+ Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N, Wolfe St, Room E5523, Baltimore, MD, 21205, United States, 1 410 502 7396, psurkan@jhu.edu
%K antenatal anxiety
%K perinatal anxiety
%K pregnancy
%K cognitive behavioral therapy
%K inflammation
%K allopregnanolone
%K Pakistan
%K randomized controlled trial
%D 2023

%7 11.4.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Anxiety and depression are common in the perinatal period and negatively affect the health of the mother and baby. Our group has developed “Happy Mother-Healthy Baby” (HMHB), a cognitive behavioral therapy–based psychosocial intervention to address risk factors specific to anxiety during pregnancy in low- and middle-income countries (LMICs). Objective: The purpose of this study is to examine biological mechanisms that may be linked to perinatal anxiety in conjunction with a randomized controlled trial of HMHB in Pakistan. Methods: We are recruiting 120 pregnant women from the Holy Family Hospital, a public facility in Rawalpindi, Pakistan. Participants are assessed for at least mild anxiety symptoms using the Hospital Anxiety and Depression Scale (ie, a score ≥8 on the anxiety scale is necessary for inclusion in the anxiety groups and <8 for inclusion in the healthy control group). Women who meet the criteria for an anxiety group are randomized into either the HMHB intervention group or an enhanced usual care (EUC) control group. Participants receive HMHB or EUC throughout pregnancy and undergo blood draws at 4 time points (baseline, second trimester, third trimester, and 6 weeks post partum). We will assess peripheral cytokine concentrations using a multiplex assay and hormone concentrations using gas chromatography and mass spectrometry. The statistical analysis will use generalized linear models and mixed effects models to assess the relationships across time among anxiety, immune dysregulation, and hormone levels, and to assess whether these biological factors mediate the relationship between anxiety and birth and child development outcomes. Results: Recruitment started on October 20, 2020, and data collection was completed on August 31, 2022. The start date for recruitment for this biological supplement study was delayed by approximately half a year due to the COVID-19 pandemic. The trial was registered at ClinicalTrials.gov (NCT03880032) on September 22, 2020. The last blood samples were shipped to the United States on September 24, 2022, where they will be processed for analysis. Conclusions: This study is an important addition to the HMHB randomized controlled trial of an intervention for antenatal anxiety. The intervention itself makes use of nonspecialist providers and, if effective, will represent an important new tool for the treatment of antenatal anxiety in LMICs. Our biological substudy is one of the first attempts to link biological mechanisms to antenatal anxiety in an LMIC in the context of a psychosocial intervention, and our findings have the potential to significantly advance our knowledge of the biological pathways of perinatal mental illness and treatment efficacy. Trial Registration: ClinicalTrials.gov NCT03880032; https://clinicaltrials.gov/ct2/show/NCT03880032 International Registered Report Identifier (IRRID): DERR1-10.2196/43193 
%M 37040167
%R 10.2196/43193
%U https://www.researchprotocols.org/2023/1/e43193
%U https://doi.org/10.2196/43193
%U http://www.ncbi.nlm.nih.gov/pubmed/37040167

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e38563
%T Video Consultations and Safety App Targeting Pregnant Women Exposed to Intimate Partner Violence in Denmark and Spain: Nested Cohort Intervention Study (STOP Study)
%A Andreasen,Karen
%A Zapata-Calvente,Antonella Ludmila
%A Martín-de-las-Heras,Stella
%A Bueno-Cavanillas,Aurora
%A Schei,Berit
%A Dokkedahl,Sarah
%A de León de León,Sabina
%A Fernandez Lopez,Rodrigo
%A Oviedo-Gutiérrez,Alba
%A Ankerstjerne,Lea Bo Sønderlund
%A Megías,Jesús L
%A Khan,Khalid Saeed
%A Rasch,Vibeke
%A Linde,Ditte S
%+ Department of Gyneacology and Obstetrics, Odense University Hospital, Kloevervaenget 10, 10th floor, Odense, 5000, Denmark, 45 65414606, karen.andreasen2@rsyd.dk
%K intimate partner violence
%K gender-based violence
%K domestic violence
%K abuse
%K telemedicine
%K video counseling
%K app
%K acceptance
%K safety
%K feasibility
%K empowerment
%D 2023

%7 20.3.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Intimate partner violence (IPV) during pregnancy is a public health issue with wide-ranging consequences for both the mother and fetus, and interventions are needed. Therefore, the Stop Intimate Partner Violence in Pregnancy (STOP) cohort was established with the overall aim to identify pregnant women exposed to IPV through digital screening and offer women screening positive for IPV a digital supportive intervention. Objective: The aim of this study was to (1) introduce the design and profile of the STOP cohort study, (2) assess the feasibility of implementing digital IPV screening among pregnant women, and (3) assess the feasibility of implementing a digital supportive intervention targeting pregnant women exposed to IPV. Methods: Pregnant women attending antenatal care in the Region of Southern Denmark and in Andalucía, Spain were offered digital screening for IPV using validated scales (Abuse Assessment Screen and Women Abuse Screening Tool). Women who screened positive were eligible to receive a digital supportive intervention. The intervention consisted of 3-6 video consultations with an IPV counselor and a safety planning app. In Denmark, IPV counselors were antenatal care midwives trained by a psychologist specialized in IPV, whereas in Spain, the counselor was a psychologist. Results: Data collection started in February 2021 and was completed in October 2022. Across Denmark and Spain, a total of 19,442 pregnant women were invited for IPV screening and 16,068 women (82.65%) completed the screening. More women in Spain screened positive for exposure to IPV (350/2055, 17.03%) than in Denmark (1195/14,013, 8.53%). Among the women who screened positive, only 31.39% (485/1545) were eligible to receive the intervention with only 104 (21.4%) of these women ultimately receiving it. Conclusions: Digital screening for IPV among pregnant women is feasible in an antenatal care context in Denmark and Spain; however, a digital supportive intervention during pregnancy appears to have limited feasibility as only a minor subgroup of women who screened positive for eligibility received the intervention. More research is needed on how to best support pregnant women exposed to IPV if universal IPV screening is to be implemented in antenatal care. 
%M 36939835
%R 10.2196/38563
%U https://formative.jmir.org/2023/1/e38563
%U https://doi.org/10.2196/38563
%U http://www.ncbi.nlm.nih.gov/pubmed/36939835

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e37953
%T Effectiveness of Interactive Digital Decision Aids in Prenatal Screening Decision-making: Systematic Review and Meta-analysis
%A Wong,Hong Yat Conrad
%A Asim,Saba
%A Feng,Qi
%A Fu,Sherry Xiao-hong
%A Sahota,Daljit Singh
%A So,Po Lam
%A Dong,Dong
%+ The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, 4/F School of Public Health Building, Prince of Wales Hospital, Shatin, Hong Kong, 852 22528461, dongdong@cuhk.edu.hk
%K informed decision-making
%K interactive digital decision aids
%K pregnancy
%K prenatal screening
%K systematic review
%D 2023

%7 14.3.2023
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Increasing prenatal screening options and limited consultation time have made it difficult for pregnant women to participate in shared decision-making. Interactive digital decision aids (IDDAs) could integrate interactive technology into health care to a facilitate higher-quality decision-making process. Objective: The objective of this study was to assess the effectiveness of IDDAs on pregnant women’s decision-making regarding prenatal screening. Methods: We searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, World Health Organization International Clinical Trials Registry Platform, Google Scholar, and reference lists of included studies until August 2021. We included the randomized controlled trials (RCTs) that compared the use of IDDAs (fulfilling basic criteria of International Patient Decision Aid Standards Collaboration and these were interactive and digital) as an adjunct to standard care with standard care alone and involved pregnant women themselves in prenatal screening decision-making. Data on primary outcomes, that is, knowledge and decisional conflict, and secondary outcomes were extracted, and meta-analyses were conducted based on standardized mean differences (SMDs). Subgroup analysis based on knowledge was performed. The Cochrane risk-of-bias tool was used for risk-of-bias assessment. Results: Eight RCTs were identified from 10,283 references, of which 7 were included in quantitative synthesis. Analyses showed that IDDAs increased knowledge (SMD 0.58, 95% CI 0.26-0.90) and decreased decisional conflict (SMD –0.15, 95% CI –0.25 to –0.05). Substantial heterogeneity in knowledge was identified, which could not be completely resolved through subgroup analysis. Conclusions: IDDAs can improve certain aspects of decision-making in prenatal screening among pregnant women, but the results require cautious interpretation. 
%M 36917146
%R 10.2196/37953
%U https://www.jmir.org/2023/1/e37953
%U https://doi.org/10.2196/37953
%U http://www.ncbi.nlm.nih.gov/pubmed/36917146

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e43634
%T Effects of Fetal Images Produced in Virtual Reality on Maternal-Fetal Attachment: Randomized Controlled Trial
%A Lee,Kyong-No
%A Kim,Hyeon Ji
%A Choe,Kiroong
%A Cho,Aeri
%A Kim,Bohyoung
%A Seo,Jinwook
%A Myung,Woojae
%A Park,Jee Yoon
%A Oh,Kyung Joon
%+ Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea, 82 31 787 7266, jyparkmd08@snu.ac.kr
%K maternal-fetal attachment
%K virtual reality
%K ultrasound
%K pregnancy
%K fetus
%K postpartum depression
%K pediatric
%K mobile app
%K mental well-being
%K mobile health app
%K maternal health
%K women's health
%D 2023

%7 24.2.2023
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Maternal-fetal attachment (MFA) has been reported to be associated with the postpartum mother-infant relationship. Seeing the fetus through ultrasound might influence MFA, and the effect could be increased by more realistic images, such as those generated in virtual reality (VR). Objective: The aim was to determine the effect of fetal images generated in VR on MFA and depressive symptoms through a prenatal-coaching mobile app. Methods: This 2-arm parallel randomized controlled trial involved a total of 80 pregnant women. Eligible women were randomly assigned to either a mobile app–only group (n=40) or an app plus VR group (n=40). The VR group experienced their own baby’s images generated in VR based on images obtained from fetal ultrasonography. The prenatal-coaching mobile app recommended health behavior for the pregnant women according to gestational age, provided feedback on entered data for maternal weight, blood pressure, and glucose levels, and included a private diary service for fetal ultrasound images. Both groups received the same app, but the VR group also viewed fetal images produced in VR; these images were stored in the app. All participants filled out questionnaires to assess MFA, depressive symptoms, and other basic medical information. The questionnaires were filled out again after the interventions. Results: Basic demographic data were comparable between the 2 groups. Most of the assessments showed comparable results for the 2 groups, but the mean score to assess interaction with the fetus was significantly higher for the VR group than the control group (0.4 vs 0.1, P=.004). The proportion of participants with an increased score for this category after the intervention was significantly higher in the VR group than the control group (43% vs 13%, P=.005). The feedback questionnaire revealed that scores for the degree of perception of fetal appearance all increased after the intervention in the VR group. Conclusions: The use of a mobile app with fetal images in VR significantly increased maternal interaction with the fetus. Trial Registration: ClinicalTrials.gov NCT04942197; https://clinicaltrials.gov/ct2/show/NCT04942197 
%M 36826976
%R 10.2196/43634
%U https://www.jmir.org/2023/1/e43634
%U https://doi.org/10.2196/43634
%U http://www.ncbi.nlm.nih.gov/pubmed/36826976

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e44456
%T An mHealth Intervention to Reduce Gestational Obesity (mami-educ): Protocol for a Randomized Controlled Trial
%A Chiarello,Delia Indira
%A Pardo,Fabian
%A Moya,Jessica
%A Pino,Maricela
%A Rodríguez,Andrea
%A Araneda,María Eugenia
%A Bertini,Ayleen
%A Gutiérrez,Jaime
%+ Cellular Signaling and Differentiation Laboratory, School of Medical Technology, Faculty of Medicine and Science, Universidad San Sebastián, Lota 2465, Santiago, 7510157, Chile, 56 (2) 22606855, delia.chiarello@uss.cl
%K gestational obesity
%K mHealth
%K primary care
%K randomized controlled trial
%D 2023

%7 15.2.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The World Federation of Obesity warns that the main health problem of the next decade will be childhood obesity. It is known that factors such as gestational obesity produce profound effects on fetal programming and are strong predictors of overweight and obesity in children. Therefore, establishing healthy eating behaviors during pregnancy is the key to the primary prevention of the intergenerational transmission of obesity. Mobile health (mHealth) programs are potentially more effective than face-to-face interventions, especially during a public health emergency such as the COVID-19 outbreak. Objective: This study aims to evaluate the effectiveness of an mHealth intervention to reduce excessive weight gain in pregnant women who attend family health care centers. Methods: The design of the intervention corresponds to a classic randomized clinical trial. The participants are pregnant women in the first trimester of pregnancy who live in urban and semiurban areas. Before starting the intervention, a survey will be applied to identify the barriers and facilitators perceived by pregnant women to adopt healthy eating behaviors. The dietary intake will be estimated in the same way. The intervention will last for 12 weeks and consists of sending messages through a multimedia messaging service with food education, addressing the 3 domains of learning (cognitive, affective, and psychomotor). Descriptive statistics will be used to analyze the demographic, socioeconomic, and obstetric characteristics of the respondents. The analysis strategy follows the intention-to-treat principle. Logistic regression analysis will be used to compare the intervention with routine care on maternal pregnancy outcome and perinatal outcome. Results: The recruitment of study participants began in May 2022 and will end in May 2023. Results include the effectiveness of the intervention in reducing the incidence of excessive gestational weight gain. We also will examine the maternal-fetal outcome as well as the barriers and facilitators that influence the weight gain of pregnant women. Conclusions: Data from this effectiveness trial will determine whether mami-educ successfully reduces rates of excessive weight gain during pregnancy. If successful, the findings of this study will generate knowledge to design and implement personalized prevention strategies for gestational obesity that can be included in routine primary care. Trial Registration: ClinicalTrials.gov NCT05114174; https://clinicaltrials.gov/ct2/show/NCT05114174 International Registered Report Identifier (IRRID): DERR1-10.2196/44456 
%M 36790846
%R 10.2196/44456
%U https://www.researchprotocols.org/2023/1/e44456
%U https://doi.org/10.2196/44456
%U http://www.ncbi.nlm.nih.gov/pubmed/36790846

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e41298
%T Effectiveness of Digital Guided Self-help Mindfulness Training During Pregnancy on Maternal Psychological Distress and Infant Neuropsychological Development: Randomized Controlled Trial
%A Zhang,Xuan
%A Li,Yang
%A Wang,Juan
%A Mao,Fangxiang
%A Wu,Liuliu
%A Huang,Yongqi
%A Sun,Jiwei
%A Cao,Fenglin
%+ School of Nursing and Rehabilitation, Shandong University, No.44 Wenhua Xi Road, Jinan, 250012, China, 86 53188382291, caofenglin2008@126.com
%K digital
%K mobile health
%K mHealth
%K guided self-help
%K psychological distress
%K pregnancy
%K psychosocial intervention
%K mindfulness
%K infant
%K neuropsychological performance
%D 2023

%7 10.2.2023
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Maternal psychological distress during pregnancy is associated with unfavorable outcomes in infants. Mindfulness-based interventions (MBIs) can effectively alleviate psychological distress, but there are often barriers to the access of face-to-face interventions. Objective: This study aimed to investigate the effectiveness of a digital guided self-help (GSH) MBI (GSH-MBI) in reducing maternal psychological distress and improving infant neuropsychological performance. Methods: This was a randomized controlled trial. We recruited 160 women who were 12 to 20 weeks pregnant and exhibited psychological distress. We randomized them into a digital GSH-MBI group and a control group (usual perinatal care). The digital GSH-MBI consisted of a 6-week intervention through a WeChat mini program, with a daily reminder sent to the participants by a research assistant via WeChat. The primary outcomes consisted of maternal psychological distress, including depression, anxiety, and pregnancy-related anxiety symptoms, which were assessed at 6 time points from baseline to 6 months post partum (only pregnancy-related anxiety symptoms were assessed 3 times during pregnancy). The secondary outcomes were infant neuropsychological outcomes, including temperament and developmental behaviors, which were assessed at 6 weeks and 6 months post partum. Results: Compared with the control group, the digital GSH-MBI group showed a significant reduction in depression, anxiety, and pregnancy-related anxiety symptoms. In addition, the scores of the digital GSH-MBI group were lower than those of the control group for the 3 types of infant temperament at 6 weeks post partum, including quality of mood, distractibility, and adaptability. Conclusions: Digital GSH-MBIs are effective in alleviating psychological distress among pregnant women and protecting infant outcomes. Trial Registration: Chinese Clinical Trial Register ChiCTR2000040717; https://www.chictr.org.cn/showproj.aspx?proj=65376 
%M 36763452
%R 10.2196/41298
%U https://www.jmir.org/2023/1/e41298
%U https://doi.org/10.2196/41298
%U http://www.ncbi.nlm.nih.gov/pubmed/36763452

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e40934
%T Engagement With and Acceptability of Digital Media Platforms for Use in Improving Health Behaviors Among Vulnerable Families: Systematic Review
%A Eppes,Elisabet V
%A Augustyn,Marycatherine
%A Gross,Susan M
%A Vernon,Paris
%A Caulfield,Laura E
%A Paige,David M
%+ Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 484 467 3121, elisabet.eppes@gmail.com
%K text messaging
%K social media
%K mobile app
%K low-income
%K engagement
%K health promotion
%K community
%K nutrition and physical activity
%K pregnancy
%K breastfeeding
%K maternal and child health
%K mobile phone
%D 2023

%7 3.2.2023
%9 Review
%J J Med Internet Res
%G English
                
%X Background: The use of digital communication platforms to improve health behaviors has increased dramatically over the last decade. Public health practitioners have adopted digital communication technologies such as text messages, mobile apps, and social media to reach diverse populations. However, the effectiveness of digital communication platforms used by community-serving agencies remains unclear, and patterns of engagement and acceptability of different platforms have not been studied. Objective: This review aimed to identify the types of digital communication strategies used by community-serving organizations to promote healthy behaviors, assess the strength of evidence for health behavioral change, and describe the degree of consumer engagement with and acceptability of these strategies. The study population included low-income pregnant women, parents of young children, and adolescents. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, Scopus, Web of Science, CINAHL, and APA PsycInfo, covering research conducted from 2009 to 2022. Studies were included if they examined the use of digital communication (ie, texting, mobile apps, or social media) to promote healthy behaviors in the target population. Risk of bias and strength of evidence were assessed using the Effective Public Health Practice Project Risk of Bias tool and criteria from Agency for Healthcare Research and Quality, respectively. Results: Twenty-three peer-reviewed research studies published between 2012 and 2022, conducted in the United States, the United Kingdom, and Australia, were included in the review. The sample comprised studies exploring the use of texting (n=12), apps (n=6), social media (n=3), and multiple platforms (n=2; eg, texting and mobile apps). Targeted health behaviors included healthy diet, physical activity, obesity prevention, healthy pregnancy, breastfeeding, vaccine use, smoking cessation, and nutrition benefit redemption. The sample included 8 randomized controlled trials, 6 pretest-posttest design, 3 mixed methods studies, 2 pilot studies, 1 feasibility study, 1 prospective cohort study, 1 descriptive study, and 1 cross-sectional study. The median sample size was 77.5. There was no strong evidence to suggest the effectiveness of digital media campaigns in improving health behaviors; however, there were moderate to high levels of engagement and high levels of acceptability across digital platforms. Conclusions: Low-income pregnant women, parents of young children, and adolescents demonstrated moderate levels of engagement with and high levels of acceptability of digital media health campaigns conducted by community-serving agencies. The effectiveness of these strategies in improving health behaviors was inconclusive. Additional rigorous studies with larger sample sizes are required. In addition, more research is required to consistently measure and report participants’ engagement with each platform. Digital communication platforms are critical tools for public health practitioners, and future investigations of the effectiveness of these platforms in engaging clients and improving health behaviors will maximize client services. 
%M 36735286
%R 10.2196/40934
%U https://www.jmir.org/2023/1/e40934
%U https://doi.org/10.2196/40934
%U http://www.ncbi.nlm.nih.gov/pubmed/36735286

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e39321
%T The Effect of an eHealth Coaching Program (Smarter Pregnancy) on Attitudes and Practices Toward Periconception Lifestyle Behaviors in Women Attempting Pregnancy: Prospective Study
%A Hojeij,Batoul
%A Schoenmakers,Sam
%A Willemsen,Sten
%A van Rossem,Lenie
%A Dinnyes,Andras
%A Rousian,Melek
%A Steegers-Theunissen,Regine PM
%+ Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, Rotterdam, 3015 GD, Netherlands, 31 06 124 726 43, r.steegers@erasmusmc.nl
%K diet
%K lifestyle
%K attitudes
%K practices
%K eHealth
%K pregnancy
%K Smarter Pregnancy
%D 2023

%7 31.1.2023
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Lifestyle behaviors during the periconception period contribute to achievement of a successful pregnancy. Assessment of attitudes and practices toward these modifiable behaviors can aid in identifying gaps in unhealthy lifestyle behaviors with impact on intervention effectiveness. Objective: This study investigates the effectiveness of coaching by the eHealth program Smarter Pregnancy during the periconception period on improvement of attitudes and practices toward fruit and vegetable intake and smoking in women attempting pregnancy through assisted reproductive technology (ART) or natural conception. Methods: Women attempting pregnancy through ART (n=1060) or natural conception (n=631) were selected during the periconception period. The intervention groups, conceived through ART or naturally, received Smarter Pregnancy coaching for 24 weeks, whereas the control group conceived through ART and did not receive coaching. Attitudes and practices at baseline and follow-up periods were obtained from self-administered online questionnaire provided by the program. Attitudes were assessed in women with unhealthy behaviors as their intention to increase their fruit and vegetable intake and to quit smoking using a yes/no question. Outcomes on practices, suggesting effectiveness, included daily fruit (pieces) and vegetable (grams) intake, and if women smoked (yes/no). Changes in attitudes and practices were compared at 12 and 24 weeks with baseline between the ART intervention and ART control groups, and within the intervention groups between ART and natural conception. Changes in practices at 12 and 24 weeks were also compared with baseline between women with negative attitude and positive attitude within the intervention groups: ART and natural conception. Analysis was performed using linear and logistic regression models adjusted for maternal confounders and baseline attitudes and practices. Results: The ART intervention group showed higher vegetable intake and lower odds for negative attitudes toward vegetable intake after 12 weeks (βadj=25.72 g, P<.001; adjusted odds ratio [ORadj] 0.24, P<.001) and 24 weeks of coaching (βadj=23.84 g, P<.001; ORadj 0.28, P<.001) compared with ART controls. No statistically significant effect was observed on attitudes and practices toward fruit intake (12 weeks: P=.16 and .08, respectively; 24 weeks: P=.16 and .08, respectively) and smoking behavior (12 weeks: P=.87; 24 weeks: P=.92). No difference was observed for the studied attitudes and practices between the ART intervention and natural conception intervention groups. Women with persistent negative attitude toward fruit and vegetable intake at week 12 showed lower fruit and vegetable intake at week 24 compared with women with positive attitude (βadj=–.49, P<.001; βadj=–30.07, P<.001, respectively). Conclusions: The eHealth Smarter Pregnancy program may improve vegetable intake–related attitudes and practices in women undergoing ART treatment. Women with no intention to increase fruit and vegetable intake had less improvement in their intakes. Despite small changes, this study demonstrates again that Smarter Pregnancy can be used to improve vegetable intake, which can complemented by blended care that combines face-to-face and online care to also improve fruit intake and smoking behavior. 
%M 36719733
%R 10.2196/39321
%U https://www.jmir.org/2023/1/e39321
%U https://doi.org/10.2196/39321
%U http://www.ncbi.nlm.nih.gov/pubmed/36719733

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 9
%N 
%P e41442
%T Risk of De Novo Hypertensive Disorders of Pregnancy After Exposure to PM1 and PM2.5 During the Period From Preconception to Delivery: Birth Cohort Study
%A Yuan,Zhichao
%A Wang,Hai-Jun
%A Li,Qin
%A Su,Tao
%A Yang,Jie
%A Chen,Junjun
%A Peng,Yuanzhou
%A Zhou,Shuang
%A Bao,Heling
%A Luo,Shusheng
%A Wang,Hui
%A Liu,Jue
%A Han,Na
%A Guo,Yuming
%A Ji,Yuelong
%+ Department of Maternal and Child Health, School of Public Health, Peking University, 38 Huayuan Road, Haidian District, Beijing, 100089, China, 86 13161989008, yuelong.ji@pku.edu.cn
%K air pollution
%K PM2.5
%K PM1
%K hypertensive disorders of pregnancy
%K preconceptional period
%K lag effect
%K pregnancy
%K hypertension
%K hypertensive disorders
%K risk
%K pollutants
%K exposure
%K maternal health
%K perinatal health
%K pollution
%D 2023

%7 23.1.2023
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Particulate matter (PM) is detrimental to the respiratory and circulatory systems. However, no study has evaluated the lag effects of weekly exposure to fine PM during the period from preconception to delivery on the risk of hypertensive disorders of pregnancy (HDPs). Objective: We set out to investigate the lag effect windows of PM on the risk of HDPs on a weekly scale. Methods: Data from women with de novo HDPs and normotensive pregnant women who were part of the Peking University Retrospective Birth Cohort, based on the hospital information system of Tongzhou district, were obtained for this study. Meteorological data and data on exposure to fine PM were predicted by satellite remote sensing data based on maternal residential address. The de novo HDP group consisted of pregnant women who were diagnosed with gestational hypertension or preeclampsia. Fine PM was defined as PM2.5 and PM1. The gestational stage of participants was from preconception (starting 12 weeks before gestation) to delivery (before the 42nd gestational week). A distributed-lag nonlinear model (DLNM) was nested in a Cox regression model to evaluate the lag effects of weekly PM exposure on de novo HDP hazard by controlling the nonlinear relationship of exposure–reaction. Stratified analyses by employment status (employed or unemployed), education level (higher or lower), and parity (primiparity or multiparity) were performed. Results: A total of 22,570 pregnant women (mean age 29.1 years) for whom data were available between 2013 and 2017 were included in this study. The prevalence of de novo HDPs was 6.7% (1520/22,570). Our findings showed that PM1 and PM2.5 were significantly associated with an elevated hazard of HDPs. Exposure to PM1 during the 5th week before gestation to the 6th gestational week increased the hazard of HDPs. A significant lag effect of PM2.5 was observed from the 1st week before gestation to the 6th gestational week. The strongest lag effects of PM1 and PM2.5 on de novo HDPs were observed at week 2 and week 6 (hazard ratio [HR] 1.024, 95% CI 1.007-1.042; HR 1.007, 95% CI 1.000-1.015, respectively, per 10 μg/m3 increase). The stratified analyses indicated that pregnant women who were employed, had low education, and were primiparous were more vulnerable to PM exposure for de novo HDPs. Conclusions: Exposure to PM1 and PM2.5 was associated with the risk of de novo HDPs. There were significant lag windows between the preconception period and the first trimester. Women who were employed, had low education, and were primiparous were more vulnerable to the effects of PM exposure; more attention should be paid to these groups for early prevention of de novo HDPs. 
%M 36689262
%R 10.2196/41442
%U https://publichealth.jmir.org/2023/1/e41442
%U https://doi.org/10.2196/41442
%U http://www.ncbi.nlm.nih.gov/pubmed/36689262

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e37537
%T Prototyping of a Digital Life Course Care Platform for Preconception and Pregnancy Care: Pilot Feasibility and Acceptability Study
%A van der Windt,Melissa
%A van Zundert,Sofie Karolina Maria
%A Schoenmakers,Sam
%A van Rossem,Lenie
%A Steegers-Theunissen,Régine Patricia Maria
%+ Department of Obstetrics and Gynecology, Erasmus University Medical Center, P O Box 2040, Rotterdam, 3000 CA, Netherlands, 31 6 14 79 23 10, r.steegers@erasmusmc.nl
%K eHealth
%K app
%K lifestyle
%K lifestyle care
%K life course care
%K preconception
%K periconception
%K pregnancy
%K health care
%K pilot
%D 2023

%7 20.1.2023
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: A healthy lifestyle plays a key role in the prevention of lifestyle-related diseases, including subfertility and pregnancy complications. Although the benefits of a healthy lifestyle are well-known, long-term adherence is limited. Moreover, memory for lifestyle-related information as well as medical information provided by the medical professional is often poor and insufficient. In order to innovate and improve health care for both the patients and health care professionals, we developed a prototype of a digital life course care platform (Smarter Health app), providing personalized lifestyle care trajectories integrated in medical care journeys. Objective: This pilot study aimed to evaluate the feasibility, defined as the actual app use, and the acceptability, which included patient satisfaction and appreciation, of the Smarter Health app. Methods: Between March 17, 2021, and September 30, 2021, pregnant women familiar with the Dutch language seeking tertiary preconception and pregnancy care were offered the app as part of standard medical care at the outpatient clinic Healthy Pregnancy of the Department of Obstetrics and Gynecology of the Erasmus University Medical Center. Three months after activation of the app, patients received a digital questionnaire consisting of aspects of feasibility and acceptability. Results: During this pilot study, 440 patients visited the outpatient clinic Healthy Pregnancy. Of the 440 patients, 293 (66.6%) activated the app. Of the 293 patients who activated the app, 125 (42.7%) filled out the questionnaire. Of these 125 patients, 48 (38.4%) used the app. Most app users used it occasionally and logged in 8 times during their medical care trajectory. Overall, app users were satisfied with the app (median 5-point Likert scale=2.4, IQR 2.0-3.3). Conclusions: Our findings showed that the Smarter Health app, which integrates lifestyle care in medical care, is a feasible health care innovation, and that patients were satisfied with the app. Follow-up and evaluation of pregnancy outcomes should be performed to further substantiate wider clinical implementation. 
%M 36662557
%R 10.2196/37537
%U https://www.jmir.org/2023/1/e37537
%U https://doi.org/10.2196/37537
%U http://www.ncbi.nlm.nih.gov/pubmed/36662557

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e36922
%T Web-Based Interventions for Pregnant Women With Gestational Diabetes Mellitus: Systematic Review and Meta-analysis
%A Guo,Pingping
%A Chen,Dandan
%A Xu,Ping
%A Wang,Xiaojuan
%A Zhang,Wei
%A Mao,Minna
%A Zheng,Qiong
%A Jin,Ying
%A Feng,Suwen
%+ Women’s Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310003, China, 86 139 5716 8708, fengsw@zju.edu.cn
%K gestational diabetes mellitus
%K internet
%K intervention
%K meta-analysis
%K pregnant women
%K systematic review
%K mobile phone
%D 2023

%7 19.1.2023
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Effective management of gestational diabetes mellitus (GDM) is essential because it is one of the most prevalent diseases during pregnancy, and the consequent condition maternal hyperglycemia is closely related to considerable short- and long-term maternal and neonatal complications. Web-based interventions (WBIs), defined as therapeutic interventions offered via the web, have been implemented to assist in managing GDM owing to their advantages of high accessibility and efficiency, but findings across relevant studies are inconsistent. Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of WBIs on glycemic control among pregnant women with GDM; examine whether specific types of intervention interactivity, format, and technology have beneficial effects on maternal glycemic control; and comprehensively assess the efficacy of WBIs in maternal behavioral outcomes, cognitive and attitudinal outcomes, mental health, maternal and neonatal clinical outcomes, and medical service use and costs among pregnant women with GDM. Methods: PubMed, Embase, Cochrane Library, Web of Science, CINAHL, and PsycINFO were searched from their respective inception to November 19, 2022, to identify relevant randomized controlled trials and controlled clinical trials. The methodological quality of the included studies was assessed using the Effective Public Health Practice Project tool. Where possible, the data for all outcomes were meta-analyzed using the Stata software (version 12.0; StataCorp). Overall, 3 subgroup analyses and post hoc sensitivity analyses of maternal glycemic control parameters were performed. Results: Overall, 25 publications arising from 21 randomized controlled trials and controlled clinical trials were included. The overall meta-analyses on glycemic control parameters demonstrated that WBIs could significantly improve fasting blood glucose (standardized mean difference=−1.764, 95% CI −2.972 to −0.557; P=.004) and 2-hour postprandial blood glucose (standardized mean difference=−1.433, 95% CI −2.561 to −0.304; P=.01) compared with the control group, whereas no significant effect was found on glycated hemoglobin and 1-hour postprandial blood glucose. The results of the subgroup analyses indicated that mobile app–delivered interventions with a personalized format and interactive function showed more beneficial effects on maternal glycemic control. Moreover, WBIs could significantly enhance compliance with the self-monitoring of blood glucose; increase the rate of normal vaginal delivery; and decrease the chance of emergency cesarean, admission to the neonatal intensive care unit, and composite neonatal complications. GDM knowledge, risk perception of the disease, self-efficacy, satisfaction with care, and medical service use of the participants in the WBI group were also improved compared with the control group. However, the effectiveness of WBIs on other secondary outcomes was either nonsignificant or uncertain. Conclusions: WBIs are a promising approach to GDM management. Personalized, interactive, and mobile app–delivered interventions seem more worthy of being recommended for future clinical practice. Further high-quality studies are required to verify these findings before making broad recommendations. Trial Registration: PROSPERO CRD42022296625; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=296625 
%M 36656629
%R 10.2196/36922
%U https://www.jmir.org/2023/1/e36922
%U https://doi.org/10.2196/36922
%U http://www.ncbi.nlm.nih.gov/pubmed/36656629

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e39985
%T Physical and Mental Effects of Foot Baths Among Women in Labor: Protocol for a Pre-Post Test Experimental Design
%A Hikita,Naoko
%A Iso,Ritsuko
%A Mizuhata,Kiyoko
%A Isoyama,Akemi
%A Kobayashi,Ayumi
%A Muroi,Rika
%+ Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan, 81 92 642 6741, nhikita-tky@umin.ac.jp
%K foot bath
%K women in labor
%K salivary cortisol
%K pregnant
%K pregnancy
%K alternative medicine
%K complementary medicine
%D 2023

%7 18.1.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Foot baths are used in complementary and alternative therapy to improve the duration and quality of sleep and reduce tension, anxiety, fatigue, and confusion. They are also known to improve the frequency of labor contractions and to increase their duration in women; thus, they are commonly used by midwives in clinical settings in Japan. However, the physical and mental effects of foot baths during labor are unknown. Objective: This study aims to assess the physical and mental effects of foot baths based on biomarker levels and self-administered questionnaires. Methods: A single-arm pre-post test trial design is being used in this study, and the study is being conducted at a general hospital in Tochigi Prefecture, Japan. The target study population is women in the first stage of labor, the phase when the uterus starts to contract and when the cervix dilates to 10 cm, or those undergoing labor induction. Participants who meet the eligibility criteria are recruited, and written informed consent is obtained from them. They are asked to answer the questionnaire and to collect 1.5 mL of saliva in 2 microtubes each, before and after the intervention. The intervention is foot baths for 15-20 minutes using a foot bath device. Data on delivery, such as gestational age, gravidity, parity, diagnosis following the last vaginal examination, and presence or absence of membrane rupture, are retrieved from the medical records. The primary outcomes are salivary cortisol levels before and after the foot baths. The secondary outcomes are levels of relaxation and comfort, labor pain, body warmth, vital signs, and interval of labor pain before and after the foot baths, which are assessed using a numerical rating scale. A paired t test or Wilcoxon signed-rank test will be performed to compare the data for salivary cortisol levels and numerical rating scale scores. Results: Data collection started on April 1, 2022. As of October 2022, we had enrolled 10 participants. Because of the COVID-19 pandemic in Japan, it is difficult for medical personnel to freely interact with women in labor until the results of the COVID-19 polymerase chain reaction test are available in the research facility, complicating the recruitment process. Conclusions: This is the first prospective study to assess the effects of foot baths using a biomarker during the first stage of labor. The findings on the effects of foot baths on women in labor will provide novel insights that may improve the outcomes of delivery. A randomized controlled trial to investigate the effects of foot baths to obtain robust evidence should be conducted in the future. Trial Registration: University Hospital Medical Information Network-Clinical Trial Registry UMIN000046539; https://tinyurl.com/2wwj7dns International Registered Report Identifier (IRRID): DERR1-10.2196/39985 
%M 36652283
%R 10.2196/39985
%U https://www.researchprotocols.org/2023/1/e39985
%U https://doi.org/10.2196/39985
%U http://www.ncbi.nlm.nih.gov/pubmed/36652283

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 9
%N 4
%P e34823
%T Acceptability and Feasibility of a Low-Cost Device for Gestational Age Assessment in a Low-Resource Setting: Qualitative Study
%A Koech,Angela
%A Musitia,Peris Muoga
%A Mwashigadi,Grace Mkanjala
%A Kinshella,Mai-Lei Woo
%A Vidler,Marianne
%A Temmerman,Marleen
%A Craik,Rachel
%A von Dadelszen,Peter
%A Noble,J Alison
%A Papageorghiou,Aris T
%A ,
%+ Centre of Excellence in Women & Child Health, Aga Khan University, 3rd Parklands Avenue, Limuru Road, P.O. Box 30270-00100, Nairobi, 4100, Kenya, 254 722 502602, angela.koech@aku.edu
%K gestational age
%K gestation
%K gynecology
%K gynecologist
%K prenatal
%K antenatal
%K maternal
%K fetus
%K fetal
%K ultrasound
%K imaging
%K pregnancy dating
%K handheld
%K portable
%K trust
%K artificial intelligence
%K sub-Saharan Africa
%K Africa
%K low cost
%K LMIC
%K low income
%K feasibility
%K acceptability
%K AI
%K pregnancy
%K pregnant
%K maternity
%K women's health
%K obstetrics
%K obstetrician
%K rural
%K remote
%K remote location
%K misconception
%K eHealth
%K digital health
%D 2022

%7 27.12.2022
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: Ultrasound for gestational age (GA) assessment is not routinely available in resource-constrained settings, particularly in rural and remote locations. The TraCer device combines a handheld wireless ultrasound probe and a tablet with artificial intelligence (AI)-enabled software that obtains GA from videos of the fetal head by automated measurements of the fetal transcerebellar diameter and head circumference. Objective: The aim of this study was to assess the perceptions of pregnant women, their families, and health care workers regarding the feasibility and acceptability of the TraCer device in an appropriate setting. Methods: A descriptive study using qualitative methods was conducted in two public health facilities in Kilifi county in coastal Kenya prior to introduction of the new technology. Study participants were shown a video role-play of the use of TraCer at a typical antenatal clinic visit. Data were collected through 6 focus group discussions (N=52) and 18 in-depth interviews. Results: Overall, TraCer was found to be highly acceptable to women, their families, and health care workers, and its implementation at health care facilities was considered to be feasible. Its introduction was predicted to reduce anxiety regarding fetal well-being, increase antenatal care attendance, increase confidence by women in their care providers, as well as save time and cost by reducing unnecessary referrals. TraCer was felt to increase the self-image of health care workers and reduce time spent providing antenatal care. Some participants expressed hesitancy toward the new technology, indicating the need to test its performance over time before full acceptance by some users. The preferred cadre of health care professionals to use the device were antenatal clinic nurses. Important implementation considerations included adequate staff training and the need to ensure sustainability and consistency of the service. Misconceptions were common, with a tendency to overestimate the diagnostic capability, and expectations that it would provide complete reassurance of fetal and maternal well-being and not primarily the GA. Conclusions: This study shows a positive attitude toward TraCer and highlights the potential role of this innovation that uses AI-enabled automation to assess GA. Clarity of messaging about the tool and its role in pregnancy is essential to address misconceptions and prevent misuse. Further research on clinical validation and related usability and safety evaluations are recommended. 
%M 36574278
%R 10.2196/34823
%U https://humanfactors.jmir.org/2022/4/e34823
%U https://doi.org/10.2196/34823
%U http://www.ncbi.nlm.nih.gov/pubmed/36574278

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 12
%P e41586
%T Telehealth Care for Mothers and Infants to Improve the Continuum of Care: Protocol for a Quasi-Experimental Study
%A Kikuchi,Kimiyo
%A Islam,Rafiqul
%A Sato,Yoko
%A Nishikitani,Mariko
%A Izukura,Rieko
%A Jahan,Nusrat
%A Yokota,Fumihiko
%A Ikeda,Subaru
%A Sultana,Nazneen
%A Nessa,Meherun
%A Nasir,Morshed
%A Ahmed,Ashir
%A Kato,Kiyoko
%A Morokuma,Seiichi
%A Nakashima,Naoki
%+ Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 8128582, Japan, 81 0926426863, kikuchi.kimiyo.715@m.kyushu-u.ac.jp
%K telehealth care
%K continuum of care
%K maternal, newborn, and child health
%K portable health clinic
%K parenting
%K prenatal
%K pediatrics
%D 2022

%7 15.12.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Ensuring an appropriate continuum of care in maternal, newborn, and child health, as well as providing nutrition care, is challenging in remote areas. To make care accessible for mothers and infants, we developed a telehealth care system called Portable Health Clinic for Maternal, Newborn, and Child Health. Objective: Our study will examine the telehealth care system’s effectiveness in improving women’s and infants’ care uptake and detecting their health problems. Methods: A quasi-experimental study will be conducted in rural Bangladesh. Villages will be allocated to the intervention and control areas. Pregnant women (≥16 gestational weeks) will participate together with their infants and will be followed up 1 year after delivery or birth. The intervention will include regular health checkups via the Portable Health Clinic telehealth care system, which is equipped with a series of sensors and an information system that can triage participants’ health levels based on the results of their checkups. Women and infants will receive care 4 times during the antenatal period, thrice during the postnatal period, and twice during the motherhood and childhood periods. The outcomes will be participants’ health checkup coverage, gestational and neonatal complication rates, complementary feeding rates, and health-seeking behaviors. We will use a multilevel logistic regression and a generalized estimating equation to evaluate the intervention’s effectiveness. Results: Recruitment began in June 2020. As of June 2022, we have consented 295 mothers in the study. Data collection is expected to conclude in June 2024. Conclusions: Our new trial will show the effectiveness and extent of using a telehealth care system to ensure an appropriate continuum of care in maternal, newborn, and child health (from the antenatal period to the motherhood and childhood periods) and improve women’s and infants’ health status. Trial Registration: ISRCTN Registry ISRCTN44966621; https://www.isrctn.com/ISRCTN44966621 International Registered Report Identifier (IRRID): DERR1-10.2196/41586 
%M 36520523
%R 10.2196/41586
%U https://www.researchprotocols.org/2022/12/e41586
%U https://doi.org/10.2196/41586
%U http://www.ncbi.nlm.nih.gov/pubmed/36520523

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 8
%N 12
%P e38045
%T Incidence of and Experiences with Abortion Attempts in Soweto, South Africa: Respondent-Driven Sampling Study
%A Gerdts,Caitlin
%A Jayaweera,Ruvani T
%A Motana,Relebohile
%A Bessenaar,Tshegofatso
%A Wesson,Paul
%+ Ibis Reproductive Health, 1736 Franklin St, Oakland, CA, 94612, United States, 1 510 822 2686, cgerdts@ibisreproductivehealth.org
%K induced abortion
%K respondent-driven sampling
%K self-managed abortion
%K abortion incidence
%D 2022

%7 8.12.2022
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Estimation of abortion incidence, particularly in settings where most abortions occur outside of health facility settings, is critical for understanding information gaps and service delivery needs in different settings. However, the existing methods for measuring out-of-facility abortion incidence are plagued with methodological challenges. Respondent-driven sampling (RDS) may offer a methodological improvement in the estimation of abortion incidence. Objective: In this study, we tested the feasibility of using RDS to recruit participants into a study about abortion and estimated the proportion of people who ever attempted abortion as well as 1-year and 5-year incidence of abortion (both in-facility and out-of-facility settings) among women of reproductive age in Soweto, South Africa. Methods: Participants were eligible if they identified as a woman; were aged between 15 and 49 years; spoke English, Tswana, isiZulu, Sotho, or Xhosa; and lived in Soweto. Working with community partners, we identified 11 seeds who were provided with coupons to refer eligible peers to the study. Upon arrival at the study site, the recruits completed an interviewer-administered questionnaire that solicited information about demographic characteristics, social network composition, health behaviors, sexual history, pregnancy history, and experience with abortion; recruits also received 3 recruitment coupons. Recruitment was tracked using coupon numbering. We used the RDS-II estimator to estimate the population proportions of demographic characteristics and our primary outcome, the proportion of people who ever attempted abortion. Results: Between April 4, 2018, and December 17, 2018, 849 eligible participants were recruited into the study. The estimated proportion of people who ever attempted abortion was 12.1% (95% CI 9.7%-14.4%). A total of 7.1% (95% CI 5.4%-8.9%) reported a facility-based abortion, and 4.4% (95% CI 3.0%-5.8%) reported an out-of-facility abortion. Conclusions: The estimated proportion of people who ever attempted abortion of 12% (102/849) in our study likely represents a substantial underestimation of the actual proportion of abortion attempts among this study population—representing a failure of the RDS method to generate more reliable estimates of abortion incidence in our study. We caution against the use of RDS to measure the incidence of abortion because of persistent concerns with underreporting but consider potential alternative applications of RDS with respect to the study of abortion. 
%M 36480253
%R 10.2196/38045
%U https://publichealth.jmir.org/2022/12/e38045
%U https://doi.org/10.2196/38045
%U http://www.ncbi.nlm.nih.gov/pubmed/36480253

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 12
%P e38821
%T Impact of Telehealth on the Delivery of Prenatal Care During the COVID-19 Pandemic: Mixed Methods Study of the Barriers and Opportunities to Improve Health Care Communication in Discussions About Pregnancy and Prenatal Genetic Testing
%A Craighead,Caitlin G
%A Collart,Christina
%A Frankel,Richard
%A Rose,Susannah
%A Misra-Hebert,Anita D
%A Tucker Edmonds,Brownsyne
%A Michie,Marsha
%A Chien,Edward
%A Coleridge,Marissa
%A Goje,Oluwatosin
%A Ranzini,Angela C
%A Farrell,Ruth M
%+ Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, United States, 1 216 445 7085, farrelr@ccf.org
%K prenatal health care delivery
%K health care communication
%K telehealth
%K access to health care
%K COVID-19
%K pregnancy
%D 2022

%7 5.12.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The COVID-19 pandemic brought significant changes in health care, specifically the accelerated use of telehealth. Given the unique aspects of prenatal care, it is important to understand the impact of telehealth on health care communication and quality, and patient satisfaction. This mixed methods study examined the challenges associated with the rapid and broad implementation of telehealth for prenatal care delivery during the pandemic. Objective: In this study, we examined patients’ perspectives, preferences, and experiences during the COVID-19 pandemic, with the aim of supporting the development of successful models to serve the needs of pregnant patients, obstetric providers, and health care systems during this time. Methods: Pregnant patients who received outpatient prenatal care in Cleveland, Ohio participated in in-depth interviews and completed the Coronavirus Perinatal Experiences-Impact Survey (COPE-IS) between January and December 2021. Transcripts were coded using NVivo 12, and qualitative analysis was used, an approach consistent with the grounded theory. Quantitative data were summarized and integrated during analysis. Results: Thematic saturation was achieved with 60 interviews. We learned that 58% (35/60) of women had telehealth experience prior to their current pregnancy. However, only 8% (5/60) of women had used both in-person and virtual visits during this pregnancy, while the majority (54/60, 90%) of women participated in only in-person visits. Among 59 women who responded to the COPE-IS, 59 (100%) felt very well supported by their provider, 31 (53%) were moderately to highly concerned about their child’s health, and 17 (29%) reported that the single greatest stress of COVID-19 was its impact on their child. Lead themes focused on establishing patient-provider relationships that supported shared decision-making, accessing the information needed for shared decision-making, and using technology effectively to foster discussions during the COVID-19 pandemic. Key findings indicated that participants felt in-person visits were more personal, established greater rapport, and built better trust in the patient-provider relationship as compared to telehealth visits. Further, participants felt they could achieve a greater dialogue and ask more questions regarding time-sensitive information, including prenatal genetic testing information, through an in-person visit. Finally, privacy concerns arose if prenatal genetic testing or general pregnancy conversations were to take place outside of the health care facility. Conclusions: While telehealth was recognized as an option to ensure timely access to prenatal care during the COVID-19 pandemic, it also came with multiple challenges for the patient-provider relationship. These findings highlighted the barriers and opportunities to achieve effective and patient-centered communication with the continued integration of telehealth in prenatal care delivery. It is important to address the unique needs of this population during the pandemic and as health care increasingly adopts a telehealth model. 
%M 36383634
%R 10.2196/38821
%U https://formative.jmir.org/2022/12/e38821
%U https://doi.org/10.2196/38821
%U http://www.ncbi.nlm.nih.gov/pubmed/36383634

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 24
%N 11
%P e37552
%T Assessing the Content and Quality of Digital Tools for Managing Gestational Weight Gain: Systematic Search and Evaluation
%A Brammall,Bonnie R
%A Garad,Rhonda M
%A Boyle,Jacqueline A
%A Hayman,Melanie J
%A de Jersey,Susan J
%A Teede,Helena J
%A Hong,Quoc V
%A Carrandi,Alayna
%A Harrison,Cheryce L
%+ Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Kanooka Grove, Clayton, 3168, Australia, 61 3 8572 2662, cheryce.harrison@monash.edu
%K digital
%K gestational
%K weight
%K tracking
%K pregnancy
%D 2022

%7 25.11.2022
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Digital health resources have the potential to assist women in optimizing gestational weight gain (GWG) during pregnancy to improve maternal health outcomes. Objective: In this study, we aimed to evaluate the quality and behavior change potential of publicly available digital tools (websites and apps) that facilitate GWG tracking. Methods: Digital tools were identified using key search terms across website search engines and app stores and evaluated using the Mobile App Rating Scale, the App Behavior Change Scale, as well as criteria to evaluate the rigor and safety of GWG information. Results: Overall, 1085 tools were screened for inclusion (162 websites and 923 apps), and 19 were deemed eligible. The mean Mobile App Rating Scale quality score was 3.31 (SD 0.53) out of 5, ranging from 2.26 to 4.39, and the mean App Behavior Change Scale score was 6 (SD 3.4) out of 21, ranging from 19 to 0. Of the 19 items used to evaluate rigor of GWG advice, most tools (n=11, 57.9%) contained ≤3 items. Conclusions: This review emphasizes the substantial limitations in current digital resources promoting the monitoring and optimization of GWG. Most tools were of low quality, had minimal behavior change potential, and were potentially unsafe, with minimal linkage to evidence-based information or partnership with health care. 
%M 36427237
%R 10.2196/37552
%U https://www.jmir.org/2022/11/e37552
%U https://doi.org/10.2196/37552
%U http://www.ncbi.nlm.nih.gov/pubmed/36427237

%0 Journal Article
        
%@ 2291-9279
%I JMIR Publications
%V 10
%N 4
%P e36695
%T The Effects of Virtual Reality in Maternal Delivery: Systematic Review and Meta-analysis
%A Xu,Nuo
%A Chen,Sijing
%A Liu,Yan
%A Jing,Yuewen
%A Gu,Ping
%+ School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, China, 86 1 358 520 5899, gpapple83@163.com
%K virtual reality technology
%K delivery
%K labor pain
%K anxiety
%K meta-analysis
%K systematic review
%K pain
%K pregnancy
%K virtual reality
%K maternity
%K labor
%K technology
%K pregnant women
%K review
%K childbirth
%K mental health
%D 2022

%7 23.11.2022
%9 Review
%J JMIR Serious Games
%G English
                
%X Background: Extreme labor pain has negative effects; pharmacologic analgesic modalities are effective but are accompanied by adverse effects. Virtual reality (VR) works as a distracting nonpharmacologic intervention for pain and anxiety relief; however, the effects of VR use in laboring women is unknown. Objective: Our study aimed to determine the safety and effectiveness of VR technology during labor and delivery and investigate whether it impacts labor and patient satisfaction. Methods: In all, 7 databases (PubMed, Embase, Web of Science, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, and Wan-Fang Database) were systematically searched for randomized controlled trials of VR use in pregnancy and childbirth from the time of database construction until November 24, 2021. Two researchers extracted data and evaluated study quality using the Cochrane Risk of Bias tool 2.0. Outcome measures were labor pain, anxiety, duration, satisfaction, and adverse events. Meta-analyses were performed where possible. Results: A total of 12 studies with 1095 participants were included, of which 1 and 11 studies were rated as “Low risk” and “Some concerns” for risk of bias, respectively. Of the 12 studies, 11 reported labor pain, 7 reported labor anxiety, and 4 reported labor duration. Meta-analysis revealed that VR use could relieve pain during labor (mean difference –1.81, 95% CI –2.04 to –1.57; P<.001) and the active period (standardized mean difference [SMD] –0.41, 95% CI –0.68 to –0.14; P=.003); reduce anxiety (SMD –1.39, 95% CI –1.99 to –0.78; P<.001); and improve satisfaction with delivery (relative risk 1.32, 95% CI 1.10-1.59; P=.003). The effects of VR on the duration of the first (SMD –1.12, 95% CI –2.38 to 0.13; P=.08) and second (SMD –0.22, 95% CI –0.67 to 0.24; P=.35) stages of labor were not statistically significant. Conclusions: VR is safe and effective in relieving maternal labor pain and anxiety; however, due to the heterogeneity among studies conducted to date, more rigorous, large-scale, and standardized randomized controlled trials are required to provide a higher-quality evidence base for the use of VR technology in maternal labor, with the aim of improving experience and outcomes. Trial Registration: PROSPERO CRD42021295410; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=295410 
%M 36416881
%R 10.2196/36695
%U https://games.jmir.org/2022/4/e36695
%U https://doi.org/10.2196/36695
%U http://www.ncbi.nlm.nih.gov/pubmed/36416881

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 11
%P e32757
%T First-time Mothers’ Understanding and Use of a Pregnancy and Parenting Mobile App (The Baby Buddy App): Qualitative Study Using Appreciative Inquiry
%A Bailey,Elizabeth
%A Nightingale,Samantha
%A Thomas,Nicky
%A Coleby,Dawn
%A Deave,Toity
%A Goodenough,Trudy
%A Ginja,Samuel
%A Lingam,Raghu
%A Kendall,Sally
%A Day,Crispin
%A Coad,Jane
%+ School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Queens Medical Centre, Derby Rd, Lenton, Nottingham, NG7 2UH, United Kingdom, 44 07717416441, jane.coad@nottingham.ac.uk
%K pregnancy
%K antenatal support
%K antenatal education
%K communication
%K digital
%K pregnancy apps
%K mobile phone
%D 2022

%7 21.11.2022
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Internationally, there is increasing emphasis on early support for pregnant women to optimize the health and development of mothers and newborns. To increase intervention reach, digital and app-based interventions have been advocated. There are growing numbers of pregnancy health care apps with great variation in style, function, and objectives, but evidence about impact on pregnancy well-being and behavior change following app interaction is lacking. This paper reports on the qualitative arm of the independent multicomponent study exploring the use and outcomes of first-time mothers using the Baby Buddy app, a pregnancy and parenting support app, available in the National Health Service App Library and developed by a UK child health and well-being charity, Best Beginnings. Objective: This study aims to understand when, why, and how first-time mothers use the Baby Buddy app and the perceived benefits and challenges. Methods: This paper reports on the qualitative arm of an independent, longitudinal, mixed methods study. An Appreciative Inquiry qualitative approach was used with semistructured interviews (17/60, 28%) conducted with new mothers, either by telephone or in a focus group setting. First-time mothers were recruited from 3 study sites from across the United Kingdom. Consistent with the Appreciative Inquiry approach, mothers were prompted to discuss what worked well and what could have been better regarding their interactions with the app during pregnancy. Thematic analysis was used, and findings are presented as themes with perceived benefits and challenges. Results: The main benefit, or what worked well, for first-time mothers when using the app was being able to access new information, which they felt was reliable and easy to find. This led to a feeling of increased confidence in the information they accessed, thus supporting family and professional communication. The main challenge was the preference for face-to-face information with a health care professional, particularly around specific issues that they wished to discuss in depth. What could have been improved included that there were some topics that some mothers would have preferred in more detail, but in other areas, they felt well-informed and thus did not feel a need to seek additional information via an app. Conclusions: Although this study included a small sample, it elicited rich data and insights into first-time mothers’ app interactions. The findings suggest that easily accessible pregnancy information, which is perceived as reliable, can support first-time mothers in communicating with health care professionals. Face-to-face contact with professionals was preferred, particularly to discuss specific and personalized needs. Further studies on maternal and professional digital support preferences after the COVID-19 global pandemic and how they facilitate antenatal education and informed decision-making are recommended, particularly because digital solutions remain as a key element in pregnancy and early parenting care. International Registered Report Identifier (IRRID): RR2-10.1017/S1463423618000294 
%M 36409530
%R 10.2196/32757
%U https://mhealth.jmir.org/2022/11/e32757
%U https://doi.org/10.2196/32757
%U http://www.ncbi.nlm.nih.gov/pubmed/36409530

%0 Journal Article
        
%@ 2563-3570
%I JMIR Publications
%V 3
%N 1
%P e36791
%T The Utilization of Heart Rate Variability for Autonomic Nervous System Assessment in Healthy Pregnant Women: Systematic Review
%A Sharifiheris,Zahra
%A Rahmani,Amir
%A Onwuka,Joseph
%A Bender,Miriam
%+ University of California, Irvine, 8420 Palo Verde, Irvine, CA, 92697, United States, 1 6506805432, sharifiz@uci.edu
%K heart rate variability
%K pregnancy
%K systematic review
%K autonomic nervous system assessment
%D 2022

%7 17.11.2022
%9 Review
%J JMIR Bioinform Biotech
%G English
                
%X Background: The autonomic nervous system (ANS) plays a central role in pregnancy-induced adaptations, and failure in the required adaptations is associated with adverse neonatal and maternal outcomes. Mapping maternal ANS function in healthy pregnancy may help to understand ANS function. Objective: This study aimed to systematically review studies on the use of heart rate variability (HRV) monitoring to measure ANS function during pregnancy and determine whether specific HRV patterns representing normal ANS function have been identified during pregnancy. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used to guide the systematic review. The CINAHL, PubMed, SCOPUS, and Web of Science databases were searched to comprehensively identify articles without a time span limitation. Studies were included if they assessed HRV in healthy pregnant individuals at least once during pregnancy or labor, with or without a comparison group (eg, complicated pregnancy). Quality assessment of the included literature was performed using the National Heart, Lung, and Blood Institute (NHLBI) tool. A narrative synthesis approach was used for data extraction and analysis, as the articles were heterogenous in scope, approaches, methods, and variables assessed, which precluded traditional meta-analysis approaches being used. Results: After full screening, 8 studies met the inclusion criteria. In 88% (7/8) of the studies, HRV was measured using electrocardiogram and operationalized in 3 different ways: linear frequency domain (FD), linear time domain (TD), and nonlinear methods. FD was measured in all (8/8), TD in 75% (6/8), and nonlinear methods in 25% (2/8) of the studies. The assessment duration varied from 5 minutes to 24 hours. TD indexes and most of the FD indexes decreased from the first to the third trimesters in the majority (5/7, 71%) of the studies. Of the FD indexes, low frequency (LF [nu]) and the LF/high frequency (HF) ratio showed an ascending trend from early to late pregnancy, indicating an increase in sympathetic activity toward the end of the pregnancy. Conclusions: We identified 3 HRV operationalization methods along with potentially indicative HRV patterns. However, we found no justification for the selection of measurement tools, measurement time frames, and operationalization methods, which threaten the generalizability and reliability of pattern findings. More research is needed to determine the criteria and methods for determining HRV patterns corresponding to ANS functioning in healthy pregnant persons. 
%R 10.2196/36791
%U https://bioinform.jmir.org/2022/1/e36791
%U https://doi.org/10.2196/36791

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 5
%N 4
%P e37581
%T Evaluation of Breastfeeding App Features: Content Analysis Study
%A Dinour,Lauren M
%A Pole,Antoinette
%+ Department of Nutrition and Food Studies, College of Education and Human Services, Montclair State University, 1 Normal Avenue, Montclair, NJ, 07043, United States, 1 973 655 5395, dinourl@montclair.edu
%K breastfeeding
%K breastmilk expression
%K bottle feeding
%K infant food
%K infant health
%K infant care
%K consumer health informatics
%K mobile apps
%K smartphone
%K cross-sectional study
%D 2022

%7 26.10.2022
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: While a variety of health apps abound, less than half of adults in the United States report using a health app, despite the ubiquity of smartphones among users aged 18 to 49 years. Several studies have examined the use of breastfeeding apps; however, less is known about the types of features found on these apps and what factors might influence app ratings. Objective: This paper seeks to characterize breastfeeding apps, assess whether apps with higher user ratings differ from apps with lower user ratings in their tracking and nontracking features, and analyze whether the type and number of features predict user star ratings and whether an app is higher- or lower-rated. Methods: Using a cross-sectional design, a convenience sample of breastfeeding apps was culled from the Apple App Store (iOS) and Google Play Store (Android). Content analysis of the apps (N=82) was conducted using a schema of 87 items, which was then compiled into 9 topical indices for breastfeeding, bottle feeding, solid foods, infant health, infant care, technical characteristics, informatics, informational characteristics, and interactivity. Analysis consisted of descriptive statistics, the Mann-Whitney U test, and Spearman rank correlations. Linear regression and binary logistic regression analyses were conducted to determine which features predicted user star ratings. Results: On average, users rated breastfeeding apps 4.4 of 5 stars. Two-thirds of apps (n=54) were higher rated (≥4.5 stars), and one-third (n=28) were lower rated (<4.5 stars). Higher-rated apps offered more tracking features for breastfeeding, bottle feeding, solid foods, infant health, and infant care than lower-rated apps. The breastfeeding, solid-food, and technical indices explained 17% of user star ratings. For each additional breastfeeding and solid-food feature, we can expect to see a 27% and 35% increase, respectively, in user star ratings. Additionally, as the number of solid-food features increased, the odds that the app is higher rated increased 1.58 times. Conclusions: Our findings suggest user ratings are driven in part by tracking features, specifically those related to breastfeeding and solid foods. The proliferation of mobile health apps offers opportunities for parents and caregivers to track behaviors associated with infant feeding and other health metrics in a dynamic, detailed, and comprehensive manner. Hence, breastfeeding apps have the potential to promote and support breastfeeding among users. 
%M 36287596
%R 10.2196/37581
%U https://pediatrics.jmir.org/2022/4/e37581
%U https://doi.org/10.2196/37581
%U http://www.ncbi.nlm.nih.gov/pubmed/36287596

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 5
%N 4
%P e37448
%T Canadian Resources on Cannabis Use and Fertility, Pregnancy, and Lactation: Scoping Review
%A Sharif,Ayni
%A Bombay,Kira
%A Murphy,Malia S Q
%A Murray,Rebecca K
%A Sikora,Lindsey
%A Cobey,Kelly D
%A Corsi,Daniel J
%+ Children's Hospital of Eastern Ontario Research Institute, 501 Smyth Road, CPCR Building, Rm L1242, Ottawa, ON, Canada, 1 6137378899 ext 71190, dcorsi@ohri.ca
%K cannabis
%K pregnancy
%K fertility
%K breastfeeding
%K patient education
%K patient resources
%K internet
%K eHealth
%K digital health
%D 2022

%7 19.10.2022
%9 Review
%J JMIR Pediatr Parent
%G English
                
%X Background: Cannabis use among reproductive-aged Canadians is increasing, but our understanding of its impacts on fertility, pregnancy, and breast milk is still evolving. Despite the availability of many web-based resources, informed decision-making and patient counseling are challenging for expectant families and providers alike. Objective: We aimed to conduct a scoping review of publicly available web-based Canadian resources to provide information on the effects of cannabis on fertility, pregnancy, and breast milk. Methods: Following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), we systematically searched 8 databases between January 1, 2010, and November 30, 2020, and web pages of 71 Canadian obstetrical, government, and public health organizations. We included English resources discussing the effects of cannabis on fertility, pregnancy, breastfeeding, or the exposed fetus and infant. Epidemiological characteristics, readability, and content information were extracted and summarized. Results: A total of 183 resources met our inclusion criteria. Resources included content for public audiences (163/183, 89.1%) and health care providers (HCPs; 31/183, 16.9%). The resources were authored by national-level (46/183, 25.1%), provincial or territorial (65/183, 35.5%), and regional (72/183, 39.3%) organizations. All provinces and territories had at least one resource attributed to them. The majority (125/183, 68.3%) were written at a >10 grade reading level, and a few (7/183, 3.8%) were available in languages other than English or French. The breadth of content on fertility (55/183, 30.1%), pregnancy (173/183, 94.5%), and breast milk or breastfeeding (133/183, 72.7%) varied across resources. Common themes included citing a need for more research into the effects of cannabis on reproductive health and recommending that patients avoid or discontinue cannabis use. Although resources for providers were consistent in recommending patient counseling, resources targeting the public were less likely to encourage seeking advice from HCPs (23/163, 14.1%). Conclusions: Canadian resources consistently identify that there is no known safe amount of cannabis that can be consumed in the context of fertility, pregnancy, and breastfeeding. Areas of improvement include increasing readability and language accessibility and encouraging bidirectional communication between HCPs and patients. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-045006 
%M 36260396
%R 10.2196/37448
%U https://pediatrics.jmir.org/2022/4/e37448
%U https://doi.org/10.2196/37448
%U http://www.ncbi.nlm.nih.gov/pubmed/36260396

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 5
%N 4
%P e41356
%T Women’s Satisfaction With Telehealth Services During The COVID-19 Pandemic: Cross-sectional Survey Study
%A Mittone,Diletta F
%A Bailey,Caitlin P
%A Eddy,Ebony L
%A Napolitano,Melissa A
%A Vyas,Amita
%+ Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, Washington, DC, DC, 20052, United States, 1 202 994 3695, avyas@gwu.edu
%K telehealth
%K COVID-19
%K maternal-child health
%K Perinatal
%K pediatrics
%K telemedicine
%K pregnancy
%K women's health
%K patient outcome
%D 2022

%7 14.10.2022
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Since March 2020, the need to reduce patients’ exposure to COVID-19 has resulted in a large-scale pivot to telehealth service delivery. Although studies report that pregnant women have been generally satisfied with their prenatal telehealth experiences during the pandemic, less is known about telehealth satisfaction among postpartum women. Objective: This study examined telehealth satisfaction among both pregnant and recently pregnant women during the COVID-19 pandemic, to determine whether demographic factors (ie, race, age, marital status, education level, household income, and employment status) are associated with telehealth satisfaction in this population. Methods: A web-based cross-sectional survey designed to capture data on health-related behaviors and health care experiences of pregnant and recently pregnant women in the United States was disseminated in Spring 2022. Eligible participants were at least 18 years old, identified as a woman, and were currently pregnant or had been pregnant in the last 3 years. Results: In the final analytic sample of N=403, the mean telehealth satisfaction score was 3.97 (SD 0.66; score range 1-5). In adjusted linear regression models, being aged 35-44 years (vs 18-24 years), having an annual income of ≥ US $100,000 (vs < US $50,000), and being recently (vs currently) pregnant were associated with greater telehealth satisfaction (P≤.049). Conclusions: Although perinatal women are generally satisfied with telehealth, disparities exist. Specifically, being aged 18-24 years, having an annual income of < US $50,000, and being currently pregnant were associated with lower telehealth satisfaction. It is critical that public health policies or programs consider these factors, especially if the expanded use of telehealth is to persist beyond the pandemic. 
%M 36125862
%R 10.2196/41356
%U https://pediatrics.jmir.org/2022/4/e41356
%U https://doi.org/10.2196/41356
%U http://www.ncbi.nlm.nih.gov/pubmed/36125862

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 10
%P e37866
%T Information Resources Among Flemish Pregnant Women: Cross-sectional Study
%A Lanssens,Dorien
%A Thijs,Inge M
%A Dreesen,Pauline
%A Van Hecke,Ann
%A Coorevits,Pascal
%A Gaethofs,Gitte
%A Derycke,Joyce
%A Tency,Inge
%+ Faculty of Medicine and Life Sciences, Limburg Clinical Research Center, University of Hasselt, Martelarenlaan 42, Hasselt, 3500, Belgium, 32 494919476, dorien.lanssens@uhasselt.be
%K pregnancy app
%K mobile app
%K questionnaire
%K pregnancy
%K pregnant
%K mHealth
%K mobile health
%K cross-sectional
%K user need
%K user expectation
%K survey
%K maternal
%K maternity
%K user experience
%D 2022

%7 11.10.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: There has been an exponential growth in the availability of apps, resulting in increased use of pregnancy apps. However, information on resources and use of apps among pregnant women is relatively limited. Objective: The aim of this study is to map the current information resources and the use of pregnancy apps among pregnant women in Flanders. Methods: A cross-sectional study was conducted, using a semistructured survey (April-June 2019) consisting of four different domains: (1) demographics; (2) use of devices; (3) sources of information; and (4) use of pregnancy apps. Women were recruited by social media, flyers, and paper questionnaires at prenatal consultations. Statistical analysis was mainly focused on descriptive statistics. Differences in continuous and categorical variables were tested using independent Student t tests and chi-square tests. Correlations were investigated between maternal characteristics and the women’s responses. Results: In total, 311 women completed the entire questionnaire. Obstetricians were the primary source of information (268/311, 86.2%) for pregnant women, followed by websites/internet (267/311, 85.9%) and apps (233/311, 74.9%). The information that was most searched for was information about the development of the baby (275/311, 88.5%), discomfort/complaints (251/311, 80.7%) and health during pregnancy (248/311, 79.7%), administrative/practical issues (233/311, 74.9%), and breastfeeding (176/311, 56.6%). About half of the women (172/311, 55.3%) downloaded a pregnancy app, and primarily searched app stores (133/311, 43.0%). Pregnant women who are single asked their mothers (22/30, 73.3%) or other family members (13/30, 43.3%) for significantly more information than did married women (mother [in law]: 82/160, 51.3%, P=.02; family members: 35/160, 21.9%, P=.01). Pregnant women with lower education were significantly more likely to have a PC or laptop than those with higher education (72/73, 98.6% vs 203/237, 85.5%; P=.008), and to consult other family members for pregnancy information (30/73, 41.1% vs 55/237, 23.1%; P<.001), but were less likely to consult a gynecologist (70/73, 95.9% vs 198/237, 83.5%; P=.001). They also followed more prenatal sessions (59/73, 80.8% vs 77/237, 32.5%; P=.04) and were more likely to search for information regarding discomfort/complaints during pregnancy (65/73, 89% vs 188/237, 79.5%; P=.02). Compared to multigravida, primigravida were more likely to solicit advice about their pregnancy from other women in their social networks (family members: primigravida 44/109, 40.4% vs multigravida 40/199, 20.1%; P<.001; other pregnant women: primigravida 58/109, 53.2% vs multigravida 80/199, 40.2%; P<.03). Conclusions: Health care professionals need to be aware that apps are important and are a growing source of information for pregnant women. Concerns rise about the quality and safety of those apps, as only a limited number of apps are subjected to an external quality check. Therefore, it is important that health care providers refer to high-quality digital resources and take the opportunity to discuss digital information with pregnant women. 
%M 36222794
%R 10.2196/37866
%U https://formative.jmir.org/2022/10/e37866
%U https://doi.org/10.2196/37866
%U http://www.ncbi.nlm.nih.gov/pubmed/36222794

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 10
%P e37452
%T The Fetal Growth Restriction at Term Managed by Angiogenic Factors Versus Feto-Maternal Doppler (GRAFD) Trial to Avoid Adverse Perinatal Outcomes: Protocol for a Multicenter, Open-Label, Randomized Controlled Trial
%A Garcia-Manau,Pablo
%A Mendoza,Manel
%A Bonacina,Erika
%A Martin-Alonso,Raquel
%A Martin,Lourdes
%A Palacios,Ana
%A Sanchez,Maria Luisa
%A Lesmes,Cristina
%A Hurtado,Ivan
%A Perez,Esther
%A Tubau,Albert
%A Ibañez,Patricia
%A Alcoz,Marina
%A Valiño,Nuria
%A Moreno,Elena
%A Borrero,Carlota
%A Garcia,Esperanza
%A Lopez-Quesada,Eva
%A Diaz,Sonia
%A Broullon,Jose Roman
%A Teixidor,Mireia
%A Chulilla,Carolina
%A Gil,Maria M
%A Lopez,Monica
%A Candela-Hidalgo,Amparo
%A Salinas-Amoros,Andrea
%A Moreno,Anna
%A Morra,Francesca
%A Vaquerizo,Oscar
%A Soriano,Beatriz
%A Fabre,Marta
%A Gomez-Valencia,Elena
%A Cuiña,Ana
%A Alayon,Nicolas
%A Sainz,Jose Antonio
%A Vives,Angels
%A Esteve,Esther
%A Ocaña,Vanesa
%A López,Miguel Ángel
%A Maroto,Anna
%A Carreras,Elena
%+ Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Passeig de la Vall d’Hebron, 119-129, Barcelona, 08035, Spain, 34 934893085, manel.mendoza@vallhebron.cat
%K fetal growth restriction
%K small for gestational age
%K PlGF
%K sFlt-1
%K Doppler
%K angiogenic factors
%D 2022

%7 11.10.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Fetal smallness affects 10% of pregnancies. Small fetuses are at a higher risk of adverse outcomes. Their management using estimated fetal weight and feto-maternal Doppler has a high sensitivity for adverse outcomes; however, more than 60% of fetuses are electively delivered at 37 to 38 weeks. On the other hand, classification using angiogenic factors seems to have a lower false-positive rate. Here, we present a protocol for the Fetal Growth Restriction at Term Managed by Angiogenic Factors Versus Feto-Maternal Doppler (GRAFD) trial, which compares the use of angiogenic factors and Doppler to manage small fetuses at term. Objective: The primary objective is to demonstrate that classification based on angiogenic factors is not inferior to estimated fetal weight and Doppler at detecting fetuses at risk of adverse perinatal outcomes. Methods: This is a multicenter, open-label, randomized controlled trial conducted in 20 hospitals across Spain. A total of 1030 singleton pregnancies with an estimated fetal weight ≤10th percentile at 36+0 to 37+6 weeks+days will be recruited and randomly allocated to either the control or the intervention group. In the control group, standard Doppler-based management will be used. In the intervention group, cases with a soluble fms-like tyrosine kinase to placental growth factor ratio ≥38 will be classified as having fetal growth restriction; otherwise, they will be classified as being small for gestational age. In both arms, the fetal growth restriction group will be delivered at ≥37 weeks and the small for gestational age group at ≥40 weeks. We will assess differences between the groups by calculating the relative risk, the absolute difference between incidences, and their 95% CIs. Results: Recruitment for this study started on September 28, 2020. The study results are expected to be published in peer-reviewed journals and disseminated at international conferences in early 2023. Conclusions: The angiogenic factor–based protocol may reduce the number of pregnancies classified as having fetal growth restriction without worsening perinatal outcomes. Moreover, reducing the number of unnecessary labor inductions would reduce costs and the risks derived from possible iatrogenic complications. Additionally, fewer inductions would lower the rate of early-term neonates, thus improving neonatal outcomes and potentially reducing long-term infant morbidities. Trial Registration: ClinicalTrials.gov NCT04502823; https://clinicaltrials.gov/ct2/show/NCT04502823 International Registered Report Identifier (IRRID): DERR1-10.2196/37452 
%M 36222789
%R 10.2196/37452
%U https://www.researchprotocols.org/2022/10/e37452
%U https://doi.org/10.2196/37452
%U http://www.ncbi.nlm.nih.gov/pubmed/36222789

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 5
%N 4
%P e31579
%T Association of Pregnancy With Coronavirus Cytokine Storm: Systematic Review and Meta-analysis
%A Muthuka,John
%A Kiptoo,Michael
%A Oluoch,Kelly
%A Nzioki,Japheth Mativo
%A Nyamai,Everlyn Musangi
%+ Head Quaters, Kenya Medical Training College, PO Box 30195-00100, Nairobi, Kenya, 254 724274843, johnmuthuka@gmail.com
%K COVID-19
%K pandemic
%K pregnancy
%K maternal health
%K cytokine
%K cytokine storm
%K immune response
%K infectious disease
%K coronavirus
%K respiratory
%K virus
%K pregnant
%D 2022

%7 4.10.2022
%9 Review
%J JMIR Pediatr Parent
%G English
                
%X Background: COVID-19 was first identified in Wuhan, China, in December 2019, spreading to the rest of the globe, becoming a pandemic. Some studies have shown an association between pregnancy status and severe COVID-19 with a cytokine storm, whereas others have shown contrasting results. Objective: The aim of this study was to examine the relationship between pregnancy status and the clinical COVID-19 severity characterized by the cytokine storm through a systematic review and meta-analysis. Methods: We searched the Google Scholar, PubMed, Scopus, Web of Science, and Embase databases to identify clinical studies suitable for inclusion in this meta-analysis. Studies reporting pregnancy status and comparing the COVID-19 severity cytokine storm outcome were included. COVID-19 severity characterized by a cytokine storm was described using parameters such as intensive care unit admission, invasive mechanical ventilation, mechanical ventilation, hospital admission, pro- and anti-inflammatory cytokine levels, consolidation on chest computed tomography scan, pulmonary infiltration, extreme fevers as characteristic of a cytokine storm, syndromic severity, higher neutrophil count indicative of a cytokine storm, and severe COVID-19 presentation. Results: A total of 17 articles including data for 840,332 women with COVID-19 were included. This meta-analysis revealed a correlation between positive pregnancy status and severe COVID-19 with a cytokine storm (random-effects model odds ratio [OR] 2.47, 95% CI 1.63-3.73; P<.001), with a cumulative incidence of 6432 (14.1%) and 24,352 (3.1%) among pregnant and nonpregnant women with COVID-19, respectively. The fixed-effects model also showed a correlation between pregnancy status and severe COVID-19 with a cytokine storm (OR 7.41, 95% CI 7.02-7.83; P<.001). Considerable heterogeneity was found among all pooled studies (I²=98%, P<.001). Furthermore, the updated analysis showed substantially low heterogeneity (I²=29 %, P=.19), and the funnel plot revealed no publication bias. The subanalysis between single-center and multicenter studies demonstrated similar heterogeneity (I2=72% and 98%, respectively). Sensitivity analysis on each subgroup revealed that pregnancy was significantly related to severe COVID-19 with a cytokine storm from single-center studies (fixed-effects model OR 3.97, 95% CI 2.26-6.95; P<.001) with very low heterogeneity (I²=2%, P=.42). Conclusions: Being pregnant is clearly associated with experiencing a severe course of COVID-19 characterized by a cytokine storm. The COVID-19 pandemic should serve as an impetus for further research on pregnant women diagnosed with COVID-19 to map out the salient risk factors associated with its severity. Trial Registration: PROSPERO CRD42021242011; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242011. 
%M 35319475
%R 10.2196/31579
%U https://pediatrics.jmir.org/2022/4/e31579
%U https://doi.org/10.2196/31579
%U http://www.ncbi.nlm.nih.gov/pubmed/35319475

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 9
%P e38368
%T Mobile for Mothers mHealth Intervention to Augment Maternal Health Awareness and Behavior of Pregnant Women in Tribal Societies: Randomized Quasi-Controlled Study
%A Choudhury,Avishek
%A Choudhury,Murari
%+ Industrial and Management Systems Engineering, Benjamin M Statler College of Engineering and Mineral Resources, West Virginia University, 1306 Evansdale Drive, PO Box 6107, Morgantown, WV, 26506-6107, United States, 1 3042939431, avishek.choudhury@mail.wvu.edu
%K maternal health
%K mHealth
%K digital divide
%K disparity
%K socioeconomic
%K India
%K health
%K awareness
%K mobile
%K intervention
%K adherence
%K health behaviors
%K tribal
%K community
%K education
%D 2022

%7 21.9.2022
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Despite several initiatives taken by government bodies, disparities in maternal health have been noticeable across India’s socioeconomic gradient due to poor health awareness. Objective: The aim of this study was to implement an easy-to-use mobile health (mHealth) app—Mobile for Mothers (MfM)—as a supporting tool to improve (1) maternal health awareness and (2) maternal health–related behavioral changes among tribal and rural communities in India. Methods: Pregnant women, aged 18 to 45 years, were selected from two rural villages of Jharkhand, India: (1) the intervention group received government-mandated maternal care through an mHealth app and (2) the control group received the same government-mandated care via traditional means (ie, verbally). A total of 800 accredited social health activists (ASHAs) were involved, of which 400 were allocated to the intervention group. ASHAs used the MfM app to engage with pregnant women during each home visit in the intervention group. The mHealth intervention commenced soon after the baseline survey was completed in February 2014. The end-line data were collected between November 2015 and January 2016. We calculated descriptive statistics related to demographics and the percentage changes for each variable between baseline and end line per group. The baseline preintervention groups were compared to the end-line postintervention groups using Pearson chi-square analyses. Mantel-Haenszel tests for conditional independence were conducted to determine if the pre- to postintervention differences in the intervention group were significantly different from those in the control group. Results: Awareness regarding the five cleans (5Cs) in the intervention group increased (P<.001) from 143 (baseline) to 555 (end line) out of 740 participants. Awareness about tetanus vaccine injections and the fact that pregnant women should receive two shots of tetanus vaccine in the intervention group significantly increased (P<.001) from 73 out of 740 participants (baseline) to 372 out of 555 participants (end line). In the intervention group, awareness regarding the fact that problems like painful or burning urination and itchy genitals during pregnancy are indicative of a reproductive tract infection increased (P<.001) from 15 (baseline) to 608 (end line) out of 740 participants. Similarly, knowledge about HIV testing increased (P<.001) from 39 (baseline) to 572 (end line) out of 740 participants. We also noted that the number of pregnant women in the intervention group who consumed the prescribed dosage of iron tablets increased (P<.001) from 193 (baseline) out of 288 participants to 612 (end line) out of 663 participants. Conclusions: mHealth interventions can augment awareness of, and persistence in, recommended maternal health behaviors among tribal communities in Jharkhand, India. In addition, mHealth could act as an educational tool to help tribal societies break away from their traditional beliefs about maternal health and take up modern health care recommendations. Trial Registration: OSF Registries 9U8D5; https://doi.org/10.17605/OSF.IO/9U8D5 
%M 36129749
%R 10.2196/38368
%U https://mhealth.jmir.org/2022/9/e38368
%U https://doi.org/10.2196/38368
%U http://www.ncbi.nlm.nih.gov/pubmed/36129749

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 9
%P e31996
%T Effect of Face-to-Face and WhatsApp Communication of a Theory-Based Health Education Intervention on Breastfeeding Self-Efficacy (SeBF Intervention): Cluster Randomized Controlled Field Trial
%A Mohamad Pilus,Farahana
%A Ahmad,Norliza
%A Mohd Zulkefli,Nor Afiah
%A Mohd Shukri,Nurul Husna
%+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Jalan Hospital Serdang, Serdang, 43400, Malaysia, 60 97692424, lizaahmad@upm.edu.my
%K self-efficacy
%K breastfeeding
%K intervention
%K social cognitive theory
%D 2022

%7 14.9.2022
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The exclusive breastfeeding rate in Malaysia is still not satisfactory. Previous studies have shown that breastfeeding self-efficacy is one of the determinants of exclusive breastfeeding, and it can be improved using social cognitive theory. WhatsApp, which is widely used among Malaysians, could be leveraged as a platform to deliver health education interventions. Objective: This study aimed to develop, implement, and evaluate the effect of using a face-to-face and WhatsApp-based health education intervention based on social cognitive theory, namely the Self-Efficacy in Breastfeeding (SeBF) module, on mothers' self-efficacy, knowledge, and attitudes in a district in Selangor state. Methods: This study was a 2-arm, parallel, single-blind, cluster randomized controlled field trial with an intervention and a control group involving primigravida or multigravida mothers who reside in a district in Selangor state and did not exclusively breastfeed during their previous pregnancy. All 12 maternity and pediatric clinics in this district were randomly divided into 6 intervention and 6 control groups. A total of 172 pregnant mothers were randomly assigned to the intervention group (n=86) or the control group (n=86). The control group received usual routine care. The primary outcome was breastfeeding self-efficacy, while secondary outcomes were knowledge and attitude toward breastfeeding. Each subject was assessed at 4 time points: at baseline, immediately after the intervention, 4 weeks post partum, and 8 weeks post partum. Generalized mixed model analysis was applied to measure the effect of health education on breastfeeding self-efficacy, knowledge, and attitude after the intervention. Results: The response rate was 81% (139/172), with the dropout rate being 7% (6/86) in the intervention group and 31% (27/86) in the control group. In the intent-to-treat analysis, the intervention group showed a significant increase in the mean total breastfeeding self-efficacy score 8 weeks after delivery compared with the control group (F21,601=111.73, P<.001). In addition, the mean total score for breastfeeding knowledge increased significantly in the intervention group after the intervention compared to the control group (F21,601=8.33, P<.001). However, no significant difference was found in the mean total score for breastfeeding attitude after the intervention (F21,602=5.50, P=.47). Conclusions: Face-to-face and WhatsApp-based participation in the SeBF program, designed on the basis of social cognitive theory, contributed to improved self-efficacy and knowledge about breastfeeding. Further studies need to be conducted with a longer duration (until 6 months post partum) to evaluate its effectiveness in increasing exclusive breastfeeding. Furthermore, new strategies in health education need to be developed to improve breastfeeding attitudes. Trial Registration: Thaiclinicaltrials.org TCTR20200213004; https://www.thaiclinicaltrials.org/show/TCTR20200213004 
%M 36103244
%R 10.2196/31996
%U https://mhealth.jmir.org/2022/9/e31996
%U https://doi.org/10.2196/31996
%U http://www.ncbi.nlm.nih.gov/pubmed/36103244

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 5
%N 3
%P e35381
%T User Experience of a Computer-Based Decision Aid for Prenatal Trisomy Screening: Mixed Methods Explanatory Study
%A Agbadje,Titilayo Tatiana
%A Pilon,Chantale
%A Bérubé,Pierre
%A Forest,Jean-Claude
%A Rousseau,François
%A Rahimi,Samira Abbasgholizadeh
%A Giguère,Yves
%A Légaré,France
%+ VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, 2480 Chemin de la Canardière, Quebec, QC, G1G 2G1, Canada, 1 418 663 5313, France.Legare@mfa.ulaval.ca
%K shared decision-making
%K computer-based decision aid
%K prenatal screening
%K trisomy
%K Down syndrome
%K mixed methods
%D 2022

%7 6.9.2022
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Mobile health tools can support shared decision-making. We developed a computer-based decision aid (DA) to help pregnant women and their partners make informed, value-congruent decisions regarding prenatal screening for trisomy. Objective: This study aims to assess the usability and usefulness of computer-based DA among pregnant women, clinicians, and policy makers. Methods: For this mixed methods sequential explanatory study, we planned to recruit a convenience sample of 45 pregnant women, 45 clinicians from 3 clinical sites, and 15 policy makers. Eligible women were aged >18 years and >16 weeks pregnant or had recently given birth. Eligible clinicians and policy makers were involved in prenatal care. We asked the participants to navigate a computer-based DA. We asked the women about the usefulness of the DA and their self-confidence in decision-making. We asked all participants about usability, quality, acceptability, satisfaction with the content of the DA, and collected sociodemographic data. We explored participants’ reactions to the computer-based DA and solicited suggestions. Our interview guide was based on the Mobile App Rating Scale. We performed descriptive analyses of the quantitative data and thematic deductive and inductive analyses of the qualitative data for each participant category. Results: A total of 45 pregnant women, 14 clinicians, and 8 policy makers participated. Most pregnant women were aged between 25 and 34 years (34/45, 75%) and White (42/45, 94%). Most clinicians were aged between 35 and 44 years (5/14, 36%) and women (11/14, 79%), and all were White (14/14, 100%); the largest proportion of policy makers was aged between 45 and 54 years (4/8, 50%), women (5/8, 62%), and White (8/8, 100%). The mean usefulness score for preparing for decision-making for women was 80/100 (SD 13), and the mean self-efficacy score was 88/100 (SD 11). The mean usability score was 84/100 (SD 14) for pregnant women, 77/100 (SD 14) for clinicians, and 79/100 (SD 23) for policy makers. The mean global score for quality was 80/100 (SD 9) for pregnant women, 72/100 (SD 12) for clinicians, and 80/100 (SD 9) for policy makers. Regarding acceptability, participants found the amount of information just right (52/66, 79%), balanced (58/66, 88%), useful (38/66, 58%), and sufficient (50/66, 76%). The mean satisfaction score with the content was 84/100 (SD 13) for pregnant women, 73/100 (SD 16) for clinicians, and 73/100 (SD 20) for policy makers. Participants thought the DA could be more engaging (eg, more customizable) and suggested strategies for implementation, such as incorporating it into clinical guidelines. Conclusions: Pregnant women, clinicians, and policy makers found the DA usable and useful. The next steps are to incorporate user suggestions for improving engagement and implementing the computer-based DA in clinical practice. 
%M 35896164
%R 10.2196/35381
%U https://pediatrics.jmir.org/2022/3/e35381
%U https://doi.org/10.2196/35381
%U http://www.ncbi.nlm.nih.gov/pubmed/35896164

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 8
%P e40134
%T Micronutrient Supplementation for Pregnant and Lactating Women to Improve Maternal and Infant Nutritional Status in Low- and Middle-Income Countries: Protocol for a Systematic Review and Meta-analysis
%A Shinde,Sachin
%A Wang,Dongqing
%A Yussuf,Mashavu H
%A Mwanyika-Sando,Mary
%A Aboud,Said
%A Fawzi,Wafaie W
%+ T H Chan School of Public Health, Harvard University, 90 Smith Street, Boston, MA, 02115, United States, 1 617 435 1445, sshinde@hsph.harvard.edu
%K antenatal care
%K multiple micronutrient supplementation
%K pregnant and lactating women
%K systematic review and meta-analysis
%K review
%K meta-analysis
%K meta-analyses
%K low- and middle-income countries
%K LMIC
%K low income
%K middle income
%K women's health
%K pregnant
%K pregnancy
%K natal
%K maternal
%K maternity
%K infant
%K baby
%K babies
%K lactation
%K lactating
%K breastfeed
%K nutrition
%K vitamin
%K nutrient
%K supplement
%D 2022

%7 30.8.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Two billion people in low- and middle-income countries (LMICs) are deficient in key nutrients. Nutritional deficiencies worsen during pregnancy, causing adverse outcomes for the mother and the fetus, with consequences after pregnancy. These effects may be mitigated by providing micronutrient supplementation to women during pregnancy and lactation. However, the effects of micronutrient supplementation on the nutritional status of pregnant and lactating women and that of their infants remain largely unclear in LMICs.  Objective: The purpose of this systematic review and meta-analysis is to determine the effects of single, double, or multiple micronutrient supplements during pregnancy or lactation on maternal and infant nutritional status in LMICs. Methods: Randomized controlled trials of single, double, or combinations of micronutrients assessing effects on the maternal (serum, plasma, and breastmilk) and infant (serum and plasma) nutritional status will be included. MEDLINE (through PubMed), EMBASE, CENTRAL (through Cochrane Library), and the World Health Organization (WHO) library database will be used to identify relevant published studies, starting from the inception of each database until February 28, 2022. The Cochrane Risk of Bias Tool will be used to assess the risk of bias in the included studies. The selection of studies, data extraction, and risk of bias assessment will be carried out independently by 2 reviewers. A narrative summary will be provided of all the included studies. Meta-analyses will be performed whenever possible, and the heterogeneity of effects will be evaluated using I2, subgroup analyses, and metaregression. The certainty of the evidence for each outcome will be assessed using the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach. Results: We will conduct meta-analyses using Stata software (version 16, StataCorp) and present both a narrative and systematic summary of all studies included in this review in text and table form. For continuous outcomes, effect estimates will be expressed as mean differences and standardized mean differences, while for binary outcomes, they will be expressed as risk ratios, rate ratios, hazards ratios, or odds ratios, all with 95% CIs and comparing the intervention group with the control group. When studies for an outcome are adequately consistent with respect to intervention, comparator, and definition of the outcome, a random-effects, inverse variance-weighted meta-analysis will be conducted. We will provide a narrative synthesis for outcomes with insufficient data or extreme heterogeneity. Conclusions: This review will provide evidence upon which to base policy and programming for women in LMICs to supplement micronutrients in pregnancy and lactation. Detailed results disaggregated by variables such as maternal age, sex of infant, duration, and dose of intervention may also help policy makers, researchers, practitioners, and government agencies to adopt more effective maternal and child health policies and programs in LMICs. The review will also identify any gaps in the existing evidence. Trial Registration: PROSPERO CRD42022308715; https://tinyurl.com/y33cxekr. International Registered Report Identifier (IRRID): PRR1-10.2196/40134 
%M 36040761
%R 10.2196/40134
%U https://www.researchprotocols.org/2022/8/e40134
%U https://doi.org/10.2196/40134
%U http://www.ncbi.nlm.nih.gov/pubmed/36040761

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 8
%P e35249
%T The Effect of Particulate Matter Exposure During Pregnancy on Pregnancy and Child Health Outcomes in South Asia: Protocol for an Instrumental Variable Analysis
%A Reitzug,Fabian
%A Luby,Stephen P
%A Pullabhotla,Hemant K
%A Geldsetzer,Pascal
%+ Big Data Institute, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, United Kingdom, 44 7414818688, fabian.reitzug@web.de
%K PM2.5
%K air pollution
%K fine particulate matter
%K birth weight
%K still birth
%K child and maternal health
%K Indo-Gangetic Plain
%K India
%K Pakistan
%K Bangladesh
%K Nepal
%D 2022

%7 10.8.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Determining the longer-term health effects of air pollution has been difficult owing to the multitude of potential confounding variables in the relationship between air pollution and health. Air pollution in many areas of South Asia is seasonal, with large spikes in particulate matter (PM) concentration occurring in the winter months. This study exploits this seasonal variation in PM concentration through a natural experiment. Objective: This project aims to determine the causal effect of PM exposure during pregnancy on pregnancy and child health outcomes. Methods: We will use an instrumental variable (IV) design whereby the estimated month of conception is our instrument for exposure to PM with a diameter less than 2.5 μm (PM2.5) during pregnancy. We will assess the plausibility of our assumption that timing of conception is exogenous with regard to our outcomes of interest and will adjust for date of monsoon onset to control for confounding variables related to harvest timing. Our outcomes are 1) birth weight, 2) pregnancy termination resulting in miscarriage, abortion, or still birth, 3) neonatal death, 4) infant death, and 5) child death. We will use data from the Demographic and Health Surveys (DHS) conducted in relevant regions of Bangladesh, India, Nepal, and Pakistan, along with monthly gridded data on PM2.5 concentration (0.1°×0.1° spatial resolution), precipitation data (0.5°×0.5° resolution), temperature data (0.5°×0.5°), and agricultural land use data (0.1°×0.1° resolution). Results: Data access to relevant DHSs was granted on June 6, 2021 for India, Nepal, Bangladesh, August 24, 2021 for Pakistan, and June 19 2022 for the latest DHS from India. Conclusions: If the assumptions for a causal interpretation of our instrumental variable analysis are met, this analysis will provide important causal evidence on the maternal and child health effects of PM2.5 exposure during pregnancy. This evidence is important to inform personal behavior and interventions, such as the adoption of indoor air filtration during pregnancy as well as environmental and health policy. International Registered Report Identifier (IRRID): DERR1-10.2196/35249 
%M 35947440
%R 10.2196/35249
%U https://www.researchprotocols.org/2022/8/e35249
%U https://doi.org/10.2196/35249
%U http://www.ncbi.nlm.nih.gov/pubmed/35947440

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 8
%P e40568
%T Grocery Delivery to Support Healthy Weight Gain Among Pregnant Young Women With Low Income: Protocol for a Randomized Controlled Trial
%A Waselewski,Marika
%A Plegue,Melissa
%A Sonneville,Kendrin
%A Resnicow,Ken
%A Ghumman,Aisha
%A Ebbeling,Cara
%A Mahmoudi,Elham
%A Sen,Ananda
%A Wolfson,Julia A
%A Chang,Tammy
%+ Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, United States, 1 734 998 7120, marikag@med.umich.edu
%K pregnancy
%K weight
%K diet
%K grocery delivery
%D 2022

%7 5.8.2022
%9 Original Paper
%J JMIR Res Protoc
%G English
                
%X Background: Excessive weight gain during pregnancy is associated with complications for both the mother and her infant including gestational diabetes, hypertensive disorders, operative delivery, and long-term obesity. A healthy diet during pregnancy promotes healthy gestational weight gain and determines fetal epigenetic programming in infants that impacts risk for future chronic disease. Objective: This project will examine the impact of grocery delivery during pregnancy on the weight, diet, and health outcomes of young pregnant women and their infants. Methods: A three-arm randomized controlled trial design will be performed. A total of 855 young pregnant women, aged 14-24 years, from across the state of Michigan will be enrolled and randomized equally into the three study arms. Participants in arm one (control) will receive usual care from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); arm two will receive WIC plus biweekly grocery delivery; and arm three will receive WIC plus biweekly grocery and unsweetened beverage delivery. Weight will be assessed weekly during pregnancy, and total pregnancy weight gain will be categorized as above, below, or within guidelines. Additionally, dietary intake will be assessed at three time points (baseline, second trimester, and third trimester), and pregnancy outcomes will be extracted from medical records. The appropriateness of pregnancy weight gain, diet quality, and occurrence of poor outcomes will be compared between groups using standard practices for multinomial regression and confounder adjustment. Results: This study was funded in April 2021, data collection started in December 2021, and data collection is expected to be concluded in 2026. Conclusions: This study will test whether grocery delivery of healthy foods improves weight, diet, and pregnancy outcomes of young moms with low income. The findings will inform policies and practices that promote a healthy diet during pregnancy, which has multigenerational impacts on health. Trial Registration: ClinicalTrials.gov NCT05000645; https://clinicaltrials.gov/ct2/show/NCT05000645 International Registered Report Identifier (IRRID): DERR1-10.2196/40568 
%M 35930351
%R 10.2196/40568
%U https://www.researchprotocols.org/2022/8/e40568
%U https://doi.org/10.2196/40568
%U http://www.ncbi.nlm.nih.gov/pubmed/35930351

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 8
%P e33850
%T Predicting the Next-Day Perceived and Physiological Stress of Pregnant Women by Using Machine Learning and Explainability: Algorithm Development and Validation
%A Ng,Ada
%A Wei,Boyang
%A Jain,Jayalakshmi
%A Ward,Erin A
%A Tandon,S Darius
%A Moskowitz,Judith T
%A Krogh-Jespersen,Sheila
%A Wakschlag,Lauren S
%A Alshurafa,Nabil
%+ McCormick School of Engineering, Northwestern University, 633 Clark St, Evanston, IL, 60208, United States, 1 8474913741, adang@u.northwestern.edu
%K explainability
%K just-in-time interventions
%K machine learning
%K prenatal stress
%K stress prediction
%K wearable
%K mobile phone
%D 2022

%7 2.8.2022
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Cognitive behavioral therapy–based interventions are effective in reducing prenatal stress, which can have severe adverse health effects on mothers and newborns if unaddressed. Predicting next-day physiological or perceived stress can help to inform and enable pre-emptive interventions for a likely physiologically and perceptibly stressful day. Machine learning models are useful tools that can be developed to predict next-day physiological and perceived stress by using data collected from the previous day. Such models can improve our understanding of the specific factors that predict physiological and perceived stress and allow researchers to develop systems that collect selected features for assessment in clinical trials to minimize the burden of data collection. Objective: The aim of this study was to build and evaluate a machine-learned model that predicts next-day physiological and perceived stress by using sensor-based, ecological momentary assessment (EMA)–based, and intervention-based features and to explain the prediction results. Methods: We enrolled pregnant women into a prospective proof-of-concept study and collected electrocardiography, EMA, and cognitive behavioral therapy intervention data over 12 weeks. We used the data to train and evaluate 6 machine learning models to predict next-day physiological and perceived stress. After selecting the best performing model, Shapley Additive Explanations were used to identify the feature importance and explainability of each feature. Results: A total of 16 pregnant women enrolled in the study. Overall, 4157.18 hours of data were collected, and participants answered 2838 EMAs. After applying feature selection, 8 and 10 features were found to positively predict next-day physiological and perceived stress, respectively. A random forest classifier performed the best in predicting next-day physiological stress (F1 score of 0.84) and next-day perceived stress (F1 score of 0.74) by using all features. Although any subset of sensor-based, EMA-based, or intervention-based features could reliably predict next-day physiological stress, EMA-based features were necessary to predict next-day perceived stress. The analysis of explainability metrics showed that the prolonged duration of physiological stress was highly predictive of next-day physiological stress and that physiological stress and perceived stress were temporally divergent. Conclusions: In this study, we were able to build interpretable machine learning models to predict next-day physiological and perceived stress, and we identified unique features that were highly predictive of next-day stress that can help to reduce the burden of data collection. 
%M 35917157
%R 10.2196/33850
%U https://mhealth.jmir.org/2022/8/e33850
%U https://doi.org/10.2196/33850
%U http://www.ncbi.nlm.nih.gov/pubmed/35917157

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 7
%P e34423
%T Detection of Potential Arbovirus Infections and Pregnancy Complications in Pregnant Women in Jamaica Using a Smartphone App (ZIKApp): Pilot Evaluation Study
%A Ruiz-Burga,Elisa
%A Bruijning-Verhagen,Patricia
%A Palmer,Paulette
%A Sandcroft,Annalisa
%A Fernandes,Georgina
%A de Hoog,Marieke
%A Bryan,Lenroy
%A Pierre,Russell
%A Bailey,Heather
%A Giaquinto,Carlo
%A Thorne,Claire
%A Christie,Celia D C
%A ,
%+ Population, Policy & Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, 30 Guilford St,, London, WC1N 1EH, United Kingdom, 44 02079052396, e.burga@ucl.ac.uk
%K mHealth
%K digital health
%K arbovirus
%K pregnancy
%K adherence
%K compliance
%K low- and middle-income countries
%K LMIC
%K maternal health
%K pregnancy complications
%K prenatal care
%K pregnancy outcomes
%K mobile phone
%D 2022

%7 27.7.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: There is growing evidence of the benefits of mobile health technology, which include symptom tracking apps for research, surveillance, and prevention. No study has yet addressed arbovirus symptom tracking in pregnancy. Objective: This study aimed to evaluate the use of a smartphone app (ZIKApp) to self-report arbovirus symptoms and pregnancy complications and to assess compliance with daily symptom diaries during pregnancy in a cohort of women in an arbovirus-endemic, subtropical, middle-income country (Jamaica). Methods: Pregnant women aged ≥16 years, having a smartphone, and planning on giving birth at the recruiting center were enrolled between February 2020 and July 2020. ZIKApp comprised a daily symptom diary based on algorithms to identify potential episodes of arbovirus infection and pregnancy complications. Sociodemographic, epidemiological, and obstetric information was collected at enrollment, with additional review of medical records, and users’ perception was collected through an exit survey. Descriptive analyses and logistic regression analysis of possible factors associated with diary adherence were performed. Results: Of the 173 women enrolled, 157 (90.8%) used ZIKApp for a median duration of 155 (IQR 127-173) days until pregnancy end, 6 (3.5%) used the app for <7 days, and 10 (5.8%) exited the study early. For each successive 30-day period from enrollment up to 150 days after enrollment, of these 157 women, 121 (77.1%) to 129 (82.2%) completed their daily symptom diary; 50 (31.8%) to 56 (35.7%) did so on the same day. Overall, 31.8% (50/157) of the women had good adherence to diary reporting (ie, they completed the task on the same day or 2 to 3 days later for ≥80% of the days enrolled). There were 3-fold higher odds of good adherence for participants aged >34 years versus those aged 25 to 29 years (adjusted odds ratio 3.14, 95% CI 1.10-8.98) and 2-fold higher odds for women with tertiary versus secondary education (adjusted odds ratio 2.26, 95% CI 1.06-4.83). Of the 161 women who ever made a diary entry, 5454 individual symptom reports were made (median 17 per woman; IQR 4-42; range 0-278); 9 (5.6%) women reported symptom combinations triggering a potential arbovirus episode (none had an adverse pregnancy outcome) and 55 (34.2%) reported painful uterine contractions or vaginal bleeding, mainly in the month before delivery. Overall, 51.8% (71/137) of the women rated the app as an excellent experience and were less likely to be poor diary adherers (P=.04) and 99.3% (138/139) reported that the app was easy to understand and use. Conclusions: This pilot found a high adherence to ZIKApp. It demonstrated the feasibility and usability of the app in an arbovirus-endemic region, supporting its future development to contribute to surveillance and diagnosis of arbovirus infections in pregnancy and to optimize maternal care. 
%M 35896029
%R 10.2196/34423
%U https://formative.jmir.org/2022/7/e34423
%U https://doi.org/10.2196/34423
%U http://www.ncbi.nlm.nih.gov/pubmed/35896029

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 24
%N 7
%P e37699
%T Effects of Structured Supervised Exercise Training or Motivational Counseling on Pregnant Women’s Physical Activity Level: FitMum - Randomized Controlled Trial
%A Knudsen,Signe de Place
%A Alomairah,Saud Abdulaziz
%A Roland,Caroline Borup
%A Jessen,Anne Dsane
%A Hergel,Ida-Marie
%A Clausen,Tine D
%A Larsen,Jakob Eg
%A van Hall,Gerrit
%A Jensen,Andreas Kryger
%A Molsted,Stig
%A Bendix,Jane M
%A Løkkegaard,Ellen
%A Stallknecht,Bente
%+ Department of Gynecology and Obstetrics, Copenhagen University Hospital—North Zealand, Dyrehavevej 29, Hillerod, 3400, Denmark, 45 25393022, signedpi@gmail.com
%K motivation
%K physical activity
%K pregnancy
%K pregnant
%K RCT
%K randomized controlled trial
%K intervention
%K commercial activity tracker
%K tracker
%K COVID-19
%K maternal health
%K doubly labeled water
%K physical activity questionnaire
%K women's health
%K maternal
%K maternity
%K digital health
%K exercise
%K fitness
%K health outcome
%D 2022

%7 20.7.2022
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Physical activity (PA) during pregnancy is an effective and safe way to improve maternal health in uncomplicated pregnancies. However, compliance with PA recommendations remains low among pregnant women. Objective: The purpose of this study was to evaluate the effects of offering structured supervised exercise training (EXE) or motivational counseling on PA (MOT) during pregnancy on moderate-to-vigorous intensity physical activity (MVPA) level. Additionally, complementary measures of PA using the Pregnancy Physical Activity Questionnaire (PPAQ) and gold standard doubly labeled water (DLW) technique were investigated. The hypotheses were that both EXE and MOT would increase MVPA in pregnancy compared with standard care (CON) and that EXE would be more effective than MOT. In addition, the association between MVPA and the number of sessions attended was explored. Methods: A randomized controlled trial included 220 healthy, inactive pregnant women with a median gestational age of 12.9 (IQR 9.4-13.9) weeks. A total of 219 women were randomized to CON (45/219), EXE (87/219), or MOT (87/219). The primary outcome was MVPA (minutes per week) from randomization to the 29th gestational week obtained by a wrist-worn commercial activity tracker (Vivosport, Garmin International). PA was measured by the activity tracker throughout pregnancy, PPAQ, and DLW. The primary outcome analysis was performed as an analysis of covariance model adjusting for baseline PA. Results: The average MVPA (minutes per week) from randomization to the 29th gestational week was 33 (95% CI 18 to 47) in CON, 50 (95% CI 39 to 60) in EXE, and 40 (95% CI 30 to 51) in MOT. When adjusted for baseline MVPA, participants in EXE performed 20 (95% CI 4 to 36) minutes per week more MVPA than participants in CON (P=.02). MOT was not more effective than CON; EXE and MOT also did not differ. MVPA was positively associated with the number of exercise sessions attended in EXE from randomization to delivery (P=.04). Attendance was higher for online (due to COVID-19 restrictions) compared with physical exercise training (P=.03). Adverse events and serious adverse events did not differ between groups. Conclusions: Offering EXE was more effective than CON to increase MVPA among pregnant women, whereas offering MOT was not. MVPA in the intervention groups did not reach the recommended level in pregnancy. Changing the intervention to online due to COVID-19 restrictions did not affect MVPA level but increased exercise participation. Trial Registration: ClinicalTrials.gov NCT03679130; https://clinicaltrials.gov/ct2/show/NCT03679130 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-043671 
%M 35857356
%R 10.2196/37699
%U https://www.jmir.org/2022/7/e37699
%U https://doi.org/10.2196/37699
%U http://www.ncbi.nlm.nih.gov/pubmed/35857356

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 7
%P e36392
%T Assessing the Views and Needs of People at High Risk of Gestational Diabetes Mellitus for the Development of Mobile Health Apps: Descriptive Qualitative Study
%A Duan,Beibei
%A Liu,Zhe
%A Liu,Weiwei
%A Gou,Baohua
%+ School of Nursing, Capital Medical University, No. 10, Xi Tou tiao, You'an Men Wai, Feng tai District, Beijing, 100069, China, 86 13581694127, lwwhlxy@ccmu.edu.cn
%K gestational diabetes mellitus
%K high-risk groups
%K mobile health
%K mHealth
%K applications
%K user-centered design
%K qualitative research
%D 2022

%7 8.7.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Early prevention of gestational diabetes mellitus (GDM) can reduce the incidence of not only GDM, but also adverse perinatal pregnancy outcomes. Moreover, it is of great significance to prevent or reduce the occurrence of type 2 diabetes. Mobile health (mHealth) apps can help pregnant women effectively prevent GDM by providing risk prediction, lifestyle support, peer support, professional support, and other functions. Before designing mHealth apps, developers must understand the views and needs of pregnant women, and closely combine users’ needs to develop app functions, in order to better improve user experience and increase the usage rate of these apps in the future. Objective: The objective of this study was to understand the views of the high-risk population of gestational diabetes mellitus on the development of mobile health apps and the demand for app functions, so as to provide a basis for the development of gestational diabetes mellitus prevention apps. Methods: Fifteen pregnant women with at least one risk factor for gestational diabetes were recruited from July to September 2021, and were interviewed via a semistructured interview using the purpose sampling method. The transcribed data were analyzed by the traditional content analysis method, and themes were extracted. Results: Respondents wanted to develop user-friendly and fully functional mobile apps for the prevention of gestational diabetes mellitus. Pregnant women's requirements for app function development include: personalized customization, accurate information support, interactive design, practical tool support, visual presentation, convenient professional support, peer support, reasonable reminder function, appropriate maternal and infant auxiliary function, and differentiated incentive function.These function settings can encourage pregnant women to improve or maintain healthy living habits during their use of the app Conclusions: This study discusses the functional requirements of target users for gestational diabetes mellitus prevention apps, which can provide reference for the development of future applications. 
%M 35802414
%R 10.2196/36392
%U https://formative.jmir.org/2022/7/e36392
%U https://doi.org/10.2196/36392
%U http://www.ncbi.nlm.nih.gov/pubmed/35802414

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 24
%N 7
%P e37725
%T Patient-Reported Outcome and Experience Measures in Perinatal Care to Guide Clinical Practice: Prospective Observational Study
%A Depla,Anne Louise
%A Lamain-de Ruiter,Marije
%A Laureij,Lyzette T
%A Ernst-Smelt,Hiske E
%A Hazelzet,Jan A
%A Franx,Arie
%A Bekker,Mireille N
%A ,
%+ Department of Obstetrics and Gynecology, Wilhemina Children’s Hospital, University Medical Center Utrecht, Lundlaan 6, Utrecht, 3584 EA, Netherlands, 31 88 7553981, M.N.Bekker-3@umcutrecht.nl
%K perinatal care
%K patient-reported outcomes
%K patient-reported experiences
%K patient-centered outcome measures
%K value-based health care
%K shared decision-making
%K personalized care
%K integrated care
%D 2022

%7 5.7.2022
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: The International Consortium for Health Outcomes Measurement has published a set of patient-centered outcome measures for pregnancy and childbirth (PCB set), including patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). To establish value-based pregnancy and childbirth care, the PCB set was implemented in the Netherlands, using the outcomes on the patient level for shared decision-making and on an aggregated level for quality improvement. Objective: This study aims to report first outcomes, experiences, and practice insights of implementing the PCB set in clinical practice. Methods: In total, 7 obstetric care networks across the Netherlands, each consisting of 1 or 2 hospitals and multiple community midwifery practices (ranging in number from 2 to 18), implemented the PROM and PREM domains of the PCB set as part of clinical routine. This observational study included all women participating in the clinical project. PROMs and PREMs were assessed with questionnaires at 5 time points: 2 during pregnancy and 3 post partum. Clinical threshold values (alerts) supported care professionals interpreting the answers, indicating possibly alarming outcomes per domain. Data collection took place from February 2020 to September 2021. Data analysis included missing (pattern) analysis, sum scores, alert rates, and sensitivity analysis. Results: In total, 1923 questionnaires were collected across the 5 time points: 816 (42.43%) at T1 (first trimester), 793 (41.23%) at T2 (early third trimester), 125 (6.5%) at T3 (maternity week), 170 (8.84%) at T4 (6 weeks post partum), and 19 (1%) at T5 (6 months post partum). Of these, 84% (1615/1923) were filled out completely. Missing items per domain ranged from 0% to 13%, with the highest missing rates for depression, pain with intercourse, and experience with pain relief at birth. No notable missing patterns were found. For the PROM domains, relatively high alert rates were found both in pregnancy and post partum for incontinence (469/1798, 26.08%), pain with intercourse (229/1005, 22.79%), breastfeeding self-efficacy (175/765, 22.88%), and mother-child bonding (122/288, 42.36%). Regarding the PREM domains, the highest alert rates were found for birth experience (37/170, 21.76%), shared decision-making (101/982, 10.29%), and discussing pain relief ante partum (310/793, 39.09%). Some domains showed very little clinical variation; for example, role of the mother and satisfaction with care. Conclusions: The PCB set is a useful tool to assess patient-reported outcomes and experiences that need to be addressed over the whole course of pregnancy and childbirth. Our results provide opportunities to improve and personalize perinatal care. Furthermore, we could propose several recommendations regarding methods and timeline of measurements based on our findings. This study supports the implementation of the PCB set in clinical practice, thereby advancing the transformation toward patient-centered, value-based health care for pregnancy and childbirth. 
%M 35787519
%R 10.2196/37725
%U https://www.jmir.org/2022/7/e37725
%U https://doi.org/10.2196/37725
%U http://www.ncbi.nlm.nih.gov/pubmed/35787519

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 24
%N 6
%P e28637
%T Present Situation and the Future Development of Web-Based Prenatal Education in China: Cross-sectional Web-Based Survey
%A Huang,Xinyu
%A Sun,Weiwei
%A Wang,Renyu
%A Wu,Huailiang
%A Yu,Shinning
%A Fang,Xuanbi
%A Liu,Yiyan
%A Akinwunmi,Babatunde
%A Huang,Jian
%A Ming,Wai-kit
%+ Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, 5/F, Block 1, To Yuen Building, 31 To Yuen Street, Tat Chee Avenue, Kowloon, Hong Kong, China (Hong Kong), 852 3442 6956, wkming2@cityu.edu.hk
%K web-based prenatal education
%K pregnancy
%K prenatal
%K information technology
%D 2022

%7 30.6.2022
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Pregnancy serves as an important chapter in the life of women since more attention needs to be paid to both their physical and psychological health during this period. Adequate prenatal knowledge plays a key role in ensuring the health and safety of not only the pregnant women but also their fetuses and the entire family. With the development of information technology, web-based prenatal education has been brought into focus owing to its accessibility to comprehensive information, with high-quality information available to improve the quality of the overall gestation period, labor process, perinatal outcomes, and fetal outcomes. Objective: This study aims to investigate the present situation of web-based prenatal education and to predict the future research direction of web-based prenatal education in China, thereby providing insights into improving the quality of health care of pregnant women. Methods: A national cross-sectional study was conducted on 590,912 pregnant women in 31 provincial administrations of mainland China between August 2018 and August 2019. These pregnant women were initially recruited from local hospitals across the nation during antenatal and postnatal periods via a web-based education school. Demographic information and course completion status (including the categories and the number of courses they completed) of all the participants were collected. Results: A total of 590,912 pregnant women participated in the web-based prenatal education in 2018. Among them, 188,508 (31.90%) participants were excluded because they did not complete any course, while 17,807 (3.01%) actively participated in web-based prenatal education and completed more than 100 courses. There were 5 categories of web-based courses; almost half of the pregnant women attended the courses on first and second trimesters (293,262/590,912, 49.63% and 298,168/590,912, 50.46%, respectively). We found that pregnant women were more concerned about the gestational diet, fetal-related knowledge, and other precautions before the labor. Conclusions: In the era of digitalization where information is rapidly disseminated, web-based prenatal education could become a more convenient, productive, and effective pathway for pregnant women since it could help them obtain adequate and optimal pregnancy-related information and gain more intellectual awareness about their pregnancy or preparation for pregnancy. 
%M 35771613
%R 10.2196/28637
%U https://www.jmir.org/2022/6/e28637
%U https://doi.org/10.2196/28637
%U http://www.ncbi.nlm.nih.gov/pubmed/35771613

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 6
%P e36771
%T Using Twitter Data for Cohort Studies of Drug Safety in Pregnancy: Proof-of-concept With β-Blockers
%A Klein,Ari Z
%A O'Connor,Karen
%A Levine,Lisa D
%A Gonzalez-Hernandez,Graciela
%+ Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Blockley Hall, 4th floor, 423 Guardian Dr, Philadelphia, PA, 19014, United States, 1 310 423 3521, ariklein@pennmedicine.upenn.edu
%K natural language processing
%K social media
%K data mining
%K pregnancy
%K pharmacoepidemiology
%D 2022

%7 30.6.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Despite the fact that medication is taken during more than 90% of pregnancies, the fetal risk for most medications is unknown, and the majority of medications have no data regarding safety in pregnancy. Objective: Using β-blockers as a proof-of-concept, the primary objective of this study was to assess the utility of Twitter data for a cohort study design—in particular, whether we could identify (1) Twitter users who have posted tweets reporting that they took medication during pregnancy and (2) their associated pregnancy outcomes. Methods: We searched for mentions of β-blockers in 2.75 billion tweets posted by 415,690 users who announced their pregnancy on Twitter. We manually reviewed the matching tweets to first determine if the user actually took the β-blocker mentioned in the tweet. Then, to help determine if the β-blocker was taken during pregnancy, we used the time stamp of the tweet reporting intake and drew upon an automated natural language processing (NLP) tool that estimates the date of the user’s prenatal time period. For users who posted tweets indicating that they took or may have taken the β-blocker during pregnancy, we drew upon additional NLP tools to help identify tweets that report their pregnancy outcomes. Adverse pregnancy outcomes included miscarriage, stillbirth, birth defects, preterm birth (<37 weeks gestation), low birth weight (<5 pounds and 8 ounces at delivery), and neonatal intensive care unit (NICU) admission. Normal pregnancy outcomes included gestational age ≥37 weeks and birth weight ≥5 pounds and 8 ounces. Results: We retrieved 5114 tweets, posted by 2339 users, that mention a β-blocker, and manually identified 2332 (45.6%) tweets, posted by 1195 (51.1%) of the users, that self-report taking the β-blocker. We were able to estimate the date of the prenatal time period for 356 pregnancies among 334 (27.9%) of these 1195 users. Among these 356 pregnancies, we identified 257 (72.2%) during which the β-blocker was or may have been taken. We manually verified an adverse pregnancy outcome—preterm birth, NICU admission, low birth weight, birth defects, or miscarriage—for 38 (14.8%) of these 257 pregnancies. We manually verified a gestational age ≥37 weeks for 198 (90.4%) and a birth weight ≥5 pounds and 8 ounces for 50 (22.8%) of the 219 pregnancies for which we did not identify an adverse pregnancy outcome. Conclusions: Our ability to detect pregnancy outcomes for Twitter users who posted tweets reporting that they took or may have taken a β-blocker during pregnancy suggests that Twitter can be a complementary resource for cohort studies of drug safety in pregnancy. 
%M 35771614
%R 10.2196/36771
%U https://formative.jmir.org/2022/6/e36771
%U https://doi.org/10.2196/36771
%U http://www.ncbi.nlm.nih.gov/pubmed/35771614

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 6
%P e33929
%T A Web-Based mHealth Intervention With Telephone Support to Increase Physical Activity Among Pregnant Patients With Overweight or Obesity: Feasibility Randomized Controlled Trial
%A Thomas,Tainayah
%A Xu,Fei
%A Sridhar,Sneha
%A Sedgwick,Tali
%A Nkemere,Linda
%A Badon,Sylvia E
%A Quesenberry,Charles
%A Ferrara,Assiamira
%A Mandel,Sarah
%A Brown,Susan D
%A Hedderson,Monique
%+ Department of Epidemiology and Population Health, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, United States, 1 3107211208, tainayah@stanford.edu
%K mobile health
%K gestational weight gain
%K obesity
%K physical activity
%K mobile phone
%D 2022

%7 22.6.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Pregnant patients with overweight or obesity are at high risk for perinatal complications. Excess gestational weight gain (GWG) further exacerbates this risk. Mobile health (mHealth) lifestyle interventions that leverage technology to facilitate self-monitoring and provide just-in-time feedback may motivate behavior change to reduce excess GWG, reduce intervention costs, and increase scalability by improving access. Objective: This study aimed to test the acceptability and feasibility of a pilot mHealth lifestyle intervention for pregnant patients with overweight or obesity to promote moderate intensity physical activity (PA), encourage guideline-concordant GWG, and inform the design of a larger pragmatic cluster randomized controlled trial. Methods: We conducted a mixed methods acceptability and feasibility randomized controlled trial among pregnant patients with a prepregnancy BMI of 25 to 40 kg/m2. Patients with singletons at 8 to 15 weeks of gestation who were aged ≥21 years and had Wi-Fi access were recruited via email from 2 clinics within Kaiser Permanente Northern California and randomized to receive usual prenatal care or an mHealth lifestyle intervention. Participants in the intervention arm received wireless scales, access to an intervention website, activity trackers to receive automated feedback on weight gain and activity goals, and monthly calls from a lifestyle coach. Surveys and focus groups with intervention participants assessed intervention satisfaction and ways to improve the intervention. PA outcomes were self-assessed using the Pregnancy Physical Activity Questionnaire, and GWG was assessed using electronic health record data for both arms. Results: Overall, 33 patients were randomly assigned to the intervention arm, and 35 patients were randomly assigned to the usual care arm. All participants in the intervention arm weighed themselves at least once a week, compared with 20% (7/35) of the participants in the usual care arm. Participants in the intervention arm wore the activity tracker 6.4 days per week and weighed themselves 5.3 times per week, and 88% (29/33) of them rated the program “good to excellent.” Focus groups found that participants desired more nutrition-related support to help them manage GWG and would have preferred an app instead of a website. Participants in the intervention arm had a 23.46 metabolic equivalent of task hours greater change in total PA per week and a 247.2-minute greater change in moderate intensity PA per week in unadjusted models, but these effects were attenuated in adjusted models (change in total PA: 15.55 metabolic equivalent of task hours per week; change in moderate intensity PA: 199.6 minutes per week). We found no difference in total GWG (mean difference 1.14 kg) compared with usual care. Conclusions: The pilot mHealth lifestyle intervention was feasible, highly acceptable, and promoted self-monitoring. Refined interventions are needed to effectively affect PA and GWG among pregnant patients with overweight or obesity. Trial Registration: ClinicalTrials.gov NCT03936283; https://clinicaltrials.gov/ct2/show/NCT03936283
 
%M 35731565
%R 10.2196/33929
%U https://formative.jmir.org/2022/6/e33929
%U https://doi.org/10.2196/33929
%U http://www.ncbi.nlm.nih.gov/pubmed/35731565

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 6
%P e37777
%T Experiences With a Postpartum mHealth Intervention During the COVID-19 Pandemic: Key Informant Interviews Among Patients, Health Care Providers, and Stakeholders
%A Sadural,Ernani
%A Riley,Kristen E
%A Zha,Peijia
%A Pacquiao,Dula
%A Faust,Amanda
%+ Department of Obstetrics and Gynecology, Cooperman Barnabas Medical Center, RWJBarnabas Health, 94 Old Short Hills Road, Suite 3148, Livingston, NJ, 07039, United States, 1 973 885 9190, ernani.sadural@rwjbh.org
%K maternal mortality
%K health disparity
%K mHealth
%K patient engagement
%K postbirth warning signs
%D 2022

%7 13.6.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Maternal morbidity and mortality in the United States continue to be a worsening public health crisis, with persistent racial disparities among Black women during the COVID-19 pandemic. Innovations in mobile health (mHealth) technology are being developed as a strategy to connect birthing women to their health care providers during the first 6 weeks of the postpartum period. Objective: This study aimed to inform a process to evaluate the barriers to mHealth implementation in the context of the COVID-19 pandemic by exploring the experiences of mothers and stakeholders who were directly involved in the pilot program. Methods: The qualitative design used GoToMeeting (GoTo) individual interviews of 13 mothers and 7 stakeholders at a suburban teaching hospital in New Jersey. Mothers were aged ≥18 years, able to read and write in English or Spanish, had a vaginal or cesarean birth at >20 weeks of estimated gestational age, and were admitted for delivery at the hospital with at least a 24-hour postpartum stay. Stakeholders were part of the hospital network’s obstetrics collaborative subcommittee comprising administrators, physicians, registered nurses, and informatics. Responses were transcribed verbatim and analyzed for emerging themes. The socioecological framework provided a holistic lens for analyzing the multilevel influences on individual experiences. Results: A total of 3 major themes were identified: mothers experienced barriers from personal situations at home and with services in the hospital and community, which were intensified by the COVID-19 pandemic; the COVID-19 pandemic negatively impacted hospital services, priorities, and individual staff; and mothers and stakeholders had positive experiences and perceptions of the mHealth intervention. Conclusions: The use and reach of the mHealth intervention were negatively influenced by interrelated factors operating at multiple levels. The system-wide and multilevel impact of the pandemic was reflected in participants’ responses, providing evidence for the need to re-evaluate mHealth implementation with more adaptable systems and structures in place using a socioecological framework. 
%M 35699998
%R 10.2196/37777
%U https://formative.jmir.org/2022/6/e37777
%U https://doi.org/10.2196/37777
%U http://www.ncbi.nlm.nih.gov/pubmed/35699998

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 6
%P e23879
%T Feasibility and Acceptability of Internet-Based Interpersonal Psychotherapy for Stress, Anxiety, and Depression in Prenatal Women: Thematic Analysis
%A Bright,Katherine S
%A Stuart,Scott
%A Mcneil,Deborah A
%A Murray,Lindsay
%A Kingston,Dawn E
%+ Faculty of Nursing, University of Calgary, PF2500B, 2500 University Drive NW,, Calgary, AB, T2N 1N4, Canada, 1 403 220 6262, ksbright@ucalgary.ca
%K internet-based
%K interpersonal psychotherapy
%K mental health
%K prenatal
%K anxiety
%K depression
%K stress
%K mobile phone
%D 2022

%7 10.6.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Prenatal mental health is a global health concern. Despite the far-reaching impact of prenatal mental health issues, many women do not receive the psychological care they require. Women in their childbearing years are frequent users of the internet and smartphone apps. Prenatal women are prime candidates for internet-based support for mental health care. Objective: This study aimed to examine the feasibility and acceptability of internet-based interpersonal psychotherapy (IPT) for prenatal women. Methods: Semistructured interviews were conducted with women who had received internet-based IPT modules with guided support as a component of a randomized controlled trial evaluating the scale-up implementation of a digital mental health platform (The Healthy Outcomes of Pregnancy and Postpartum Experiences digital platform) for pregnant women. Qualitative thematic analysis was used to explore and describe women’s experiences. Data were analyzed for emerging themes, which were identified and coded. Results: A total of 15 prenatal women were interviewed to examine their experiences and views on the feasibility and acceptability of internet-based IPT modules. Participants found the content informative and appreciated the ways in which the digital mental health platform made the IPT modules accessible to users. Participants voiced some differing requirements regarding the depth and the way information was presented and accessed on the digital mental health platform. The important areas for improvement that were identified were acknowledging greater depth and clarity of content, the need for sociability and relationships, and refinement of the digital mental health platform to a smartphone app. Conclusions: This study provides useful evidence regarding treatment format and content preferences, which may inform future development. It also provides research data on the feasibility and acceptability of web-based applications for prenatal mental health care. Trial Registration: ClinicalTrials.gov NCT01901796; https://clinicaltrials.gov/ct2/show/NCT01901796 
%M 35687403
%R 10.2196/23879
%U https://formative.jmir.org/2022/6/e23879
%U https://doi.org/10.2196/23879
%U http://www.ncbi.nlm.nih.gov/pubmed/35687403

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 6
%P e33625
%T OptimalMe Intervention for Healthy Preconception, Pregnancy, and Postpartum Lifestyles: Protocol for a Randomized Controlled Implementation Effectiveness Feasibility Trial
%A Harrison,Cheryce L
%A Brammall,Bonnie R
%A Garad,Rhonda
%A Teede,Helena
%+ Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, 43-51 Kanooka Grove, Clayton, 3168, Australia, 61 8572 2662, cheryce.harrison@monash.edu
%K preconception
%K pregnancy
%K postpartum
%K weight
%K obesity prevention
%K womens health
%K intervention
%K implementation
%D 2022

%7 9.6.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Reproductive-aged women are a high-risk population group for accelerated weight gain and obesity development, with pregnancy recognized as a critical contributory life-phase. Healthy lifestyle interventions during the antenatal period improve maternal and infant health outcomes, yet translation and implementation of such interventions into real-world health care settings remains limited. Objective: We aim to generate key implementation learnings to inform the feasibility of future scale up and determine the effectiveness of intervention delivery methods on engagement, experience, acceptability, knowledge, risk perception, health literacy, and modifiable weight-related health behaviors in women during preconception, pregnancy, and postpartum periods. Methods: This randomized hybrid implementation effectiveness study will evaluate the penetration, reach, feasibility, acceptability, adoption, and fidelity of a healthy lifestyle intervention (OptimalMe) implemented into, and in partnership with, private health care. Individual health outcomes associated with implementation delivery mode, including knowledge, risk perception, health literacy, self-management, and health behaviors, are secondary outcomes. A total of 300 women aged 18 to 44 years, who are not pregnant but wish to conceive within the next 12 months, and with access to the internet will be recruited. All participants will receive the same digital lifestyle intervention, OptimalMe, which is supported by health coaching and text messages during preconception, pregnancy, and postpartum periods. We will use a parallel 2-arm design to compare telephone with videoconference remote delivery methods for health coaching. Methods are theoretically underpinned by the Consolidated Framework for Implementation Research and outcomes based on the Reach, Engagement, Adaptation, Implementation and Maintenance framework. Results: The study was approved on August 16, 2019 and has been registered. Recruitment commenced in July 2020, and data collection is ongoing. Results are expected to be published in 2022. Conclusions: The study’s design aligns with best practice implementation research. Results will inform translation of evidence from randomized controlled trials on healthy lifestyle interventions into practice targeting women across preconception, pregnancy, and postpartum periods. Learnings will target consumers, program facilitators, health professionals, services, and policy makers to inform future scale up to ultimately benefit the health of women across these life-phases. Trial Registration: Australian and New Zealand Clinical Trial Registry ACTRN12620001053910; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378243&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/33625 
%M 35679115
%R 10.2196/33625
%U https://www.researchprotocols.org/2022/6/e33625
%U https://doi.org/10.2196/33625
%U http://www.ncbi.nlm.nih.gov/pubmed/35679115

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 5
%P e30573
%T Identifying Barriers to Enrollment in Patient Pregnancy Registries: Building Evidence Through Crowdsourcing
%A Pimenta,Jeanne M
%A Painter,Jeffery L
%A Gemzoe,Kim
%A Levy,Roger Abramino
%A Powell,Marcy
%A Meizlik,Paige
%A Powell,Gregory
%+ Safety Innovation and Analytics, GlaxoSmithKline, 5 Moore Dr, Research Triangle, Durham, NC, 27709, United States, 1 919 619 3297, gregory.e.powell@gsk.com
%K belimumab
%K crowdsourcing
%K systemic lupus erythematosus
%K pregnancy
%K registry
%D 2022

%7 25.5.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Enrollment in pregnancy registries is challenging despite substantial awareness-raising activities, generally resulting in low recruitment owing to limited safety data. Understanding patient and physician awareness of and attitudes toward pregnancy registries is needed to facilitate enrollment. Crowdsourcing, in which services, ideas, or content are obtained by soliciting contributions from a large group of people using web-based platforms, has shown promise for improving patient engagement and obtaining patient insights. Objective: This study aimed to use web-based crowdsourcing platforms to evaluate Belimumab Pregnancy Registry (BPR) awareness among patients and physicians and to identify potential barriers to pregnancy registry enrollment with the BPR as a case study. Methods: We conducted 2 surveys using separate web-based crowdsourcing platforms: Amazon Mechanical Turk (a 14-question patient survey) and Sermo RealTime (a 11-question rheumatologist survey). Eligible patients were women, aged 18-55 years; diagnosed with systemic lupus erythematosus (SLE); and pregnant, recently pregnant (within 2 years), or planning pregnancy. Eligible rheumatologists had prescribed belimumab and treated pregnant women. Responses were descriptively analyzed. Results: Of 151 patient respondents over a 3-month period (n=88, 58.3% aged 26-35 years; n=149, 98.7% with mild or moderate SLE; and n=148, 98% from the United States), 51% (77/151) were currently or recently pregnant. Overall, 169 rheumatologists completed the survey within 48 hours, and 59.2% (100/169) were based in the United States. Belimumab exposure was reported by 41.7% (63/151) patients, whereas 51.7% (75/145) rheumatologists had prescribed belimumab to <5 patients, 25.5% (37/145) had prescribed to 5-10 patients, and 22.8% (33/145) had prescribed to >10 patients who were pregnant or trying to conceive. Of the patients exposed to belimumab, 51% (32/63) were BPR-aware, and 45.5% (77/169) of the rheumatologists were BPR-aware. Overall, 60% (38/63) of patients reported belimumab discontinuation because of pregnancy or planned pregnancy. Among the 77 BPR-aware rheumatologists, 70 (91%) referred patients to the registry. Concerns among rheumatologists who did not prescribe belimumab during pregnancy included unknown pregnancy safety profile (119/169, 70.4%), and 61.5% (104/169) reported their patients’ concerns about the unknown pregnancy safety profile. Belimumab exposure during or recently after pregnancy or while trying to conceive was reported in patients with mild (6/64, 9%), moderate (22/85, 26%), or severe (1/2, 50%) SLE. Rheumatologists more commonly recommended belimumab for moderate (84/169, 49.7%) and severe (123/169, 72.8%) SLE than for mild SLE (36/169, 21.3%) for patients trying to conceive recently or currently pregnant. Overall, 81.6% (138/169) of the rheumatologists suggested a belimumab washout period before pregnancy of 0-30 days (44/138, 31.9%), 30-60 days (64/138, 46.4%), or >60 days (30/138, 21.7%). Conclusions: In this case, crowdsourcing efficiently obtained patient and rheumatologist input, with some patients with SLE continuing to use belimumab during or while planning a pregnancy. There was moderate awareness of the BPR among patients and physicians. 
%M 35612888
%R 10.2196/30573
%U https://formative.jmir.org/2022/5/e30573
%U https://doi.org/10.2196/30573
%U http://www.ncbi.nlm.nih.gov/pubmed/35612888

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 5
%P e34852
%T Access to and Use of Mobile Phone by Postpartum, Married Women in Punjab, India: Secondary Analysis of mHealth Intervention Pilot Data
%A Pendse,Ruchita S
%A El Ayadi,Alison M
%A Sharma,Preetika
%A Ahuja,Alka
%A Hosapatna Basavarajappa,Darshan
%A Duggal,Mona
%A Kankaria,Ankita
%A Singh,Pushpendra
%A Kumar,Vijay
%A Bagga,Rashmi
%A Diamond-Smith,Nadia G
%+ Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St 2nd floor, San Francisco, CA, 94158, United States, 1 4154762300, nadia.diamond-smith@ucsf.edu
%K pregnancy
%K mothers
%K postpartum period
%K postnatal care
%K mobile phone use
%K mHealth
%K mobile health
%K digital health
%K telemedicine
%K health education
%K sex factors
%K gender
%K India
%K South Asia
%D 2022

%7 12.5.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: As mobile phone uptake in India continues to grow, there is also continued interest in mobile platform–based interventions for health education. There is a significant gender gap in mobile phone access—women’s access to mobile phones is constrained by economic and social barriers. Pregnancy and postpartum care is one of many targets for mobile health (mHealth) interventions that particularly rely upon women’s access to and facility with mobile phone use. Objective: We aimed to describe the dynamics and patterns of married pregnant and postpartum women’s mobile phone access and use (among both phone owners and nonowners) who participated in an mHealth postpartum care intervention and to identify potential barriers to their participation in mobile platform–based interventions. Methods: A secondary analysis was performed on mixed methods data obtained for a pilot mHealth intervention for postpartum care of mothers in rural Punjab from July 2020 to February 2021. Two formative sources included exploratory in-depth interviews among postpartum women (n=20; 1-3 months postpartum) and quantitative maternal health survey among women who were pregnant or who had recently given birth (n=102). We also utilized mixed methods intervention assessment data from early postpartum women who participated in the pilot intervention (n=29), including intervention moderator perspectives. Qualitative and quantitative analyses were performed, and pertinent findings were grouped thematically. Results: The majority of women owned a phone (maternal health survey: 75/102, 74%; demographic survey: 17/29, 59%), though approximately half (53/102, 52%) still reported sharing phones with other family members. Sharing a phone with female family members typically allowed for better access than sharing with male family members. Some households had strict preferences against daughters-in-law having phones, or otherwise significantly restricted women’s phone access. Others reported concerns about phone use–related health hazards  for mother and infant during the pregnancy or postpartum period. Conclusions: These findings suggest nuance regarding what is meant by women’s phone ownership and access—there were numerous additional constraints on women’s use of phones, particularly during pregnancy and the postpartum period. Future research and mHealth interventions should probe these domains to better understand the dynamics governing women’s access, use, and fluency with mobile phones to optimally design mHealth interventions. 
%M 35551059
%R 10.2196/34852
%U https://formative.jmir.org/2022/5/e34852
%U https://doi.org/10.2196/34852
%U http://www.ncbi.nlm.nih.gov/pubmed/35551059

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 4
%P e37279
%T Investigating New Sensory Methods Related to Taste Sensitivity, Preferences, and Diet of Mother-Infant Pairs and Their Relationship With Body Composition and Biomarkers: Protocol for an Explorative Study
%A Fuchs-Neuhold,Bianca
%A Staubmann,Wolfgang
%A Peterseil,Marie
%A Rath,Anna
%A Schweighofer,Natascha
%A Kronberger,Anika
%A Riederer,Monika
%A van der Kleyn,Moenie
%A Martin,Jochen
%A Hörmann-Wallner,Marlies
%A Waldner,Irmgard
%A Konrad,Manuela
%A Aufschnaiter,Anna Lena
%A Siegmund,Barbara
%A Berghold,Andrea
%A Holasek,Sandra
%A Pail,Elisabeth
%+ Health Perception Lab, Institute of Dietetics and Nutrition, FH JOANNEUM GmbH - University of Applied Sciences, Eggenberger Allee 11, Graz, 8010, Austria, 43 316 5453 ext 6726, bianca.fuchsneuhold@fh-joanneum.at
%K taste
%K preferences
%K nutrition
%K biomarkers
%K body composition
%K air displacement plethysmography
%K Baby Facial Actions Coding System
%K mother
%K infant
%K parenting
%K pediatrics
%K prenatal
%K postnatal
%D 2022

%7 27.4.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Early experiences with different flavors play an important role in infant development, including food and taste acceptance. Flavors are already perceived in utero with the development of the taste and olfactory system and are passed on to the child through breast and bottle feeding. Therefore, the first 1000 days of life are considered a critical window for infant developmental programming. Objective: The objective of our study is to investigate, both in the prenatal and postnatal period, taste sensitivity, preferences, and dietary diversity of mother-infant pairs. The explorative study design will also report on the impact of these variables on body composition (BC) and biomarkers. In contrast to conventional methods, this study involves long-term follow-up data collection from mother-infant pairs; moreover, the integration of audiovisual tools for recording infants' expressions pertaining to taste stimuli is a novelty of this study. Considering these new methodological approaches, the study aims to assess taste-related data in conjunction with BC parameters like fat-free mass or fat mass, biomarkers, and nutritional intake in infants and children. Methods: Healthy pregnant women aged between 18 and 50 years (BMI≥18.5 kg/m2 to ≤30 kg/m2; <28 weeks of gestation) were recruited from January 2014 to October 2014. The explorative design implies 2 center visits during pregnancy (24-28 weeks of gestation and 32-34 weeks of gestation) and 2 center visits after delivery (6-8 weeks postpartum and 14-16 weeks postpartum) as well as follow-up visits at 1, 3-3.5, and 6 years after delivery. Data collection encompasses anthropometric and biochemical measurements as well as BC analyses with air displacement plethysmography, taste perception assessments, and multicomponent questionnaires on demographics, feeding practices, and nutritional and lifestyle behaviors. Audiovisual data from infants’ reactions to sensory stimuli are collected and coded by trained staff using Baby Facial Action Coding and the Body Action Posture System. Birth outcomes and weight development are obtained from medical records, and additional qualitative data are gathered from 24 semistructured interviews. Results: Our cohort represents a homogenous group of healthy women with stringent exclusion criteria. A total of 54 women met the eligibility criteria, whereas 47 mother-child pairs completed data collection at 4 center visits during and after pregnancy. Follow-up phases, data analyses, and dissemination of the findings are scheduled for the end of 2023. The study was approved by the ethics committee of the Medical University of Graz (EC No 26–066 ex 13/14), and all participants provided informed consent. Conclusions: The results of this study could be useful for elucidating the connections between maternal and infant statuses regarding diet, taste, biomarkers, and prenatal and postnatal weight development. This study may also be relevant to the establishment of further diagnostic and interventional strategies targeting childhood obesity and early body fat development. International Registered Report Identifier (IRRID): DERR1-10.2196/37279 
%M 35475790
%R 10.2196/37279
%U https://www.researchprotocols.org/2022/4/e37279
%U https://doi.org/10.2196/37279
%U http://www.ncbi.nlm.nih.gov/pubmed/35475790

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 24
%N 4
%P e35554
%T Effectiveness of Digital Interventions for Preventing Alcohol Consumption in Pregnancy: Systematic Review and Meta-analysis
%A Oh,Sarah Soyeon
%A Moon,Jong Youn
%A Chon,Doukyoung
%A Mita,Carol
%A Lawrence,Jourdyn A
%A Park,Eun-Cheol
%A Kawachi,Ichiro
%+ Department of Preventive Medicine, Gachon University College of Medicine, 191 Hambangmoe-ro, Yeonsu-gu, Incheon, 21936, Republic of Korea, 82 8572647167, moonjy@gachon.ac.kr
%K fetal alcohol spectrum disorders
%K fetal alcohol syndrome
%K digital health
%K pregnancy
%K alcohol consumption
%K text message
%K text messaging
%K alcohol
%K digital intervention
%K mother
%K systematic review
%K meta-analysis
%K mobile health
%K mHealth
%K computer-based intervention
%K internet-based intervention
%D 2022

%7 11.4.2022
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Alcohol consumption in pregnancy has been associated with serious fetal health risks and maternal complications. While previous systematic reviews of digital interventions during pregnancy have targeted smoking cessation and flu vaccine uptake, few studies have sought to evaluate their effectiveness in preventing alcohol consumption during pregnancy. Objective: This systematic review aims to assess (1) whether digital interventions are effective in preventing alcohol consumption during the pregnancy/pregnancy-planning period, and (2) the differential effectiveness of alternative digital intervention platforms (ie, computers, mobiles, and text messaging services). Methods: PubMed, Embase, CINAHL, and Web of Science were searched for studies with digital interventions aiming to prevent alcohol consumption among pregnant women or women planning to become pregnant. A random effects primary meta-analysis was conducted to estimate the combined effect size and extent to which different digital platforms were successful in preventing alcohol consumption in pregnancy. Results: Six studies were identified and included in the final review. The primary meta-analysis produced a sample-weighted odds ratio (OR) of 0.62 (95% CI 0.42-0.91; P=.02) in favor of digital interventions decreasing the risk of alcohol consumption during pregnancy when compared to controls. Computer/internet-based interventions (OR 0.59, 95% CI 0.38-0.93) were an effective platform for preventing alcohol consumption. Too few studies of text messaging (OR 0.29, 95% CI 0.29-2.52) were available to draw a conclusion. Conclusions: Overall, our review highlights the potential for digital interventions to prevent alcohol consumption among pregnant women and women planning to become pregnant. Considering the advantages of digital interventions in promoting healthy behavioral changes, future research is necessary to understand how certain platforms may increase user engagement and intervention effectiveness to prevent women from consuming alcohol during their pregnancies. 
%M 35404257
%R 10.2196/35554
%U https://www.jmir.org/2022/4/e35554
%U https://doi.org/10.2196/35554
%U http://www.ncbi.nlm.nih.gov/pubmed/35404257

%0 Journal Article
        
%@ 2371-4379
%I JMIR Publications
%V 7
%N 2
%P e30156
%T Content Quality of YouTube Videos About Gestational Diabetes: Systematic Evaluation
%A Birch,Eleanor M
%A Leziak,Karolina
%A Jackson,Jenise
%A Dahl,Emma
%A Niznik,Charlotte M
%A Yee,Lynn M
%+ Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, 250 E. Superior Street, #5-2145, Chicago, IL, 60611, United States, 1 312 472 4685, lynn.yee@northwestern.edu
%K diabetes
%K gestational diabetes
%K health information
%K internet
%K web-based
%K pregnancy
%K YouTube
%D 2022

%7 7.4.2022
%9 Original Paper
%J JMIR Diabetes
%G English
                
%X Background: People with gestational diabetes have enhanced learning requirements during pregnancy, and management of their disease often requires the translation of health information into new health behavior changes. Seeking information from the internet to augment learning from health professionals is becoming more common during pregnancy. YouTube is a popular free and accessible web-based resource, which may be particularly useful for individuals with low health literacy or other barriers to receiving high-quality health care; however, the quality and content of YouTube videos varies, and little is known about those covering gestational diabetes. Objective: We aimed to systematically evaluate the quality, content, and reliability of YouTube videos about gestational diabetes. Methods: A systematic search of YouTube videos was conducted over the course of 1 week in April 2020 using the following keywords: “gestational diabetes,” “gestational diabetes management,” “gestational diabetes treatment,” and “pregnancy and diabetes.” The search results were displayed by relevance, replicating a default YouTube search attempt. The first 60 results from each keyword were reviewed (n=240). Exclusion criteria were videos unrelated to gestational diabetes, videos not in English, and those for which the full video was not available at the time of review. For each unique video, a gestational diabetes content score was used to rate video comprehensiveness and accuracy, and the DISCERN instrument, a validated metric to assess consumer health information, was used to evaluate the reliability of information presented. Videos were further categorized by quality: videos with DISCERN scores lower than 3 (out of 5) or a content score less than 4 (out of 7) were categorized as low quality, and all others were designated high quality. We performed descriptive analysis and compared video characteristics by source and quality rating. Results: For 115 unique videos, the mean content score (out of 7) was 3.5 (SD 2.0) , and the mean DISCERN score (out of 5) was 2.7 (SD 0.7), representing low to moderate information comprehensiveness and reliability respectively. Video sources were categorized as personal vlog (12/115, 10.4%), web-based education (37/115, 32.2%), medical (52/115, 45.2%), business or company (13/115, 11.3%), and media clip (1/115, 0.9%). DISCERN and content scores trended higher among medical and web-based education videos. The majority of videos (n=88) were categorized as low quality, while 27 videos were categorized as high quality. Video duration was longer for high-quality videos (P<.001); high- and low-quality videos otherwise had similar views and viewer interaction numbers. Conclusions: Although high-quality videos about gestational diabetes exist, reliability, accuracy, and comprehensiveness were low overall, and higher quality was not associated with increased viewer interaction. It is important to acknowledge the limitations of this platform and to assist patients in accessing high quality content and differentiating the quality of information sources. 
%M 35389355
%R 10.2196/30156
%U https://diabetes.jmir.org/2022/2/e30156
%U https://doi.org/10.2196/30156
%U http://www.ncbi.nlm.nih.gov/pubmed/35389355

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 8
%N 4
%P e29906
%T Health-Related Quality of Life of HIV-Positive and HIV-Negative Pregnant Women in an Impoverished Area: Cross-sectional Study
%A Qu,Shuiling
%A Wang,Ailing
%A Wang,Xiaoyan
%A Yang,Yehuan
%A Pan,Xiaoping
%A Zhang,Tong
%+ Capital Institute of Pediatrics, No 2 Yabao Road, Chaoyang District, Beijing, 100020, China, 86 10 85695188, zt@chinawch.org.cn
%K health-related quality of life
%K EQ-5D-3L
%K HIV
%K impoverished area
%K public health
%K pregnant women
%K depression
%K anxiety
%D 2022

%7 5.4.2022
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Liangshan prefecture of Sichuan province was an impoverished mountainous area in China, where the annual number of HIV-positive pregnant women accounted for approximately 10% of China’s total population in the decades before 2020. In general, pregnant women living here are likely to be physically and mentally different from those in other places. Objective: This study aims to explore the health-related quality of life (HRQoL) of pregnant women living with HIV in an impoverished area. Methods: From December 2018 to January 2019, HIV-positive and HIV-negative parturients within 18 months after delivery were recruited in Liangshan Prefecture, Sichuan Province. Questionnaires were designed to collect their demographic data, while the EuroQol 5-Dimension, 3-Level questionnaire was used to measure their HRQoL when they were in the second trimester from 4 to 6 months of pregnancy, and their quantitative health scores were converted to corresponding healthy utility values by using the Chinese Utility Value Integral System (time trade-off coefficient). Results: A total of 250 pregnant women (133 HIV-positive and 117 HIV-negative) were enrolled in the study. Among them, 55 (41.35%) and 75 (64.10%) of HIV-positive and HIV-negative pregnant women self-reported full health (healthy state 11111), respectively. The median health utility value of the 250 pregnant women was 0.961 (IQR –0.046 to 0.961), and those of the HIV-positive and HIV-negative pregnant women were 0.875 (0.424-0.961) and 0.961 (IQR –0.046 to 0.961), respectively. We observed a significant difference only in the dimension of anxiety or depression between the two groups (P=.002) and no significant difference in the distribution of health utility indices between the two groups in terms of maternal age, education level, occupation, annual household income, prenatal care visits, family size, and medical insurance category. Multivariate ordinal logistic regression analysis showed that age (odds ratio [OR] 0.62, P<.05) and prenatal care visit (OR 0.29, P<.01) were independent risk factors for health status. Conclusions: Most pregnant women self-reported satisfactory HRQoL in this impoverished mountainous area. HIV-negative pregnant women had an edge over HIV-positive pregnant women, and there were significant differences in anxiety or depression dimensions between the two groups. 
%M 35380543
%R 10.2196/29906
%U https://publichealth.jmir.org/2022/4/e29906
%U https://doi.org/10.2196/29906
%U http://www.ncbi.nlm.nih.gov/pubmed/35380543

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 3
%P e32791
%T The Successes and Challenges of Implementing Telehealth for Diverse Patient Populations Requiring Prenatal Care During COVID-19: Qualitative Study
%A Farrell,Ruth
%A Collart,Christina
%A Craighead,Caitlin
%A Pierce,Madelyn
%A Chien,Edward
%A Frankel,Richard
%A Tucker Edmonds,Brownsyne
%A Perni,Uma
%A Coleridge,Marissa
%A Ranzini,Angela C
%A Rose,Susannah
%+ Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, United States, 1 216 445 7085, farrelr@ccf.org
%K prenatal health care delivery
%K telehealth
%K COVID-19
%K patient experience
%K challenge
%K telemedicine
%K pregnancy
%K women
%K diversity
%K prenatal
%K obstetric
%K reception
%K experience
%K development
%D 2022

%7 30.3.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Although telehealth appears to have been accepted among some obstetric populations before the COVID-19 pandemic, patients’ receptivity and experience with the rapid conversion of this mode of health care delivery are unknown. Objective: In this study, we examine patients' prenatal care needs, preferences, and experiences during the COVID-19 pandemic, with the aim of supporting the development of successful models to serve the needs of pregnant patients, obstetric providers, and health care systems during this time. Methods: This study involved qualitative methods to explore pregnant patients’ experiences with prenatal health care delivery at the onset of the COVID-19 pandemic. We conducted in-depth interviews with pregnant patients in the first and second trimester of pregnancy who received prenatal care in Cleveland, Ohio, from May to July 2020. An interview guide was used to probe experiences with health care delivery as it rapidly evolved at the onset of the pandemic. Results: Although advantages of telehealth were noted, there were several concerns noted with the broad implementation of telehealth for prenatal care during the pandemic. This included concerns about monitoring the pregnancy at home; the need for additional reassurance for the pregnancy, given the uncertainties presented by the pandemic; and the ability to have effective patient-provider discussions via a telehealth visit. The need to tailor telehealth to prenatal health care delivery was noted. Conclusions: Although previous studies have demonstrated that telehealth is a flexible and convenient alternative for some prenatal appointments, our study suggests that there may be specific needs and concerns among the diverse patient groups using this modality during the pandemic. More research is needed to understand patients' experiences with telehealth during the pandemic and develop approaches that are responsive to the needs and preferences of patients. 
%M 35275833
%R 10.2196/32791
%U https://formative.jmir.org/2022/3/e32791
%U https://doi.org/10.2196/32791
%U http://www.ncbi.nlm.nih.gov/pubmed/35275833

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 3
%P e34421
%T The Volume and Tone of Twitter Posts About Cannabis Use During Pregnancy: Protocol for a Scoping Review
%A Cresswell,Liam
%A Espin-Noboa,Lisette
%A Murphy,Malia S Q
%A Ramlawi,Serine
%A Walker,Mark C
%A Karsai,Márton
%A Corsi,Daniel J
%+ CHEO Research Institute, 501 Smyth Rd, Centre for Practice Changing Research, Room L1242, Box 241, Ottawa, ON, K1H 8L6, Canada, 1 613 737 8899, dcorsi@ohri.ca
%K cannabis
%K pregnancy
%K health information
%K social media
%K Twitter
%D 2022

%7 29.3.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Cannabis use has increased in Canada since its legalization in 2018, including among pregnant women who may be motivated to use cannabis to reduce symptoms of nausea and vomiting. However, a growing body of research suggests that cannabis use during pregnancy may harm the developing fetus. As a result, patients increasingly seek medical advice from online sources, but these platforms may also spread anecdotal descriptions or misinformation. Given the possible disconnect between online messaging and evidence-based research about the effects of cannabis use during pregnancy, there is a potential for advice taken from social media to affect the health of mothers and their babies. Objective: This study aims to quantify the volume and tone of English language posts related to cannabis use in pregnancy from January 2012 to December 2021. Methods: Modeling published frameworks for scoping reviews, we will collect publicly available posts from Twitter that mention cannabis use during pregnancy and use the Twitter Application Programming Interface for Academic Research to extract data from tweets, including public metrics such as the number of likes, retweets, and quotes, as well as health effect mentions, sentiment, location, and users’ interests. These data will be used to quantify how cannabis use during pregnancy is discussed on Twitter and to build a qualitative profile of supportive and opposing posters. Results: The CHEO Research Ethics Board reviewed our project and granted an exemption in May 2021. As of December 2021, we have gained approval to use the Twitter Application Programming Interface for Academic Research and have developed a preliminary search strategy that returns over 3 million unique tweets posted between 2012 and 2021. Conclusions: Understanding how Twitter is being used to discuss cannabis use during pregnancy will help public health agencies and health care providers assess the messaging patients may be receiving and develop communication strategies to counter misinformation, especially in geographical regions where legalization is recent or imminent. Most importantly, we foresee that our findings will assist expecting families in making informed choices about where they choose to access advice about using cannabis during pregnancy. Trial Registration: Open Science Framework 10.17605/OSF.IO/BW8DA; www.osf.io/6fb2e International Registered Report Identifier (IRRID): PRR1-10.2196/34421 
%M 35348465
%R 10.2196/34421
%U https://www.researchprotocols.org/2022/3/e34421
%U https://doi.org/10.2196/34421
%U http://www.ncbi.nlm.nih.gov/pubmed/35348465

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 3
%P e33363
%T Associations Between Prenatal Exposure to Serotonergic Medications and Biobehavioral Stress Regulation: Protocol for a Systematic Review and Meta-analysis
%A Zusman,Enav Z
%A Lavu,Alekhya
%A Pawliuk,Colleen
%A Pawluski,Jodi
%A Hutchison,Sarah M
%A Platt,Robert W
%A Oberlander,Tim F
%+ Department of Pediatrics, Faculty of Medicine, University of British Columbia, 4480 Oak St, Vancouver, BC, V6H 3V4, Canada, 1 (604) 875 3200, enav.zusman@bcchr.ca
%K pregnancy
%K serotonergic medications
%K antidepressants
%K stress regulation
%K systematic review
%K meta-analysis
%D 2022

%7 28.3.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Up to 20% of mothers experience antenatal depression and approximately 30% of these women are treated with serotonergic psychotropic pharmacological therapy during pregnancy. Serotonergic antidepressants readily cross the placenta and the fetal blood-brain barrier, altering central synaptic serotonin signaling and potentially altering serotonin levels in the developing fetal brain. Objective: The aim of this study is to assess the impact of prenatal exposure to serotonergic antidepressants, accounting for maternal mood disturbances, on markers of stress regulation during childhood. Methods: We will follow PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and will search MEDLINE, Embase, CINAHL, PsycINFO, and ClinicalTrials.gov for full-length studies that assessed physiological (eg, cortisol level, heart rate variability, salivary amylase, pupillary size, C-reactive protein) indices of stress regulation in children of pregnant people who were treated with a serotonergic antidepressant at any point during pregnancy. We will assess the quality of observational studies using the Newcastle-Ottawa Scale and the quality of experimental studies using the Cochrane risk-of-bias tool. When possible, we will conduct a random-effects meta-analysis. If meta-analysis is not possible, we will conduct a narrative review. If a sufficient number of studies are found, we will perform subgroup analysis and assess outcomes measured by drug class, dose, trimester of exposure, and child’s age and gender. Results: We registered our review protocol with PROSPERO (International Prospective Register of Systematic Reviews; CRD42021275750), completed the literature search, and initiated title and abstract review in August 2021. We expect to finalize this review by April 2022. Conclusions: Findings should identify the impact of prenatal antidepressant effects on stress regulation and distinguish it from the impact of prenatal exposure to maternal mood disturbances. This review should inform decisions about serotonergic antidepressant use during pregnancy. Trial Registration: PROSPERO CRD42021275750; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=275750 International Registered Report Identifier (IRRID): PRR1-10.2196/33363 
%M 35343913
%R 10.2196/33363
%U https://www.researchprotocols.org/2022/3/e33363
%U https://doi.org/10.2196/33363
%U http://www.ncbi.nlm.nih.gov/pubmed/35343913

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 24
%N 3
%P e31831
%T Review of Mobile Apps for Women With Anxiety in Pregnancy: Maternity Care Professionals’ Guide to Locating and Assessing Anxiety Apps
%A Evans,Kerry
%A Donelan,Jasper
%A Rennick-Egglestone,Stefan
%A Cox,Serena
%A Kuipers,Yvonne
%+ School of Health Sciences, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, NG7 2HA, United Kingdom, 44 115 95 15559, kerry.evans1@nottingham.ac.uk
%K anxiety
%K pregnancy
%K antenatal
%K mobile applications
%K digital interventions
%K mHealth
%K mobile app
%K psychological well-being
%K maternity
%K evaluation
%K quality assessment
%D 2022

%7 23.3.2022
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Mental health and pregnancy apps are widely available and have the potential to improve health outcomes and enhance women’s experience of pregnancy. Women frequently access digital information throughout their pregnancy. However, health care providers and women have little information to guide them toward potentially helpful or effective apps. Objective: This review aimed to evaluate a methodology for systematically searching and reviewing commercially available apps that support pregnant women with symptoms of anxiety in order to assist maternity care professionals in identifying resources that they could recommend for these women. Methods: A stepwise systematic approach was used to identify, select, describe, and assess the most popular and highly user-rated apps available in the United Kingdom from January to March 2021. This included developing a script-based search strategy and search process, writing evaluation criteria, and conducting a narrative description and evaluation of the selected apps. Results: Useful search terms were identified, which included nonclinical, aspirational, and problem-based phrases. There were 39 apps selected for inclusion in the review. No apps specifically targeted women with anxiety in pregnancy. Of the 39 apps included in the review, 33 (85%) focused solely on mind-body techniques to promote relaxation, stress reduction, and psychological well-being. Only 8 of the 39 (21%) apps included in the review reported that health care professionals had contributed to app development and only 1/39 (3%) provided empirical evidence on the effectiveness and acceptability of the app. The top 12/39 (31%) apps were evaluated by 2 independent reviewers using the developed criteria and scores. There was a small negative correlation between the reviewers’ scores and app user rating scores, with higher user rating scores associated with lower reviewer scores. Conclusions: App developers, publishers, and maternity care professionals should seek advice from women with lived experience of anxiety symptoms in pregnancy to locate, promote, and optimize the visibility of apps for pregnant women. There is a lack of resources that provide coping strategies based on current evidence for the treatment of anxiety in pregnancy. Maternity care providers are limited in their ability to locate and recommend acceptable and trustworthy apps because of the lack of information on the evidence base, development, and testing of apps. Maternity care professionals and women need access to libraries of trusted apps that have been evaluated against relevant and established criteria. 
%M 35319482
%R 10.2196/31831
%U https://www.jmir.org/2022/3/e31831
%U https://doi.org/10.2196/31831
%U http://www.ncbi.nlm.nih.gov/pubmed/35319482

%0 Journal Article
        
%@ 2291-9694
%I JMIR Publications
%V 10
%N 3
%P e25477
%T A Comparison of Census and Cohort Sampling Models for the Longitudinal Collection of User-Reported Data in the Maternity Care Pathway: Mixed Methods Study
%A Jamieson Gilmore,Kendall
%A Bonciani,Manila
%A Vainieri,Milena
%+ Management and Healthcare Laboratory, Department of Economics and Management in the era of Data Science, Institute of Management, Sant'Anna Scuola Superiore, 33 Piazza Martiri della Libertà, Pisa, 56127, Italy, 39 050 883111, k.jamiesongilmore@santannapisa.it
%K longitudinal studies
%K mothers
%K pregnancy
%K survival analysis
%K patient-reported outcome measures
%K patient-reported experience measures
%K surveys
%K maternity
%K postpartum
%K online
%K digital health
%K digital collection
%D 2022

%7 4.3.2022
%9 Original Paper
%J JMIR Med Inform
%G English
                
%X Background: Typical measures of maternity performance remain focused on the technical elements of birth, especially pathological elements, with insufficient measurement of nontechnical measures and those collected pre- and postpartum. New technologies allow for patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) to be collected from large samples at multiple time points, which can be considered alongside existing administrative sources; however, such models are not widely implemented or evaluated. Since 2018, a longitudinal, personalized, and integrated user-reported data collection process for the maternal care pathway has been used in Tuscany, Italy. This model has been through two methodological iterations. Objective: The aim of this study was to compare and contrast two sampling models of longitudinal user-reported data for the maternity care pathway, exploring factors influencing participation, cost, and suitability of the models for different stakeholders. Methods: Data were collected by two modes: (1) “cohort” recruitment at the birth hospital of a predetermined sample size and (2) continuous, ongoing “census” recruitment of women at the first midwife appointment. Surveys were used to collect experiential and outcome data related to existing services. Women were included who passed 12 months after initial enrollment, meaning that they either received the surveys issued after that interval or dropped out in the intervening period. Data were collected from women in Tuscany, Italy, between September 2018 and July 2020. The total sample included 7784 individuals with 38,656 observations. The two models of longitudinal collection of user-reported data were analyzed using descriptive statistics, survival analysis, cost comparison, and a qualitative review. Results: Cohort sampling provided lower initial participation than census sampling, although very high subsequent response rates (87%) were obtained 1 year after enrollment. Census sampling had higher initial participation, but greater dropout (up to 45% at 1 year). Both models showed high response rates for online surveys. There were nonproportional dropout hazards over time. There were higher rates of dropout for women with foreign nationality (hazard ratio [HR] 1.88, P<.001), and lower rates of dropout for those who had a higher level of education (HR 0.77 and 0.61 for women completing high school and college, respectively; P<.001), were employed (HR 0.87, P=.01), in a relationship (HR 0.84, P=.04), and with previous pregnancies (HR 0.86, P=.002). The census model was initially more expensive, albeit with lower repeat costs and could become cheaper if repeated more than six times. Conclusions: The digital collection of user-reported data enables high response rates to targeted surveys in the maternity care pathway. The point at which pregnant women or mothers are recruited is relevant for response rates and sample bias. The census model of continuous enrollment and real-time data availability offers a wider set of potential benefits, but at an initially higher cost and with the requirement for more substantial data translation and managerial capacity to make use of such data. 
%M 35254268
%R 10.2196/25477
%U https://medinform.jmir.org/2022/3/e25477
%U https://doi.org/10.2196/25477
%U http://www.ncbi.nlm.nih.gov/pubmed/35254268

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 5
%N 1
%P e29189
%T COVID-19 and Pregnancy: Citation Network Analysis and Evidence Synthesis
%A Ruiz-Roman,Rebeca
%A Martinez-Perez,Clara
%A Gil Prados,Inés
%A Cristóbal,Ignacio
%A Sánchez-Tena,Miguel Ángel
%+ Department of Gynecology and Obstetrics, Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, Madrid, 28040, Spain, 34 913303000, rebecaruizroman@gmail.com
%K pandemic
%K COVID-19
%K SARS-CoV-2
%K pregnancy
%K perinatal
%K citation
%K bibliometric
%K network analysis
%K women
%K maternal health
%K fetal health
%K research
%K literature
%K transmission
%K delivery
%K impact
%D 2022

%7 3.3.2022
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: COVID-19 spread quickly around the world shortly after the first outbreaks of the new coronavirus disease at the end of December 2019, affecting all populations, including pregnant women. Objective: The aim of this study was to analyze the relationship between different publications on COVID-19 in pregnancy and their authors through citation networks, as well as to identify the research areas and to determine the publication that has been the most highly cited. Methods: The search for publications was carried out through the Web of Science database using terms such as “pregnancy,” “SARS-CoV-2,” “pregnant,” and “COVID-19” for the period between January and December 2020. Citation Network Explorer software was used for publication analysis and VOSviewer software was used to construct the figures. This approach enabled an in-depth network analysis to visualize the connections between the related elements and explain their network structure. Results: A total of 1330 publications and 5531 citation networks were identified in the search, with July being the month with the largest number of publications, and the United States, China, and England as the countries with the greatest number of publications. The most cited publication was “Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records” by Chen and colleagues, which was published in March 2020. Six groups identified as being close in the citation network reflect multidisciplinary research, including clinical characteristics and outcomes in pregnancy, vertical transmission, delivery mode, and psychological impacts of the pandemic on pregnant women. Conclusions: Thousands of articles on COVID-19 have been published in several journals since the disease first emerged. Identifying relevant publications and obtaining a global view of the main papers published on COVID-19 and pregnancy can lead to a better understanding of the topic. With the accumulation of scientific knowledge, we now know that the clinical features of COVID-19 during pregnancy are generally similar to those of infected nonpregnant women. There is a small increase in frequency of preterm birth and cesarean birth, related to severe maternal illness. Vaccination for all pregnant women is recommended. Several agents are being evaluated for the treatment of COVID-19, but with minimal or no information on safety in pregnancy. These results could form the basis for further research. Future bibliometric and scientometric studies on COVID-19 should provide updated information to analyze other relevant indicators in this field. 
%M 35044301
%R 10.2196/29189
%U https://pediatrics.jmir.org/2022/1/e29189
%U https://doi.org/10.2196/29189
%U http://www.ncbi.nlm.nih.gov/pubmed/35044301

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 2
%P e32428
%T Understanding the Needs of a Mobile Phone–Based Telemonitoring Program for Pregnant Women at High Risk for Pre-Eclampsia: Interpretive Qualitative Description Study
%A Feroz,Anam Shahil
%A De Vera,Kristina
%A D Bragagnolo,Nadia
%A Saleem,Sarah
%A Bhutta,Zulfiqar
%A Seto,Emily
%+ Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 6478676702, anam.shahil@mail.utoronto.ca
%K telemonitoring
%K pre-eclampsia
%K qualitative study
%K Pakistan
%K pregnant women at high risk
%K low- to middle-income country
%K pregnant
%K pregnancy
%K women
%K mobile phone
%D 2022

%7 24.2.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Lack of early risk detection, diagnosis, and treatment of pregnant women at high risk for pre-eclampsia can result in high maternal mortality and morbidity not only in Pakistan but also in other low- to middle-income countries (LMICs). A potential tool for supporting pregnant women at high risk for pre-eclampsia for early detection is telemonitoring (TM). However, there is a limited body of evidence on end-user needs and preferences to inform the design of the TM programs for pregnant women at high risk for pre-eclampsia, specifically in LMICs such as Pakistan. Objective: This study aims to explore the needs of TM for pregnant women at high risk for pre-eclampsia in Karachi, Pakistan, to inform a potential future feasibility trial of a mobile phone–based TM program. Methods: An interpretive qualitative description approach was used to conduct and analyze 36 semistructured interviews with 15 (42%) pregnant women and 21 (58%) key informants, including clinicians; nurses; maternal, neonatal, and child health specialists; and digital health experts to explore the perspectives, needs, and preferences of a mobile phone–based TM program to support pregnant women at high risk for pre-eclampsia. Pregnant women were identified through heterogeneous sampling, whereas key informants were selected through purposive sampling. The interview transcripts were analyzed using a conventional content analysis technique. Results: The following four themes emerged from the analysis of the transcripts: poor use of antenatal care during pregnancy, the value of a TM program in high-risk pregnancy, barriers influencing the adoption of TM programs and potential strategies, and considerations for implementing TM programs. The pregnant women and health care providers were willing to use a TM program as they perceived many benefits, including early identification of pregnancy complications, prompt treatment, convenience, cost-effectiveness, increased sense of empowerment for one’s health care, improved care continuity, and reduced clinical workload. However, some providers and pregnant women mentioned some concerns regarding the adoption of a TM program, including malfunctioning and safety concerns, potential inaccuracy of blood pressure machines, increased clinical workload, and resistance to learning new technology. Our study recommends building the capacity of patients and providers on TM program use, sensitizing the community and family members on the usefulness of the TM program, using an approach incorporating user-centered design and phased implementation to determine the clinical workload and whether additional staff for the TM program is required, and ensuring greater levels of co-design and the engagement of consumer representatives. Conclusions: Our findings highlight the perceived feasibility of a mobile phone–based TM program for pregnant women at high risk for pre-eclampsia and provide insights that can be directly used for the design of future TM programs with the aim of reducing mortality and morbidity from pre-eclampsia and eclampsia in LMICs. 
%M 35200152
%R 10.2196/32428
%U https://formative.jmir.org/2022/2/e32428
%U https://doi.org/10.2196/32428
%U http://www.ncbi.nlm.nih.gov/pubmed/35200152

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 24
%N 2
%P e33337
%T Digitalized Cognitive Behavioral Interventions for Depressive Symptoms During Pregnancy: Systematic Review
%A Wan Mohd Yunus,Wan Mohd Azam
%A Matinolli,Hanna-Maria
%A Waris,Otto
%A Upadhyaya,Subina
%A Vuori,Miika
%A Korpilahti-Leino,Tarja
%A Ristkari,Terja
%A Koffert,Tarja
%A Sourander,Andre
%+ Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, Turku, 20014, Finland, 358 503653447, andsou@utu.fi
%K pregnancy
%K antenatal depression
%K systematic review
%K cognitive behavior therapy
%K digital interventions
%K COVID-19
%D 2022

%7 23.2.2022
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Studies have shown a high prevalence of depression during pregnancy, and there is also evidence that cognitive behavioral therapy (CBT) is one of the most effective psychosocial interventions. Emerging evidence from randomized controlled trials (RCTs) has shown that technology has been successfully harnessed to provide CBT interventions for other populations. However, very few studies have focused on their use during pregnancy. This approach has become increasingly important in many clinical areas due to the COVID-19 pandemic, and our study aimed to expand the knowledge in this particular clinical area. Objective: Our systematic review aimed to bring together the available research-based evidence on digitalized CBT interventions for depression symptoms during pregnancy. Methods: A systematic review of the Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, Embase, PsycINFO, Scopus, ClinicalTrials.gov, and EBSCO Open Dissertations databases was carried out from the earliest available evidence to October 27, 2021. Only RCT studies published in English were considered. The PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-analyses) guidelines were followed, and the protocol was registered on the Prospective Register of Systematic Reviews. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials. Results: The review identified 7 studies from 5 countries (the United States, China, Australia, Norway, and Sweden) published from 2015 to 2021. The sample sizes ranged from 25 to 1342 participants. The interventions used various technological elements, including text, images, videos, games, interactive features, and peer group discussions. They comprised 2 guided and 5 unguided approaches. Using digitalized CBT interventions for depression during pregnancy showed promising efficacy, with guided intervention showing higher effect sizes (Hedges g=1.21) than the unguided interventions (Hedges g=0.14-0.99). The acceptability of the digitalized CBT interventions was highly encouraging, based on user feedback. Attrition rates were low for the guided intervention (4.5%) but high for the unguided interventions (22.1%-46.5%). A high overall risk of bias was present for 6 of the 7 studies. Conclusions: Our search only identified a small number of digitalized CBT interventions for pregnant women, despite the potential of this approach. These showed promising evidence when it came to efficacy and positive outcomes for depression symptoms, and user feedback was positive. However, the overall risk of bias suggests that the efficacy of the interventions needs to be interpreted with caution. Future studies need to consider how to mitigate these sources of biases. Digitalized CBT interventions can provide prompt, effective, evidence-based interventions for pregnant women. This review increases our understanding of the importance of digitalized interventions during pregnancy, including during the COVID-19 pandemic. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020216159; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216159 
%M 35195532
%R 10.2196/33337
%U https://www.jmir.org/2022/2/e33337
%U https://doi.org/10.2196/33337
%U http://www.ncbi.nlm.nih.gov/pubmed/35195532

%0 Journal Article
        
%@ 2368-7959
%I JMIR Publications
%V 9
%N 2
%P e31116
%T eHealth Interventions for Treatment and Prevention of Depression, Anxiety, and Insomnia During Pregnancy: Systematic Review and Meta-analysis
%A Silang,Katherine A
%A Sohal,Pooja R
%A Bright,Katherine S
%A Leason,Jennifer
%A Roos,Leslie
%A Lebel,Catherine
%A Giesbrecht,Gerald F
%A Tomfohr-Madsen,Lianne M
%+ Department of Psychology, University of Calgary, 2500 University Drive, NW, Calgary, AB, T2N 1N4, Canada, 1 403 220 2243, ltomfohr@ucalgary.ca
%K eHealth
%K pregnancy
%K depression
%K anxiety
%K insomnia
%K mobile phone
%D 2022

%7 21.2.2022
%9 Review
%J JMIR Ment Health
%G English
                
%X Background: Pregnancy is associated with an increased risk for depression, anxiety, and insomnia. eHealth interventions provide a promising and accessible treatment alternative to face-to-face interventions. Objective: The objective of this systematic review and meta-analysis is to determine the effectiveness of eHealth interventions in preventing and treating depression, anxiety, and insomnia during pregnancy. Secondary aims are to identify demographic and intervention moderators of effectiveness. Methods: A total of 5 databases (PsycINFO, Medline, CINAHL, Embase, and Cochrane) were searched from inception to May 2021. Terms related to eHealth, pregnancy, randomized controlled trials (RCTs), depression, anxiety, and insomnia were included. RCTs and pilot RCTs were included if they reported an eHealth intervention for the prevention or treatment of depression, anxiety, or insomnia in pregnant women. Study screening, data extractions, and quality assessment were conducted independently by 2 reviewers from an 8-member research team (KAS, PRS, Hangsel Sanguino, Roshni Sohail, Jasleen Kaur, Songyang (Mark) Jin, Makayla Freeman, and Beatrice Valmana). Random-effects meta-analyses of pooled effect sizes were conducted to determine the effect of eHealth interventions on prenatal mental health. Meta-regression analyses were conducted to identify potential moderators. Results: In total, 17 studies were included in this review that assessed changes in depression (11/17, 65%), anxiety (10/17, 59%), and insomnia (3/17, 18%). Several studies included both depression and anxiety symptoms as outcomes (7/17, 41%). The results indicated that during pregnancy, eHealth interventions showed small effect sizes for preventing and treating symptoms of anxiety and depression and a moderate effect size for treating symptoms of insomnia. With the exception of intervention type for the outcome of depressive symptoms, where mindfulness interventions outperformed other intervention types, no significant moderators were detected. Conclusions: eHealth interventions are an accessible and promising resource for treating symptoms of anxiety, depression, and insomnia during pregnancy. However, more research is necessary to identify ways to increase the efficacy of eHealth interventions for this population. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42020205954; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=205954 
%M 35188471
%R 10.2196/31116
%U https://mental.jmir.org/2022/2/e31116
%U https://doi.org/10.2196/31116
%U http://www.ncbi.nlm.nih.gov/pubmed/35188471

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 5
%N 1
%P e32235
%T Understanding Information Needs and Barriers to Accessing Health Information Across All Stages of Pregnancy: Systematic Review
%A Lu,Yu
%A Barrett,Laura A
%A Lin,Rebecca Z
%A Amith,Muhammad
%A Tao,Cui
%A He,Zhe
%+ School of Information, Florida State University, 142 Collegiate Loop, Tallahassee, FL, 32306, United States, 1 850 644 5775, zhe@fsu.edu
%K pregnancy
%K information needs
%K ontology
%K systematic review
%K fertility
%K parenting
%K pregnancy information
%K online information
%K health database
%D 2022

%7 21.2.2022
%9 Review
%J JMIR Pediatr Parent
%G English
                
%X Background: Understanding consumers’ health information needs across all stages of the pregnancy trajectory is crucial to the development of mechanisms that allow them to retrieve high-quality, customized, and layperson-friendly health information. Objective: The objective of this study was to identify research gaps in pregnancy-related consumer information needs and available information from different sources. Methods: We conducted a systematic review of CINAHL, Cochrane, PubMed, and Web of Science for relevant articles that were published from 2009 to 2019. The quality of the included articles was assessed using the Critical Appraisal Skills Program. A descriptive data analysis was performed on these articles. Based on the review result, we developed the Pregnancy Information Needs Ontology (PINO) and made it publicly available in GitHub and BioPortal. Results: A total of 33 articles from 9 countries met the inclusion criteria for this review, of which the majority were published no earlier than 2016. Most studies were either descriptive (9/33, 27%), interviews (7/33, 21%), or surveys/questionnaires (7/33, 21%); 20 articles mentioned consumers’ pregnancy-related information needs. Half (9/18, 50%) of the human-subject studies were conducted in the United States. More than a third (13/33, 39%) of all studies focused on during-pregnancy stage; only one study (1/33, 3%) was about all stages of pregnancy. The most frequent consumer information needs were related to labor delivery (9/20, 45%), medication in pregnancy (6/20, 30%), newborn care (5/20, 25%), and lab tests (6/20, 30%). The most frequently available source of information was the internet (15/24, 63%). PINO consists of 267 classes, 555 axioms, and 271 subclass relationships. Conclusions: Only a few articles assessed the barriers to access to pregnancy-related information and the quality of each source of information; further work is needed. Future work is also needed to address the gaps between the information needed and the information available. 
%M 35188477
%R 10.2196/32235
%U https://pediatrics.jmir.org/2022/1/e32235
%U https://doi.org/10.2196/32235
%U http://www.ncbi.nlm.nih.gov/pubmed/35188477

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 24
%N 2
%P e28093
%T Remotely Delivered Interventions to Support Women With Symptoms of Anxiety in Pregnancy: Mixed Methods Systematic Review and Meta-analysis
%A Evans,Kerry
%A Rennick-Egglestone,Stefan
%A Cox,Serena
%A Kuipers,Yvonne
%A Spiby,Helen
%+ School of Health Sciences, University of Nottingham, Queen's Medical Centre, Derby Rd, Lenton, Nottingham, NG7 2HA, United Kingdom, 44 7596783920, kerry.evans1@nottingham.ac.uk
%K anxiety
%K pregnancy
%K antenatal
%K systematic review
%K digital interventions
%K eHealth
%K remote interventions
%K electronic health
%K parenting
%K remote delivery
%K therapy
%K CBT
%K fear
%K distress
%K mobile phone
%D 2022

%7 15.2.2022
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Symptoms of anxiety are common in pregnancy, with severe symptoms associated with negative outcomes for women and babies. Low-level psychological therapy is recommended for women with mild to moderate anxiety, with the aim of preventing an escalation of symptoms and providing coping strategies. Remotely delivered interventions have been suggested to improve access to treatment and support and provide a cost-effective, flexible, and timely solution. Objective: This study identifies and evaluates remotely delivered, digital, or web-based interventions to support women with symptoms of anxiety during pregnancy. Methods: This mixed methods systematic review followed a convergent segregated approach to synthesize qualitative and quantitative data. The ACM Digital Library, Allied and Complementary Medicine Database, Applied Social Sciences Index and Abstracts, Centre for Reviews and Dissemination database, the Cochrane Central Register of Controlled Trials, the Cochrane Library, CINAHL, Embase, Health Technology Assessment Library, IEEE Xplore, Joanna Briggs Institute, Maternity and Infant Care, MEDLINE, PsycINFO, and the Social Science Citation Index were searched in October 2020. Quantitative or qualitative primary research that included pregnant women and evaluated remotely delivered interventions reporting measures of anxiety, fear, stress, distress, women’s views, and opinions were included. Results: Overall, 3 qualitative studies and 14 quantitative studies were included. Populations included a general antenatal population and pregnant women having anxiety and depression, fear of childbirth, insomnia, and preterm labor. Interventions included cognitive behavioral therapy, problem solving, mindfulness, and educational designs. Most interventions were delivered via web-based platforms, and 62% (8/13) included direct contact from trained therapists or coaches. A meta-analysis of the quantitative data found internet-based cognitive behavioral therapy and facilitated interventions showed a beneficial effect in relation to the reduction of anxiety scores (standardized mean difference −0.49, 95% CI −0.75 to −0.22; standardized mean difference −0.48, 95% CI −0.75 to −0.22). Due to limitations in the amount of available data and study quality, the findings should be interpreted with caution. Synthesized findings found some evidence to suggest that interventions are more effective when women maintain regular participation which may be enhanced by providing regular contact with therapists or peer support, appropriate targeting of interventions involving components of relaxation and cognitive-based skills, and providing sufficient sessions to develop new skills without being too time consuming. Conclusions: There is limited evidence to suggest that women who are pregnant may benefit from remotely delivered interventions. Components of interventions that may improve the effectiveness and acceptability of remotely delivered interventions included  providing web-based contact with a therapist, health care professional, or peer community. Women may be more motivated to complete interventions that are perceived as relevant or tailored to their needs. Remote interventions may also provide women with greater anonymity to help them feel more confident in disclosing their symptoms. 
%M 35166688
%R 10.2196/28093
%U https://www.jmir.org/2022/2/e28093
%U https://doi.org/10.2196/28093
%U http://www.ncbi.nlm.nih.gov/pubmed/35166688

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 2
%P e28886
%T Effectiveness of a Step Counter Smartband and Midwife Counseling Intervention on Gestational Weight Gain and Physical Activity in Pregnant Women With Obesity (Pas and Pes Study): Randomized Controlled Trial
%A Gonzalez-Plaza,Elena
%A Bellart,Jordi
%A Arranz,Ángela
%A Luján-Barroso,Leila
%A Crespo Mirasol,Esther
%A Seguranyes,Gloria
%+ Maternal-Fetal Medicine Department at BCNatal, Clinic Hospital of Barcelona, Sabino de Arana, 1, Barcelona, 08028, Spain, 34 932275400 ext 7294, eplaza@clinic.cat
%K obesity
%K maternal
%K pregnancy
%K mHealth
%K mobile apps
%K telemedicine
%K telenursing
%K physical activity
%K gestational weight gain
%K lifestyle
%K mobile phone
%D 2022

%7 15.2.2022
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Women who are pregnant and have obesity and excessive gestational weight gain (GWG) present a higher risk of maternal and perinatal complications. The use of mobile apps and a wristband during pregnancy may contribute to promoting healthy lifestyles and, thus, improving maternal and neonatal health. Objective: This study aims to evaluate the effectiveness of a complex digital health intervention, using a smartband and app with midwife counseling, on GWG and physical activity (PA) in women who are pregnant and have obesity and analyze its impact on maternal and perinatal outcomes. In addition, we aim to study the frequency of use, usability, and satisfaction with the mobile apps used by the women in the intervention group. Methods: A parallel, 2-arm, randomized controlled trial was conducted. A total of 150 women who were pregnant and had obesity were included. The intervention group received a complex combined digital intervention. The intervention was delivered with a smartband (Mi Band 2) linked to the app Mi Fit to measure PA and the Hangouts app with the midwife to provide personal health information. The control group received usual care. The validated Spanish versions of the International Physical Activity Questionnaire–Short Form and the System Usability Scale were used. Satisfaction was measured on a 1- to 5-point Likert scale. Results: We analyzed 120 women, of whom 30 (25%) were withdrawn because of the COVID-19 pandemic. The median GWG in the intervention group was 7.0 (IQR 4-11) kg versus 9.3 (IQR 5.9-13.3) kg in the control group (P=.04). The adjusted mean GWG per week was 0.5 (95% CI 0.4-0.6) kg per week in the control group and 0.3 (95% CI 0.3-0.4) kg per week in the intervention group (df=0.1, 95% CI −0.2 to 0.03; P=.008). During the 35 and 37 gestational weeks, women in the intervention group had higher mean PA than women in the control group (1980 metabolic equivalents of tasks–minutes per week vs 1386 metabolic equivalents of tasks–minutes per week, respectively; P=.01). No differences were observed between the study groups in the incidence of maternal and perinatal outcomes. In the intervention group, 61% (36/59) of the women who were pregnant used the smartband daily, and 75% (44/59) evaluated the usability of the Mi Fit app as excellent. All women in the intervention group used the Hangouts app at least once a week. The mean of the satisfaction scale with the health counseling app and midwife support was 4.8/5 (SD 0.6) points. Conclusions: The use of a complex mobile health intervention was associated with adequate GWG, which was lower in the intervention group than in the control group. In addition, we observed that the intervention group had increases in PA. No differences were observed in maternal perinatal complications. Trial Registration: ClinicalTrials.gov NCT03706872; https://www.clinicaltrials.gov/ct2/show/NCT03706872 
%M 35166684
%R 10.2196/28886
%U https://mhealth.jmir.org/2022/2/e28886
%U https://doi.org/10.2196/28886
%U http://www.ncbi.nlm.nih.gov/pubmed/35166684

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 9
%N 1
%P e30989
%T Improving Pelvic Floor Muscle Training Adherence Among Pregnant Women: Validation Study
%A Jaffar,Aida
%A Mohd-Sidik,Sherina
%A Foo,Chai Nien
%A Admodisastro,Novia
%A Abdul Salam,Sobihatun Nur
%A Ismail,Noor Diana
%+ Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia, 60 3 9769 2541, sherina@upm.edu.my
%K User-centered design
%K mHealth app
%K Digital intervention
%K mHealth Development and Evaluation Framework
%K Usability
%K Acceptability
%K Pelvic Floor Muscle Training
%K Urinary incontinence
%K Pregnancy
%D 2022

%7 3.2.2022
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: Mobile health apps, for example, the Tät, have been shown to be potentially effective in improving pelvic floor muscle training (PFMT) among women, but they have not yet been studied among pregnant women. Adherence to daily PFMT will improve pelvic floor muscle strength leading to urinary incontinence (UI) improvement during the pregnancy. Objective: This study aims to document the validation process in developing the Kegel Exercise Pregnancy Training app, which was designed to improve the PFMT adherence among pregnant women. Methods: We utilized an intervention mapping approach incorporated within the mobile health development and evaluation framework. The framework involved the following steps: (1) conceptualization, (2) formative research, (3) pretesting, (4) pilot testing, (5) randomized controlled trial, and (6) qualitative research. The user-centered design-11 checklist was used to evaluate the user-centeredness properties of the app. Results: A cross-sectional study was conducted to better understand PFMT and UI among 440 pregnant women. The study reported a UI prevalence of 40.9% (180/440), with less than half having good PFMT practice despite their good knowledge. Five focus group discussions were conducted to understand the app design preferred by pregnant women. They agreed a more straightforward design should be used for better app usability. From these findings, a prototype was designed and developed accordingly, and the process conformed to the user-centered design–11 (UCD-11) checklist. A PFMT app was developed based on the mHealth development and evaluation framework model, emphasizing higher user involvement in the application design and development. The application was expected to improve its usability, acceptability, and ease of use. Conclusions: The Kegel Exercise Pregnancy Training app was validated using a thorough design and development process to ensure its effectiveness in evaluating the usability of the final prototype in our future randomized control trial study. 
%M 35113025
%R 10.2196/30989
%U https://humanfactors.jmir.org/2022/1/e30989
%U https://doi.org/10.2196/30989
%U http://www.ncbi.nlm.nih.gov/pubmed/35113025

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 1
%P e29644
%T Mobile Phone App Use Among Pregnant Women in China and Associations Between App Use and Perinatal Outcomes: Retrospective Study
%A Zhang,Puhong
%A Chen,Huan
%A Shang,Jie
%A Ge,Jun
%A Zhang,Huichen
%A Xu,Mingjun
%A Bian,Cui
%A Zhao,Yang
%A Chen,Minyuan
%A Hirst,Jane Elizabeth
%+ The George Institute for Global Health at Peking University Health Science Center, Room 011, Unit 2, Tayuan Diplomatic Office Building, No. 14 Liangmahe Nan Lu, Chaoyang District, Beijing, 100600, China, 86 13691270366, zpuhong@georgeinstitute.org.cn
%K maternal and child health
%K mHealth
%K mobile apps
%K retrospective study
%K pregnancy outcomes
%D 2022

%7 25.1.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Maternal and child health (MCH)–related mobile apps are becoming increasingly popular among pregnant women; however, few apps have demonstrated that they lead to improvements in pregnancy outcomes. Objective: This study aims to investigate the use of MCH apps among pregnant women in China and explore associations with pregnancy outcomes. Methods: A retrospective study was conducted at 6 MCH hospitals in northern China. Women who delivered a singleton baby at >28 weeks’ gestation at the study hospitals were sequentially recruited from postnatal wards from October 2017 to January 2018. Information was collected on the women’s self-reported MCH app use during their pregnancy, along with clinical outcomes. Women were categorized as nonusers of MCH apps and users (further divided into intermittent users and continuous users). The primary outcome was a composite adverse pregnancy outcome (CAPO) comprising preterm birth, birth weight <2500 g, birth defects, stillbirth, and neonatal asphyxia. The association between app use and CAPO was explored using multivariable logistic analysis. Results: The 1850 participants reported using 127 different MCH apps during pregnancy. App use frequency was reported as never, 24.7% (457/1850); intermittent, 47.4% (876/1850); and continuous, 27.9% (517/1850). Among app users, the most common reasons for app use were health education (1393/1393, 100%), self-monitoring (755/1393, 54.2%), and antenatal appointment reminders (602/1393, 43.2%). Nonusers were older, with fewer years of education, lower incomes, and higher parity (P<.01). No association was found between any app use and CAPO (6.8% in nonusers compared with 6.3% in any app users; odds ratio 0.77, 95% CI 0.48-1.25). Conclusions: Women in China access a large number of different MCH apps, with social disparities in access and frequency of use. Any app use was not found to be associated with improved pregnancy outcomes, highlighting the need for rigorous development and testing of apps before recommendation for use in clinical settings. 
%M 35076402
%R 10.2196/29644
%U https://formative.jmir.org/2022/1/e29644
%U https://doi.org/10.2196/29644
%U http://www.ncbi.nlm.nih.gov/pubmed/35076402

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 8
%N 1
%P e29718
%T Health-Related Quality of Life Among Pregnant Women With Pre-pregnancy Smoking and Smoking Cessation During Pregnancy in China: National Cross-sectional Study
%A Hu,Kadi
%A Zou,Shiqian
%A Zhang,Casper JP
%A Wu,Huailiang
%A Akinwunmi,Babatunde
%A Wang,Zilian
%A Ming,Wai-Kit
%+ Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, To Yuen Building, 31 To Yuen Street, Hong Kong, China, 852 34426956, wkming2@cityu.edu.hk
%K health-related quality of life
%K pregnant women
%K smoking status
%K pre-pregnancy smoking
%D 2022

%7 24.1.2022
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Previous studies have hardly explored the influence of pre-pregnancy smoking and smoking cessation during pregnancy on the health-related quality of life (HRQoL) of pregnant women, which is a topic that need to be addressed. In addition, pregnant women in China constitute a big population in the largest developing country of the world and cannot be neglected. Objective: This study aims to evaluate the HRQoL of pregnant women in China with different smoking statuses and further estimate the association between pre-pregnancy smoking, smoking cessation, and the HRQoL. Methods: A nationwide cross-sectional study was conducted to determine the association between different smoking statuses (smoking currently, quit smoking, never smoking) and the HRQoL in pregnant women across mainland China. A web-based questionnaire was delivered through the Banmi Online Maternity School platform, including questions about demographics, smoking status, and the HRQoL. EuroQoL Group’s 5-dimension 5-level (EQ-5D-5L) scale with EuroQoL Group’s visual analog scale (EQ-VAS) was used for measuring the HRQoL. Ethical approval was granted by the institutional review board of the First Affiliated Hospital of Sun Yat-sen University (ICE-2017-296). Results: From August to September 2019, a total of 16,483 participants from 31 provinces were included, of which 93 (0.56%) were smokers, 731 (4.43%) were ex-smokers, and 15,659 (95%) were nonsmokers. Nonsmokers had the highest EQ-VAS score (mean 84.49, SD 14.84), smokers had the lowest EQ-VAS score (mean 77.38, SD 21.99), and the EQ-VAS score for ex-smokers was in between (mean 81.04, SD 17.68). A significant difference in EQ-VAS scores was detected between nonsmokers and ex-smokers (P<.001), which indicated that pre-pregnancy smoking does have a negative impact on the HRQoL (EQ-VAS) of pregnant women. Compared with nonsmokers, ex-smokers suffered from more anxiety/depression problems (P=.001, odds ratio [OR] 1.29, 95% CI 1.12-1.50). Among ex-smokers, the increased cigarette consumption was associated with a lower EQ-5D index (P=.007) and EQ-VAS score (P=.01) of pregnant women. Compared to smokers, no significant difference was found in the ex-smokers’ EQ-5D index and EQ-VAS score (P=.33). Conclusions: Smoking history is associated with a lower HRQoL in pregnant Chinese women. Pre-pregnancy smoking is related to a lower HRQoL (EQ-VAS) and a higher incidence of depression/anxiety problems. Smoking cessation during pregnancy does not significantly improve the HRQoL of pregnant Chinese women. Among ex-smokers, the more cigarettes they smoke, the lower HRQoL they have during pregnancy. We suggest that the Chinese government should strengthen the education on quitting smoking and avoiding second-hand smoke for women who have pregnancy plans and their family members. 
%M 35072649
%R 10.2196/29718
%U https://publichealth.jmir.org/2022/1/e29718
%U https://doi.org/10.2196/29718
%U http://www.ncbi.nlm.nih.gov/pubmed/35072649

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 1
%P e31607
%T Evaluating Evidence-Based Content, Features of Exercise Instruction, and Expert Involvement in Physical Activity Apps for Pregnant Women: Systematic Search and Content Analysis
%A Hayman,Melanie J
%A Alfrey,Kristie-Lee
%A Waters,Kim
%A Cannon,Summer
%A Mielke,Gregore I
%A Keating,Shelley E
%A Mena,Gabriela P
%A Mottola,Michelle F
%A Evenson,Kelly R
%A Davenport,Margie H
%A Barlow,S Ariel
%A Budzynski-Seymour,Emily
%A Comardelle,Natalie
%A Dickey,Madison
%A Harrison,Cheryce L
%A Kebbe,Maryam
%A Moholdt,Trine
%A Moran,Lisa J
%A Nagpal,Taniya S
%A Schoeppe,Stephanie
%A Alley,Stephanie
%A Brown,Wendy J
%A Williams,Susan
%A Vincze,Lisa
%+ Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Bruce Highway, Building 7/LG.12, North Rockhampton Campus, Rockhampton, 4701, Australia, 61 749306912, m.j.hayman@cqu.edu.au
%K apps
%K exercise
%K mobile health
%K mHealth
%K mobile phone
%K physical activity
%K pregnancy
%K exercise prescription
%K evidence-based guidelines
%K app development
%K systematic review
%K mobile phone
%D 2022

%7 19.1.2022
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Guidelines for physical activity and exercise during pregnancy recommend that all women without contraindications engage in regular physical activity to improve both their own health and the health of their baby. Many women are uncertain how to safely engage in physical activity and exercise during this life stage and are increasingly using mobile apps to access health-related information. However, the extent to which apps that provide physical activity and exercise advice align with current evidence-based pregnancy recommendations is unclear. Objective: This study aims to conduct a systematic search and content analysis of apps that promote physical activity and exercise in pregnancy to examine the alignment of the content with current evidence-based recommendations; delivery, format, and features of physical activity and exercise instruction; and credentials of the app developers. Methods: Systematic searches were conducted in the Australian App Store and Google Play Store in October 2020. Apps were identified using combinations of search terms relevant to pregnancy and exercise or physical activity and screened for inclusion (with a primary focus on physical activity and exercise during pregnancy, free to download or did not require immediate paid subscription, and an average user rating of ≥4 out of 5). Apps were then independently reviewed using an author-designed extraction tool. Results: Overall, 27 apps were included in this review (Google Play Store: 16/27, 59%, and App Store: 11/27, 41%). Two-thirds of the apps provided some information relating to the frequency, intensity, time, and type principles of exercise; only 11% (3/27) provided this information in line with current evidence-based guidelines. Approximately one-third of the apps provided information about contraindications to exercise during pregnancy and referenced the supporting evidence. None of the apps actively engaged in screening for potential contraindications. Only 15% (4/27) of the apps collected information about the user’s current exercise behaviors, 11% (3/27) allowed users to personalize features relating to their exercise preferences, and a little more than one-third provided information about developer credentials. Conclusions: Few exercise apps designed for pregnancy aligned with current evidence-based physical activity guidelines. None of the apps screened users for contraindications to physical activity and exercise during pregnancy, and most lacked appropriate personalization features to account for an individual’s characteristics. Few involved qualified experts during the development of the app. There is a need to improve the quality of apps that promote exercise in pregnancy to ensure that women are appropriately supported to engage in exercise and the potential risk of injury, complications, and adverse pregnancy outcomes for both mother and child is minimized. This could be done by providing expert guidance that aligns with current recommendations, introducing screening measures and features that enable personalization and tailoring to individual users, or by developing a recognized system for regulating apps. 
%M 35044318
%R 10.2196/31607
%U https://mhealth.jmir.org/2022/1/e31607
%U https://doi.org/10.2196/31607
%U http://www.ncbi.nlm.nih.gov/pubmed/35044318

%0 Journal Article
        
%@ 2291-9694
%I JMIR Publications
%V 10
%N 1
%P e28183
%T Effects of Social Media Use for Health Information on COVID-19–Related Risk Perceptions and Mental Health During Pregnancy: Web-Based Survey
%A Wang,Qian
%A Xie,Luyao
%A Song,Bo
%A Di,Jiangli
%A Wang,Linhong
%A Mo,Phoenix Kit-Han
%+ Center for Health Behaviours Research, Faculty of Medicine, School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, 202D, Hong Kong, Hong Kong, 852 2252 8765, phoenix.mo@cuhk.edu.hk
%K COVID-19
%K pregnant
%K social media use
%K risk perception
%K worry
%K depression
%D 2022

%7 13.1.2022
%9 Original Paper
%J JMIR Med Inform
%G English
                
%X Background: Social media has become an important source of health information during the COVID-19 pandemic. Very little is known about the potential mental impact of social media use on pregnant women. Objective: This study aims to examine the association between using social media for health information and risk perception for COVID-19, worry due to COVID-19, and depression among pregnant women in China. Methods: A total of 4580 pregnant women were recruited from various provinces of China. The participants completed a cross-sectional, web-based survey in March 2020. Results: More than one-third (1794/4580, 39.2%) of the participants reported always using social media for obtaining health information. Results of structural equation modeling showed that the frequency of social media use for health information was positively associated with perceived susceptibility (β=.05; P<.001) and perceived severity (β=.12; P<.001) of COVID-19, which, in turn, were positively associated with worry due to COVID-19 (β=.19 and β=.72, respectively; P<.001). Perceived susceptibility (β=.09; P<.001), perceived severity (β=.08; P<.001), and worry due to COVID-19 (β=.15; P<.001) all had a positive association with depression. Bootstrapping analysis showed that the indirect effects of frequency of social media use for health information on both worry due to COVID-19 (β=.09, 95% CI 0.07-0.12) and depression (β=.05, 95% CI 0.02-0.07) were statistically significant. Conclusions: This study provides empirical evidence on how social media use for health information might have a negative impact on the mental health of pregnant women. Interventions are needed to equip this population with the skills to use social media properly and with caution. 
%M 34762065
%R 10.2196/28183
%U https://medinform.jmir.org/2022/1/e28183
%U https://doi.org/10.2196/28183
%U http://www.ncbi.nlm.nih.gov/pubmed/34762065

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 1
%P e33792
%T Toward Using Twitter Data to Monitor COVID-19 Vaccine Safety in Pregnancy: Proof-of-Concept Study of Cohort Identification
%A Klein,Ari Z
%A O'Connor,Karen
%A Gonzalez-Hernandez,Graciela
%+ Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Blockley Hall, 4th Fl., 423 Guardian Dr., Philadelphia, PA, 19104, United States, 1 215 746 1101, ariklein@pennmedicine.upenn.edu
%K natural language processing
%K social media
%K COVID-19
%K data mining
%K COVID-19 vaccine
%K pregnancy outcomes
%D 2022

%7 6.1.2022
%9 Short Paper
%J JMIR Form Res
%G English
                
%X Background: COVID-19 during pregnancy is associated with an increased risk of maternal death, intensive care unit admission, and preterm birth; however, many people who are pregnant refuse to receive COVID-19 vaccination because of a lack of safety data. Objective: The objective of this preliminary study was to assess whether Twitter data could be used to identify a cohort for epidemiologic studies of COVID-19 vaccination in pregnancy. Specifically, we examined whether it is possible to identify users who have reported (1) that they received COVID-19 vaccination during pregnancy or the periconception period, and (2) their pregnancy outcomes. Methods: We developed regular expressions to search for reports of COVID-19 vaccination in a large collection of tweets posted through the beginning of July 2021 by users who have announced their pregnancy on Twitter. To help determine if users were vaccinated during pregnancy, we drew upon a natural language processing (NLP) tool that estimates the timeframe of the prenatal period. For users who posted tweets with a timestamp indicating they were vaccinated during pregnancy, we drew upon additional NLP tools to help identify tweets that reported their pregnancy outcomes. Results: We manually verified the content of tweets detected automatically, identifying 150 users who reported on Twitter that they received at least one dose of COVID-19 vaccination during pregnancy or the periconception period. We manually verified at least one reported outcome for 45 of the 60 (75%) completed pregnancies. Conclusions: Given the limited availability of data on COVID-19 vaccine safety in pregnancy, Twitter can be a complementary resource for potentially increasing the acceptance of COVID-19 vaccination in pregnant populations. The results of this preliminary study justify the development of scalable methods to identify a larger cohort for epidemiologic studies. 
%M 34870607
%R 10.2196/33792
%U https://formative.jmir.org/2022/1/e33792
%U https://doi.org/10.2196/33792
%U http://www.ncbi.nlm.nih.gov/pubmed/34870607

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 12
%P e30578
%T A Pragmatic Intervention Using Financial Incentives for Pregnancy Weight Management: Feasibility Randomized Controlled Trial
%A Krukowski,Rebecca
%A Johnson,Brandi
%A Kim,Hyeonju
%A Sen,Saunak
%A Homsi,Riad
%+ Department of Public Health Science, University of Virginia, PO Box 800765, Charlottesville, VA, 22908-0765, United States, 1 434 924 1000, bkrukowski@virginia.edu
%K pregnancy
%K weight
%K physical activity
%K self-weighing
%D 2021

%7 24.12.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Excessive gestational weight gain (GWG) is common and can result in maternal and child health complications. Pragmatic behavioral interventions that can be incorporated into standard obstetric care are needed, and financial incentives are a promising approach. Objective: The aim of this study is to evaluate the feasibility of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, in a behavioral program. The program provided small incentives for meeting behavioral goals of self-weighing and physical activity as well as larger outcome incentives for meeting GWG goals. Methods: We recruited 40 adult women in their first trimester of pregnancy from February 2019 to September 2019 at an obstetric clinic. Participants were randomized to 3 intervention components using a 2×2×2 factorial design: daily incentives for self-weighing (lottery vs certain loss), incentives for adhering to the Institute of Medicine’s GWG guidelines based on BMI category (monthly vs overall), and incentives for reaching physical activity goals (yes vs no). Participants were asked to complete daily weigh-ins using the Withings Body wireless scale provided by the study, as well as wear a physical activity tracker (Fitbit Flex 2). Feasibility outcomes of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, were assessed. Weight assessments were conducted at baseline, 32-week gestation, and 36-week gestation. Results: Participants were enrolled at, on average, 9.6 (SD 1.8) weeks’ gestation. Of the 39 participants who were oriented to their condition and received the intervention, 24 (62%) were Black or African American, 30 (77%) were not married, and 29 (74%) had an annual household income of less than US $50,000. Of the 39 participants, 35 (90%) completed the follow-up data collection visit. Participants were generally quite positive about the intervention components, with a particular emphasis on the helpfulness of, and the enjoyment of using, the e-scale in both the quantitative and qualitative feedback. Participants who received the loss incentive, on average, had 2.86 times as many days of self-weighing as those who received the lottery incentive. Participants had a relatively low level of activity, with no difference between those who received a physical activity incentive and those who did not. Conclusions: A financial incentive–based pragmatic intervention was feasible and acceptable for pregnant women for promoting self-weighing, physical activity, and healthy GWG. Participants were successfully recruited early in their first trimester of pregnancy and retained for follow-up data collection in the third trimester. Participants demonstrated promising engagement in self-weighing, particularly with loss-based incentives, and reported finding the self-weighing especially helpful. This study supports further investigation of pragmatic, clinic-based financial incentive–based interventions for healthy GWG behaviors. Trial Registration: ClinicalTrials.gov NCT03834194; https://clinicaltrials.gov/ct2/show/NCT03834194 
%M 34951594
%R 10.2196/30578
%U https://formative.jmir.org/2021/12/e30578
%U https://doi.org/10.2196/30578
%U http://www.ncbi.nlm.nih.gov/pubmed/34951594

%0 Journal Article
        
%@ 2368-7959
%I JMIR Publications
%V 8
%N 12
%P e26665
%T Evaluation of Repeated Web-Based Screening for Predicting Postpartum Depression: Prospective Cohort Study
%A Haßdenteufel,Kathrin
%A Lingenfelder,Katrin
%A Schwarze,Cornelia E
%A Feisst,Manuel
%A Brusniak,Katharina
%A Matthies,Lina Maria
%A Goetz,Maren
%A Wallwiener,Markus
%A Wallwiener,Stephanie
%+ Department of Obstetrics and Gynecology, Heidelberg University, Im Neuenheimer Feld 440, Heidelberg, D-69120, Germany, 49 62215637551, stephanie.wallwiener@med.uni-heidelberg.de
%K postpartum depression
%K Edinburgh Postnatal Depression Scale
%K screening
%K pregnancy
%K algorithm
%D 2021

%7 10.12.2021
%9 Original Paper
%J JMIR Ment Health
%G English
                
%X Background: Postpartum depression (PPD) is a severe mental disorder that often results in poor maternal-infant attachment and negatively impacts infant development. Universal screening has recently been recommended to identify women at risk, but the optimal screening time during pregnancy has not been defined so far. Thus, web-based technologies with widespread use among women of childbearing age create new opportunities to detect pregnancies with a high risk for adverse mental health outcomes at an early stage. Objective: The aim of this study was to stratify the risk for PPD and to determine the optimal screening time during pregnancy by using a web-based screening tool collecting electronic patient-reported outcomes (ePROs) as the basis for a screening algorithm. Methods: In total, 214 women were repeatedly tested for depressive symptoms 5 times during and 3 times after pregnancy by using the Edinburgh Postnatal Depression Scale (EPDS), accessible on a web-based pregnancy platform, developed by the authors of this study. For each prenatal assessment, the area under the curve (AUC), sensitivity, specificity, and predictive values for PPD were calculated. Multivariate logistic regression analyses were applied to identify further potential predictors, such as age, education, parity, relationship quality, and anxiety, to increase predictive accuracy. Results: Digitally collected data from 214 pregnant women were analyzed. The predictive accuracy of depressive symptoms 3 and 6 months postpartum was reasonable to good regarding the screening in the second (AUC=0.85) and third (AUC=0.75) trimester. The multivariate logistic regression analyses resulted in an excellent AUC of 0.93 at 3 months and a good AUC of 0.87 at 6 months postpartum. Conclusions: The best predictive accuracy for PPD has been shown for screening between the 24th and the 28th gestational week (GW) and seems to be beneficial for identifying women at risk. In combination with the aforementioned predictive factors, the discriminatory power improved, particularly at 3 months postpartum. Screening for depression during pregnancy, combined with the women’s personal risk profile, can be used as a starting point for developing a digital screening algorithm. Thereby, web-based assessment tools constitute feasible, efficient, and cost-effective approaches. Thus, they seem to be beneficial in detecting high-risk pregnancies in order to improve maternal and infant birth outcomes in the long term. 
%M 34890349
%R 10.2196/26665
%U https://mental.jmir.org/2021/12/e26665
%U https://doi.org/10.2196/26665
%U http://www.ncbi.nlm.nih.gov/pubmed/34890349

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 12
%P e28644
%T Combined Clinical Audits and Low-Dose, High-frequency, In-service Training of Health Care Providers and Community Health Workers to Improve Maternal and Newborn Health in Mali: Protocol for a Pragmatic Cluster Randomized Trial
%A Zombre,David
%A Kortenaar,Jean-Luc
%A Zareef,Farhana
%A Doumbia,Moussa
%A Doumbia,Sekou
%A Haidara,Fadima
%A McLaughlin,Katie
%A Sow,Samba
%A Bhutta,Zulfiqar A
%A Bassani,Diego G
%+ Centre for Global Child Health, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada, 1 4389857763, davyd.zombre@gmail.com
%K perinatal mortality
%K low dose high frequency training
%K maternal and newborn health outcomes
%K Mali
%D 2021

%7 10.12.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Although most births in Mali occur in health facilities, a substantial number of newborns still die during delivery and within the first 7 days of life, mainly because of existing training deficiencies and the challenges of maintaining intrapartum and postpartum care skills. Objective: This trial aims to assess the effectiveness and cost-effectiveness of an intervention combining clinical audits and low-dose, high-frequency (LDHF) in-service training of health care providers and community health workers to reduce perinatal mortality. Methods: The study is a three-arm cluster randomized controlled trial in the Koulikoro region in Mali. The units of randomization are each of 84 primary care facilities. Each trial arm will include 28 facilities. The facilities in the first intervention arm will receive support in implementing mortality and morbidity audits, followed by one-day LDHF training biweekly, for 6 months. The health workers in the second intervention arm (28 facilities) will receive a refresher course in maternal neonatal and child health (MNCH) for 10 days in a classroom setting, in addition to mortality and morbidity audits and LDHF hands-on training for 6 months. The control arm, also with 28 facilities, will consist solely of the standard MNCH refresher training delivered in a classroom setting. The main outcomes are perinatal deaths in the intervention arms compared with those in the control arm. A final sample of approximately 600 deliveries per cluster was expected for a total of 30,000 newborns over 14 months. Data sources included both routine health records and follow-up household surveys of all women who recently gave birth in the study facility 7 days postdelivery. Data collection tools will capture perinatal deaths, complications, and adverse events, as well as the status of the newborn during the perinatal period. A full economic evaluation will be conducted to determine the incremental cost-effectiveness of each of the case-based focused LDHF hands-on training strategies in comparison to MNCH refresher training in a classroom setting. Results: The trial is complete. The recruitment began on July 15, 2019, and data collection began on July 23, 2019, and was completed in November 2020. Data cleaning or analyses began at the time of submission of the protocol. Conclusions: The results will provide policy makers and practitioners with crucial information on the impact of different health care provider training modalities on maternal and newborn health outcomes and how to successfully implement these strategies in resource-limited settings. Trial Registration: ClinicalTrials.gov NCT03656237; https://clinicaltrials.gov/ct2/show/NCT03656237 International Registered Report Identifier (IRRID): DERR1-10.2196/28644 
%M 34889776
%R 10.2196/28644
%U https://www.researchprotocols.org/2021/12/e28644
%U https://doi.org/10.2196/28644
%U http://www.ncbi.nlm.nih.gov/pubmed/34889776

%0 Journal Article
        
%@ 2564-1891
%I JMIR Publications
%V 1
%N 1
%P e31774
%T COVID-19 Information Sources and Health Behaviors During Pregnancy: Results From a Prenatal App-Embedded Survey
%A Bohnhoff,James
%A Davis,Alexander
%A Bruine de Bruin,Wändi
%A Krishnamurti,Tamar
%+ Division of General Internal Medicine, University of Pittsburgh School of Medicine, 200 Meyran Ave, Suite 200, Pittsburgh, PA, 15213, United States, 1 412 692 4855, tamark@pitt.edu
%K COVID-19
%K health behavior
%K health behaviour
%K pregnancy
%K obstetrics
%K perinatal
%K preventive
%K preventative
%K mHealth
%K risk
%K information source
%K medical literacy
%K media literacy
%K information literacy
%K protection
%K protective
%K harm
%K women
%K engagement
%K online health information
%K behavior
%K information-seeking
%K critical appraisal
%K communication
%D 2021

%7 7.12.2021
%9 Original Paper
%J JMIR Infodemiology
%G English
                
%X Background: Pregnancy is a time of heightened COVID-19 risk. Pregnant individuals’ choice of specific protective health behaviors during pregnancy may be affected by information sources. Objective: This study examined the association between COVID-19 information sources and engagement in protective health behaviors among a pregnant population in a large academic medical system. Methods: Pregnant patients completed an app-based questionnaire about their sources of COVID-19 information and engagement in protective health behaviors. The voluntary questionnaire was made available to patients using a pregnancy app as part of their routine prenatal care between April 21 and November 27, 2020. Results: In total, 637 pregnant responders routinely accessed a median of 5 sources for COVID-19 information. The most cited source (79%) was the Centers for Disease Control and Prevention (CDC). Self-reporting evidence-based protective actions was relatively common, although 14% self-reported potentially harmful behaviors to avoid COVID-19 infection. The CDC and other sources were positively associated with engaging in protective behaviors while others (eg, US president Donald Trump) were negatively associated with protective behaviors. Participation in protective behaviors was not associated with refraining from potentially harmful behaviors (P=.93). Moreover, participation in protective behaviors decreased (P=.03) and participation in potentially harmful actions increased (P=.001) over the course of the pandemic. Conclusions: Pregnant patients were highly engaged in COVID-19–related information-seeking and health behaviors. Clear, targeted, and regular communication from commonly accessed health organizations about which actions may be harmful, in addition to which actions offer protection, may offer needed support to the pregnant population. 
%M 34926994
%R 10.2196/31774
%U https://infodemiology.jmir.org/2021/1/e31774
%U https://doi.org/10.2196/31774
%U http://www.ncbi.nlm.nih.gov/pubmed/34926994

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 12
%P e28628
%T Users’ Perceptions Toward mHealth Technologies for Health and Well-being Monitoring in Pregnancy Care: Qualitative Interview Study
%A Li,Jane
%A Silvera-Tawil,David
%A Varnfield,Marlien
%A Hussain,M Sazzad
%A Math,Vanitha
%+ Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Cnr Vimiera and Pembroke Roads, Marsfield, 2122, Australia, 61 02 93724163, jane.li@csiro.au
%K pregnancy care
%K wearable sensors
%K mobile health
%K acceptance
%K mHealth service
%K design
%K mobile phone
%D 2021

%7 2.12.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Mobile health (mHealth) technologies, such as wearable sensors, smart health devices, and mobile apps, that are capable of supporting pregnancy care are emerging. Although mHealth could be used to facilitate the tracking of health changes during pregnancy, challenges remain in data collection compliance and technology engagement among pregnant women. Understanding the interests, preferences, and requirements of pregnant women and those of clinicians is needed when designing and introducing mHealth solutions for supporting pregnant women’s monitoring of health and risk factors throughout their pregnancy journey. Objective: This study aims to understand clinicians’ and pregnant women’s perceptions on the potential use of mHealth, including factors that may influence their engagement with mHealth technologies and the implications for technology design and implementation. Methods: A qualitative study using semistructured interviews was conducted with 4 pregnant women, 4 postnatal women, and 13 clinicians working in perinatal care. Results: Clinicians perceived the potential benefit of mHealth in supporting different levels of health and well-being monitoring, risk assessment, and care provision in pregnancy care. Most pregnant and postnatal female participants were open to the use of wearables and health monitoring devices and were more likely to use these technologies if they knew that clinicians were monitoring their data. Although it was acknowledged that some pregnancy-related medical conditions are suitable for an mHealth model of remote monitoring, the clinical and technical challenges in the introduction of mHealth for pregnancy care were also identified. Incorporating appropriate health and well-being measures, intelligently detecting any abnormalities, and providing tailored information for pregnant women were the critical aspects, whereas usability and data privacy were among the main concerns of the participants. Moreover, this study highlighted the challenges of engaging pregnant women in longitudinal mHealth monitoring, the additional work required for clinicians to monitor the data, and the need for an evidence-based technical solution. Conclusions: Clinical, technical, and practical factors associated with the use of mHealth to monitor health and well-being in pregnant women need to be considered during the design and feasibility evaluation stages. Technical solutions and appropriate strategies for motivating pregnant women are critical to supporting their long-term data collection compliance and engagement with mHealth technology during pregnancy. 
%M 34860665
%R 10.2196/28628
%U https://formative.jmir.org/2021/12/e28628
%U https://doi.org/10.2196/28628
%U http://www.ncbi.nlm.nih.gov/pubmed/34860665

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 11
%P e29214
%T mHealth-Based Health Promotion Intervention to Improve Use of Maternity Care Services Among Women in Rural Southwestern Uganda: Iterative Development Study
%A Atukunda,Esther Cathyln
%A Matthews,Lynn T
%A Musiimenta,Angella
%A Mugyenyi,Godfrey Rwambuka
%A Mugisha,Samuel
%A Ware,Norma C
%A Obua,Celestino
%A Siedner,Mark J
%+ Mbarara University of Science and Technology, Faculty of Medicine, Plot 11-18, Kabale Road, P O Box 1410, Mbarara City, Uganda, 256 702949832, eatukunda@must.ac.ug
%K mHealth app
%K app development
%K messaging
%K health education
%K health promotion
%K mobile phone
%D 2021

%7 25.11.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Antenatal care (ANC) prevents perinatal morbidity and mortality, but use of these services in Uganda remains low and maternal mortality rates are among the highest in the world. There is growing evidence that mobile health (mHealth) approaches improve timely communication of health-related information and produce positive health behavior change as well as health outcomes. However, there are limited data to guide development of such interventions in settings where ANC attendance and uptake of skilled maternity care are low. Objective: The aim of this study is to develop a novel patient-centered mHealth intervention to encourage and support women to use maternity care services in Mbarara district, southwestern Uganda. Methods: Using an iterative development approach, we conducted formative stakeholder interviews with 30 women and 5 health care providers (HCPs) to identify preferred key ANC topics and characterize the preferred messaging intervention; developed content for SMS text messaging and audio messaging with the help of 4 medical experts based on the identified topics; designed an app prototype through partnership with an mHealth development company; and pilot-tested the prototype and sought user experiences and feedback to refine the intervention through 3 sets of iterative interviews, a focus group discussion, and 5 cognitive interviews. Qualitative data were coded and analyzed using NVivo (version 12.0; QSR International). Results: Of the 75 women who completed interviews during the development of the prototype, 39 (52%) had at least a primary education and 75 (100%) had access to a mobile phone. The formative interviews identified 20 preferred perinatal health topics, ranging from native medicine use to comorbid disorders and danger signs during pregnancy. In all, 6 additional topics were identified by the interviewed HCPs, including birth preparedness, skilled delivery, male partner’s involvement, HCP interaction, immunization, and caring for the baby. Positive audio messaging and SMS text messaging content without authoritative tones was developed as characterized by the interviewed women. The postpilot iterative interviews and focus group discussion revealed a preference for customized messaging, reflecting an individual need to be included and connected. The women preferred short, concise, clear actionable messages that guided, supported, and motivated them to keep alert and seek professional help. Complementary weekly reminders to the women’s significant others were also preferred to encourage continuity or prompt the needed social support for care seeking. Conclusions: We used an iterative approach with diffuse stakeholders to develop a patient-centered audio messaging and SMS text messaging app designed to communicate important targeted health-related information and support rural pregnant women in southwestern Uganda. Involving both HCPs and end users in developing and formulating the mHealth intervention allowed us to tailor the intervention characteristics to the women’s preferences. Future work will address the feasibility, acceptability, and effectiveness of this design approach. 
%M 34842541
%R 10.2196/29214
%U https://formative.jmir.org/2021/11/e29214
%U https://doi.org/10.2196/29214
%U http://www.ncbi.nlm.nih.gov/pubmed/34842541

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 11
%P e27995
%T Content, Behavior Change Techniques, and Quality of Pregnancy Apps in Spain: Systematic Search on App Stores
%A Muñoz-Mancisidor,Aranzazu
%A Martin-Payo,Ruben
%A Gonzalez-Mendez,Xana
%A Fernández-Álvarez,María Del Mar
%+ Universidad de Oviedo, Calle Julián Clavería s/n, Campus del Cristo, Oviedo, 33006, Spain, 34 985 103 147, martinruben@uniovi.es
%K pregnancy
%K mobile apps
%K behavior
%K technology assessment, biomedical
%K telemedicine
%D 2021

%7 17.11.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Women consult information in mobile apps (apps) during pregnancy, and even obstetrics specialists highlight that pregnancy is the ideal moment for the use of apps as consultation sources. However, the high number of apps designed for pregnancy requires a careful assessment to determine their suitability before recommendation. Objective: The aim of this study is to identify the apps available in Spanish that can be recommended based on their content, behavior change techniques (BCTs), and quality as a complementary tool during pregnancy. Methods: A systematic search on app stores to identify apps was performed in the Apple App Store and Google Play with the subject term “pregnancy.” The apps meeting the following criteria were chosen: pregnancy-related content, free, and available in Spanish. An app was excluded if it was classified as a game or entertainment and thus lacking an educational or health aim and if it did not target the population under study. The selected apps were downloaded, and their quality was assessed using the Mobile Application Rating Scale (MARS), with the BCTs included evaluated using the BCT taxonomy version 1 and its content. Results: A total of 457 apps were identified, 25 of which were downloaded for assessment (5.6%). The median for objective and subjective quality was 2.94 (IQR 2.71-3.46) and 1.75 (IQR 1.25-2.25), respectively. Regarding content, the median of topics included in the apps was 23 (IQR 16-23), with weight gain, nutrition, fetal development, and physical activity being the most common. The median number of BCTs was 12 (IQR 0.5-3.5). The most frequently identified BCTs in the apps were “Self-Monitoring of Outcomes,” followed by “Goal Behavior” and “Instructions.” Statistically significant correlations were observed between objective quality and content (ρ=0.624; P=.001), subjective quality and content (ρ=0.638; P=.001), objective quality and BCTs (ρ=0.672; P<.001), subjective quality and BCTs (ρ=0.623; P<.001), and BCTs and content (ρ=0.580; P=.002). Conclusions: The results of this study suggest that only a small percentage of free pregnancy apps available in Spanish should be recommended. The apps with the best MARS scores were those that addressed a higher number of topics and included a higher number of BCTs. Those with the best content and quality, and a higher number of BCTs included could be recommended by health professionals. 
%M 34787587
%R 10.2196/27995
%U https://mhealth.jmir.org/2021/11/e27995
%U https://doi.org/10.2196/27995
%U http://www.ncbi.nlm.nih.gov/pubmed/34787587

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 11
%P e30991
%T A Technology-Based Pregnancy Health and Wellness Intervention (Two Happy Hearts): Case Study
%A Jimah,Tamara
%A Borg,Holly
%A Kehoe,Priscilla
%A Pimentel,Pamela
%A Turner,Arlene
%A Labbaf,Sina
%A Asgari Mehrabadi,Milad
%A Rahmani,Amir M.
%A Dutt,Nikil
%A Guo,Yuqing
%+ Sue & Bill Gross School of Nursing, University of California, Irvine, 299D Berk Hall, Irvine, CA, 92697, United States, 1 949 824 9057, tjimah@hs.uci.edu
%K ecological momentary assessment
%K heart rate
%K mHealth
%K physical activity
%K pregnancy
%K sleep
%K wearable electronic device
%D 2021

%7 17.11.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts intervention is a personalized mind-body program coached by community health workers that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement. Objective: The aims of this study are to (1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and (2) explore the user’s engagement with the Two Happy Hearts intervention prototype, as well as understand their experiences with various intervention components. Methods: A case study with a mixed design was used. We recruited a 29-year-old woman at 33 weeks of gestation with a singleton pregnancy. She had no medical complications or physical restrictions, and she was enrolled in the Medi-Cal public health insurance plan. The participant engaged in the Two Happy Hearts intervention prototype from her third trimester until delivery. The Oura smart ring was used to continuously monitor objective physical and emotional states, such as resting heart rate, resting heart rate variability, sleep, and physical activity. In addition, the participant self-reported her physical and emotional health using the Two Happy Hearts mobile app–based 24-hour recall surveys (sleep quality and level of physical activity) and ecological momentary assessment (positive and negative emotions), as well as the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. Engagement with the Two Happy Hearts intervention was recorded via both the smart ring and phone app, and user experiences were collected via Research Electronic Data Capture satisfaction surveys. Objective data from the Oura ring and subjective data on physical and emotional health were described. Regression plots and Pearson correlations between the objective and subjective data were presented, and content analysis was performed for the qualitative data. Results: Decreased resting heart rate was significantly correlated with increased heart rate variability (r=–0.92, P<.001). We found significant associations between self-reported responses and Oura ring measures: (1) positive emotions and heart rate variability (r=0.54, P<.001), (2) sleep quality and sleep score (r=0.52, P<.001), and (3) physical activity and step count (r=0.77, P<.001). In addition, deep sleep appeared to increase as light and rapid eye movement sleep decreased. The psychological measures of stress, depression, and anxiety appeared to decrease from baseline to post intervention. Furthermore, the participant had a high completion rate of the components of the Two Happy Hearts intervention prototype and shared several positive experiences, such as an increased self-efficacy and a normal delivery. Conclusions: The Two Happy Hearts intervention prototype shows promise for potential use by underserved pregnant women. 
%M 34787576
%R 10.2196/30991
%U https://formative.jmir.org/2021/11/e30991
%U https://doi.org/10.2196/30991
%U http://www.ncbi.nlm.nih.gov/pubmed/34787576

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 11
%P e31611
%T The Efficacy of a Personalized mHealth Coaching Program During Pregnancy on Maternal Diet, Supplement Use, and Physical Activity: Protocol for a Parallel-Group Randomized Controlled Trial
%A Nuruddin,Rozina
%A Vadsaria,Khadija
%A Mohammed,Nuruddin
%A Sayani,Saleem
%+ Department of Community Health Sciences, Medical College, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan, 92 21 3486 ext 4833, rozina.nuruddin@aku.edu
%K coaching
%K compliance
%K diet
%K maternal health
%K mobile health
%K offspring health
%K physical activity
%K pregnancy
%K supplement use
%K usability
%D 2021

%7 16.11.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Adequate intake of macro- and micronutrients and adoption of an active lifestyle during pregnancy are essential for optimum maternal and fetal health and offspring development. Dietary counseling and advice regarding adequate physical activity are integral components of antenatal care. Personalized coaching through the use of mobile health (mHealth) that supports behavior modification is an innovative approach that needs exploration. Objective: Our primary aim is to assess the efficacy of an mHealth program in improving diet, supplement use, and physical activity during pregnancy. Secondary objectives include evaluation of the program’s effect on maternal and offspring health outcomes and assessment of its compliance and usability. Methods: A randomized controlled trial was initiated at the Aga Khan University Hospital in Karachi, Pakistan, in January 2020. We aim to recruit 300 pregnant women in their first trimester who have smartphones, do not have comorbidities, and are not taking medications. The intervention group will be trained to use an mHealth app called PurUmeed Aaghaz. Through this app, the subjects will report information about their diet, supplement use, and physical activity and will receive personalized advice and three push messages as weekly reminders. The research assistant will obtain similar information from the control group via a paperless questionnaire; this group will receive standard face-to-face counseling regarding diet, supplement use, and physical activity. Data will be collected at enrollment and during four follow-up sessions scheduled 6 weeks apart. Primary study outcomes include improvements in diet (ie, change in mean dietary risk score from baseline to each follow-up), supplement use (ie, changes in mean supplement use score and biochemical levels of folic acid, iron, calcium, and vitamin D on a study subset), and mean duration of reported physical activity (minutes). Secondary study outcomes relate to maternal health (ie, gestational diabetes mellitus, gestational hypertension, pre-eclampsia, and gestational weight gain), newborn health (ie, birth weight and length and gestational age at delivery), and infant health (ie, BMI and blood pressure at 1 year of age). Compliance will be determined by the proportion of participants who complete the 6-month coaching program. Usability will be assessed based on features related to design, interface, content, coaching, perception, and personal benefit. Results: The study was approved by the Ethics Review Committee of the Aga Khan University in 2017. The recruitment of study participants was completed in September 2021. All follow-ups and outcome assessments are expected to be completed by March 2023 and analysis is expected to be completed by June 2023. We  expect the results to be published by the end of 2023. Conclusions: This study will be an important step toward evaluating the role of mHealth in improving behaviors related to a healthy diet, supplement use, and promotion of physical activity during pregnancy, as well as in influencing maternal and offspring outcomes. If proven effective, mHealth interventions can be scaled up and included in antenatal care packages at tertiary care hospitals of low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT04216446; https://clinicaltrials.gov/ct2/show/NCT04216446 International Registered Report Identifier (IRRID): DERR1-10.2196/31611 
%M 34783675
%R 10.2196/31611
%U https://www.researchprotocols.org/2021/11/e31611
%U https://doi.org/10.2196/31611
%U http://www.ncbi.nlm.nih.gov/pubmed/34783675

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 11
%P e23874
%T Formative Study of Mobile Phone Use for Family Planning Among Young People in Sierra Leone: Global Systematic Survey
%A Chukwu,Emeka
%A Gilroy,Sonia
%A Addaquay,Kojo
%A Jones,Nki Nafisa
%A Karimu,Victor Gbadia
%A Garg,Lalit
%A Dickson,Kim Eva
%+ Department of Computer Information System, Faculty of Information and Communications Technology (ICT), University of Malta, Msida, MSD 2080, Malta, 356 99330888, nnaemeka_ec@hotmail.com
%K young people
%K short message service
%K SMS
%K chatbot
%K text message
%K interactive voice response
%K IVR
%K WhatsApp
%K Facebook
%K family planning
%K contraceptives
%K Sierra Leone
%D 2021

%7 12.11.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Teenage pregnancy remains high with low contraceptive prevalence among adolescents (aged 15-19 years) in Sierra Leone. Stakeholders leverage multiple strategies to address the challenge. Mobile technology is pervasive and presents an opportunity to reach young people with critical sexual reproductive health and family planning messages. Objective: The objectives of this research study are to understand how mobile health (mHealth) is used for family planning, understand phone use habits among young people in Sierra Leone, and recommend strategies for mobile-enabled dissemination of family planning information at scale. Methods: This formative research study was conducted using a systematic literature review and focus group discussions (FGDs). The literature survey assessed similar but existing interventions through a systematic search of 6 scholarly databases. Cross-sections of young people of both sexes and their support groups were engaged in 9 FGDs in an urban and a rural district in Sierra Leone. The FGD data were qualitatively analyzed using MAXQDA software (VERBI Software GmbH) to determine appropriate technology channels, content, and format for different user segments. Results: Our systematic search results were categorized using Grading of Recommended Assessment and Evaluation (GRADE) into communication channels, audiovisual messaging format, purpose of the intervention, and message direction. The majority of reviewed articles report on SMS-based interventions. At the same time, most intervention purposes are for awareness and as helpful resources. Our survey did not find documented use of custom mHealth apps for family planning information dissemination. From the FGDs, more young people in Sierra Leone own basic mobile phones than those that have feature capablilities or are smartphone. Young people with smartphones use them mostly for WhatsApp and Facebook. Young people widely subscribe to the social media–only internet bundle, with the cost ranging from 1000 leones (US $0.11) to 1500 leones (US $0.16) daily. Pupils in both districts top-up their voice call and SMS credit every day between 1000 leones (US $0.11) and 5000 leones (US $0.52). Conclusions: mHealth has facilitated family planning information dissemination for demand creation around the world. Despite the widespread use of social and new media, SMS is the scalable channel to reach literate and semiliterate young people. We have cataloged mHealth for contraceptive research to show SMS followed by call center as widely used channels. Jingles are popular for audiovisual message formats, mostly delivered as either push or pull only message directions (not both). Interactive voice response and automated calls are best suited to reach nonliterate young people at scale. 
%M 34766908
%R 10.2196/23874
%U https://formative.jmir.org/2021/11/e23874
%U https://doi.org/10.2196/23874
%U http://www.ncbi.nlm.nih.gov/pubmed/34766908

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 23
%N 10
%P e25667
%T Mobile Health Apps for Pregnant Women: Systematic Search, Evaluation, and Analysis of Features
%A Frid,Gabriela
%A Bogaert,Kelly
%A Chen,Katherine T
%+ Icahn School of Medicine at Mount Sinai, 1 Gustace L. Levy Pl, New York, NY, 10029, United States, 1 3478664514, gabriela.frid@icahn.mssm.edu
%K app
%K app store
%K mHealth
%K mobile health
%K prenatal
%K pregnancy
%K women's health
%D 2021

%7 18.10.2021
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Many pregnant women use the internet to obtain information about pregnancy and childbirth. Over 50% of pregnant women use pregnancy apps and must search through thousands of pregnancy or women’s health–related apps available on app stores. The COVID-19 pandemic is changing how women receive prenatal care. Mobile health apps may help maintain women’s satisfaction with their prenatal care. Objective: Our objective is to identify pregnancy mobile apps and to evaluate the apps using a modified APPLICATIONS (app comprehensiveness, price, privacy, literature used, in-app purchases, connectivity, advertisements, text search field, images/videos, other special features, navigation ease, subjective presentation) scoring system. Methods: A list of pregnancy apps was identified in the first 20 Google search results using the search term “pregnancy app.” After excluding irrelevant, inaccurate, malfunctioning, or no longer available apps, all unique apps were downloaded and evaluated with the modified APPLICATIONS scoring system, which includes both objective and subjective criteria and evaluation of special features. Results: A list of 57 unique pregnancy apps was generated. After 28 apps were excluded, the remaining 29 apps were evaluated, with a mean score of 9.4 points out of a maximum of 16. The highest scoring app scored 15 points. Over 60% (18/29) of apps did not have comprehensive information for every stage of pregnancy or did not contain all four desired components of pregnancy apps: health promotion/patient education, communication, health tracking, and notifications and reminders. Only 24% (7/29) of apps included a text search field, and only 28% (8/29) of apps cited literature. Conclusions: Our search yielded many high-scoring apps, but few contained all desired components and features. This list of identified and rated apps can lessen the burden on pregnant women and providers to find available apps on their own. Although health care providers should continue to vet apps before recommending them to patients, these findings also highlight that a Google search is a successful way for patients and providers to find useful and comprehensive pregnancy apps. 
%M 34524100
%R 10.2196/25667
%U https://www.jmir.org/2021/10/e25667
%U https://doi.org/10.2196/25667
%U http://www.ncbi.nlm.nih.gov/pubmed/34524100

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 10
%P e30404
%T Characteristics and Quality of Mobile Apps Containing Prenatal Genetic Testing Information: Systematic App Store Search and Assessment
%A Wu,Ko-Lin
%A Alegria,Rebeca
%A Gonzalez,Jazzlyn
%A Hu,Harrison
%A Wang,Haocen
%A Page,Robin
%A Robbins-Furman,Patricia
%A Ma,Ping
%A Tseng,Tung-Sung
%A Chen,Lei-Shih
%+ Department of Health and Kinesiology, Texas A&M University, 4243 TAMU, College Station, TX, 77840, United States, 1 979 862 2912, lacechen@tamu.edu
%K mobile applications
%K prenatal genetic testing
%K pregnancy
%K review
%K evaluation
%D 2021

%7 14.10.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Prenatal genetic testing is an essential part of routine prenatal care. Yet, obstetricians often lack the time to provide comprehensive prenatal genetic testing education to their patients. Pregnant women lack prenatal genetic testing knowledge, which may hinder informed decision-making during their pregnancies. Due to the rapid growth of technology, mobile apps are a potentially valuable educational tool through which pregnant women can learn about prenatal genetic testing and improve the quality of their communication with obstetricians. The characteristics, quality, and number of available apps containing prenatal genetic testing information are, however, unknown. Objective: This study aims to conduct a firstreview to identify, evaluate, and summarize currently available mobile apps that contain prenatal genetic testing information using a systematic approach. Methods: We searched both the Apple App Store and Google Play for mobile apps containing prenatal genetic testing information. The quality of apps was assessed based on the criteria adopted from two commonly used and validated mobile app scoring systems, including the Mobile Application Rating Scale (MARS) and the APPLICATIONS evaluation criteria. Results: A total of 64 mobile apps were identified. Of these, only 2 apps were developed for a specific prenatal genetic test. All others were either pregnancy-related (61/64, 95%) or genetics-related (1/64, 2%) apps that provided prenatal genetic testing information. The majority of the apps (49/64, 77%) were developed by commercial companies. The mean quality assessment score of the included apps was 13.5 (SD 2.9), which was equal to the average of possible theoretical score. Overall, the main weaknesses of mobile apps in this review included the limited number of prenatal genetic tests mentioned; incomprehensiveness of testing information; unreliable and missing information sources; absence of developmental testing with users (not evidence based); high level of readability; and the lack of visual information, customization, and a text search field. Conclusions: Our findings suggest that the quality of mobile apps with prenatal genetic testing information must be improved and that pregnant women should be cautious when using these apps for prenatal genetic testing information. Obstetricians should carefully examine mobile apps before referring any of them to their patients for use as an educational tool. Both improving the quality of existing mobile apps, and developing new, evidence-based, high-quality mobile apps targeting all prenatal genetic tests should be the focus of mobile app developers going forward. 
%M 34647898
%R 10.2196/30404
%U https://mhealth.jmir.org/2021/10/e30404
%U https://doi.org/10.2196/30404
%U http://www.ncbi.nlm.nih.gov/pubmed/34647898

%0 Journal Article
        
%@ 2369-1999
%I JMIR Publications
%V 7
%N 4
%P e24984
%T Secondhand Smoke Exposure of Expectant Mothers in China: Factoring in the Role of Culture in Data Collection
%A Su,Zhaohui
%A McDonnell,Dean
%A Abbas,Jaffar
%A Shi,Lili
%A Cai,Yuyang
%A Yang,Ling
%+ Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States, 1 5128399965, szh@utexas.edu
%K cancer
%K secondhand smoking
%K secondhand smoke
%K expectant mothers
%K pregnant women
%K China
%K transitional Chinese culture
%K “doing the month”
%K smoking
%K pregnancy
%K women
%K China
%K culture
%K behavior
%D 2021

%7 7.10.2021
%9 Viewpoint
%J JMIR Cancer
%G English
                
%X Cancer is the leading cause of death worldwide. Tobacco smoking, including secondhand smoking, causes cancer and is responsible for over 22% of global cancer deaths. The adverse impacts of secondhand smoke are more pronounced for expectant mothers, and can deteriorate both mothers’ and infants’ health and well-being. Research suggests that secondhand smoke significantly increases expectant mothers’ risk of miscarriage, cancer, and other chronic disease conditions, and exposes their unborn babies to an increased likelihood of having life-long poor health. In China, a pregnant woman’s family members, such as her husband, parents, or in-laws, are the most likely people to be smoking around her. Due to traditional Chinese cultural practices, even though some expectant mothers understand the harm of secondhand smoke, they may be reluctant to report their family members’ smoking behaviors. Resulting in severe underreporting, this compromises health experts’ ability to understand the severity of the issue. This paper proposes a novel approach to measure secondhand smoke exposure of pregnant women in the Chinese context. The proposed system could act as a stepping stone that inspires creative methods to help researchers more accurately measure secondhand smoking rates of expectant mothers in China. This, in turn, could help health experts better establish cancer control measures for expectant mothers and decrease their cancer risk.
%M 34617907
%R 10.2196/24984
%U https://cancer.jmir.org/2021/4/e24984
%U https://doi.org/10.2196/24984
%U http://www.ncbi.nlm.nih.gov/pubmed/34617907

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 10
%P e22653
%T Appropriation of mHealth Interventions for Maternal Health Care in Sub-Saharan Africa: Hermeneutic Review
%A Maliwichi,Priscilla
%A Chigona,Wallace
%A Sowon,Karen
%+ Department of Information Systems, Faculty of Commerce, University of Cape Town, Private Bag X1, Rondebosch, Cape Town, 7701, South Africa, 27 21 650 2261, pmaliwichi@must.ac.mw
%K mHealth
%K appropriation
%K mobile phones
%K model of technology appropriation
%K maternal health
%K community of purpose
%K hermeneutic literature review
%D 2021

%7 6.10.2021
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Many maternal clients from poorly resourced communities die from preventable pregnancy-related complications. The situation is especially grave in sub-Saharan Africa. Mobile health (mHealth) interventions have the potential to improve maternal health outcomes. mHealth interventions are used to encourage behavioral change for health care–seeking by maternal clients. However, the appropriation of such interventions among maternal health clients is not always guaranteed. Objective: This study aims to understand how maternal clients appropriate mHealth interventions and the factors that affect this appropriation. Methods: This study used a hermeneutic literature review informed by the model of technology appropriation. We used data from three mHealth case studies in sub-Saharan Africa: Mobile Technology for Community Health, MomConnect, and Chipatala Cha Pa Foni. We used the search and acquisition hermeneutic circle to identify and retrieve peer-reviewed and gray literature from the Web of Science, Google Scholar, Google, and PubMed. We selected 17 papers for analysis. We organized the findings using three levels of the appropriation process: adoption, adaptation, and integration. Results: This study found that several factors affected how maternal clients appropriated mHealth interventions. The study noted that it is paramount that mHealth designers and implementers should consider the context of mHealth interventions when designing and implementing interventions. However, the usefulness of an mHealth intervention may enhance how maternal health clients appropriate it. Furthermore, a community of purpose around the maternal client may be vital to the success of the mHealth intervention. Conclusions: The design and implementation of interventions have the potential to exacerbate inequalities within communities. To mitigate against inequalities during appropriation, it is recommended that communities of purpose be included in the design and implementation of maternal mHealth interventions. 
%M 34612835
%R 10.2196/22653
%U https://mhealth.jmir.org/2021/10/e22653
%U https://doi.org/10.2196/22653
%U http://www.ncbi.nlm.nih.gov/pubmed/34612835

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 4
%N 4
%P e27769
%T Delivery Outcomes During the COVID-19 Pandemic as Reported in a Pregnancy Mobile App: Retrospective Cohort Study
%A Noddin,Katie
%A Bradley,Dani
%A Wolfberg,Adam
%+ Ovia Health, 308 Congress St, Boston, MA, 02210, United States, 1 3392032545, katie@oviahealth.com
%K digital health
%K COVID-19
%K maternal health
%K obstetrics
%K COVID
%K pandemic
%K pregnant women
%K birth
%K hospital
%K delivery
%K women's health
%K Cesarean sections
%D 2021

%7 4.10.2021
%9 Short Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: The COVID-19 pandemic has presented obstacles for providers and patients in the maternal health care setting, causing changes to many pregnant women’s birth plans, as well as abrupt changes in hospital labor and delivery policies and procedures. Few data exist on the effects of the COVID-19 pandemic on the maternal health care landscape at the national level in the United States. Objective: The aim of this study is to assess the incidence of key obstetrics outcomes (preterm delivery, Cesarean sections, and home births) and length of hospital stay during the COVID-19 pandemic as compared to the 6 months prior. Methods: We conducted a retrospective cohort study of women aged 18-44 years in the United States who delivered between October 1, 2019, and September 30, 2020, had singleton deliveries, and completed a birth report in the Ovia Pregnancy mobile app. Women were assigned to the prepandemic cohort if they delivered between October 2019 and March 2020, and the pandemic cohort if they delivered between April and September 2020. Gestational age at delivery, delivery method, delivery facility type, and length of hospital stay were compared. Results: A total of 304,023 birth reports were collected, with 152,832 (50.26%) in the prepandemic cohort and 151,191 (49.73%) in the pandemic cohort. Compared to the prepandemic cohort, principal findings indicate a 5.67% decrease in preterm delivery rates in the pandemic cohort (P<.001; odds ratio [OR] 0.94, 95% CI 0.91-0.96), a 30.0% increase in home birth rates (P<.001; OR 1.3, 95% CI 1.23-1.4), and a 7.81% decrease in the average hospital length of stay postdelivery (mean 2.48 days, SD 1.35). There were no overall changes in Cesarean section rates between cohorts, but differences were observed between age, race, and ethnicity subgroups. Conclusions: Results suggest a need for continuous monitoring of maternal health trends as the COVID-19 pandemic progresses and underline the important role of digital data collection, particularly during the pandemic. 
%M 34509975
%R 10.2196/27769
%U https://pediatrics.jmir.org/2021/4/e27769
%U https://doi.org/10.2196/27769
%U http://www.ncbi.nlm.nih.gov/pubmed/34509975

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 9
%P e27801
%T Remote Patient Monitoring and Incentives to Support Smoking Cessation Among Pregnant and Postpartum Medicaid Members: Three Randomized Controlled Pilot Studies
%A Joyce,Caroline M
%A Saulsgiver,Kathryn
%A Mohanty,Salini
%A Bachireddy,Chethan
%A Molfetta,Carin
%A Steffy,Mary
%A Yoder,Alice
%A Buttenheim,Alison M
%+ Department of Epidemiology, Faculty of Medicine, McGill University, 845 Sherbrooke Street W, Montreal, QC, H3A 0G4, Canada, 1 514 398 6258, Caroline.joyce@mail.mcgill.ca
%K maternal smoking
%K smoking cessation
%K financial incentives
%K smoking
%K pregnant
%K postpartum
%K incentives
%K mHealth
%K mobile health
%K mobile phone
%K smart devices
%D 2021

%7 30.9.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Smoking rates among low-income individuals, including those eligible for Medicaid, have not shown the same decrease that is observed among high-income individuals. The rate of smoking among pregnant women enrolled in Medicaid is almost twice that among privately insured women, which leads to significant disparities in birth outcomes and a disproportionate cost burden placed on Medicaid. Several states have identified maternal smoking as a key target for improving birth outcomes and reducing health care expenditures; however, efficacious, cost-effective, and feasible cessation programs have been elusive. Objective: This study aims to examine the feasibility, acceptability, and effectiveness of a smartwatch-enabled, incentive-based smoking cessation program for Medicaid-eligible pregnant smokers. Methods: Pilot 1 included a randomized pilot study of smartwatch-enabled remote monitoring versus no remote monitoring for 12 weeks. Those in the intervention group also received the SmokeBeat program. Pilot 2 included a randomized pilot study of pay-to-wear versus pay-to-quit for 4 weeks. Those in a pay-to-wear program could earn daily incentives for wearing the smartwatch, whereas those in pay-to-quit program could earn daily incentives if they wore the smartwatch and abstained from smoking. Pilot 3, similar to pilot 2, had higher incentives and a duration of 3 weeks. Results: For pilot 1 (N=27), self-reported cigarettes per week among the intervention group declined by 15.1 (SD 27) cigarettes over the study; a similar reduction was observed in the control group with a decrease of 17.2 (SD 19) cigarettes. For pilot 2 (N=8), self-reported cigarettes per week among the pay-to-wear group decreased by 43 cigarettes (SD 12.6); a similar reduction was seen in the pay-to-quit group, with an average of 31 (SD 45.6) fewer cigarettes smoked per week. For pilot 3 (N=4), one participant in the pay-to-quit group abstained from smoking for the full study duration and received full incentives. Conclusions: Decreases in smoking were observed in both the control and intervention groups during all pilots. The use of the SmokeBeat program did not significantly improve cessation. The SmokeBeat program, remote cotinine testing, and remote delivery of financial incentives were considered feasible and acceptable. Implementation challenges remain for providing evidence-based cessation incentives to low-income pregnant smokers. The feasibility and acceptability of the SmokeBeat program were moderately high. Moreover, the feasibility and acceptability of remote cotinine testing and the remotely delivered contingent financial incentives were successful. Trial Registration: ClinicalTrials.gov NCT03209557; https://clinicaltrials.gov/ct2/show/NCT03209557. 
%M 34591023
%R 10.2196/27801
%U https://formative.jmir.org/2021/9/e27801
%U https://doi.org/10.2196/27801
%U http://www.ncbi.nlm.nih.gov/pubmed/34591023

%0 Journal Article
        
%@ 2368-7959
%I JMIR Publications
%V 8
%N 9
%P e30422
%T Trends in Stress Throughout Pregnancy and Postpartum Period During the COVID-19 Pandemic: Longitudinal Study Using Ecological Momentary Assessment and Data From the Postpartum Mothers Mobile Study
%A Omowale,Serwaa S
%A Casas,Andrea
%A Lai,Yu-Hsuan
%A Sanders,Sarah A
%A Hill,Ashley V
%A Wallace,Meredith L
%A Rathbun,Stephen L
%A Gary-Webb,Tiffany L
%A Burke,Lora E
%A Davis,Esa M
%A Mendez,Dara D
%+ Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, United States, 1 4126243001, ddm11@pitt.edu
%K COVID-19
%K ecological momentary assessment
%K health status disparities
%K pandemics
%K postpartum
%K pregnancy
%K psychological stress
%D 2021

%7 21.9.2021
%9 Original Paper
%J JMIR Ment Health
%G English
                
%X Background: Stress is associated with adverse birth and postpartum health outcomes. Few studies have longitudinally explored racial differences in maternal stress in a birthing population in the United States during the ongoing COVID-19 pandemic. Objective: This study aimed to do the following: (1) assess changes in reported stress before, during, and after initial emergency declarations (eg, stay-at-home orders) were in place due to the COVID-19 pandemic, and (2) assess Black-White differences in reported stress in a pregnant and postpartum population from Southwestern Pennsylvania. Methods: We leveraged data from the ongoing Postpartum Mothers Mobile Study (PMOMS), which surveys participants in real time throughout the pregnancy and postpartum periods via ecological momentary assessment (EMA) and smartphone technology. We analyzed data from a subset of PMOMS participants (n=85) who were either Black or White, and who submitted EMA responses regarding stress between November 1, 2019, and August 31, 2020, the time frame of this study. We divided data into four phases based on significant events during the COVID-19 pandemic: “pre” phase (baseline), “early” phase (first case of COVID-19 reported in United States), “during” phase (stay-at-home orders), and “post” phase (stay-at-home orders eased). We assessed mean stress levels at each phase using linear mixed-effects models and post hoc contrasts based on the models. Results: Overall mean stress (0=not at all to 4=a lot) during the pre phase was 0.8 for Black and White participants (range for Black participants: 0-3.9; range for White participants: 0-2.8). There was an increase of 0.3 points (t5649=5.2, P<.001) in the during phase as compared with the pre phase, and an increase of 0.2 points (t5649=3.1, P=.002) in the post phase compared with the pre phase (n=85). No difference was found between Black and White participants in the change in mean stress from the pre phase to the during phase (overall change predicted for the regression coefficient=–0.02, P=.87). There was a significant difference between Black and White participants in the change in mean stress from the during phase to the post phase (overall change predicted for the regression coefficient=0.4, P<.001). Conclusions: There was an overall increase in mean stress levels in this subset of pregnant and postpartum participants during the same time as the emergency declarations/stay-at-home orders in the United States. Compared to baseline, mean stress levels remained elevated when stay-at-home orders eased. We found no significant difference in the mean stress levels by race. Given that stress is associated with adverse birth outcomes and postpartum health, stress induced by the ongoing COVID-19 pandemic may have adverse implications for birthing populations in the United States. International Registered Report Identifier (IRRID): RR2-10.2196/13569 
%M 34328420
%R 10.2196/30422
%U https://mental.jmir.org/2021/9/e30422
%U https://doi.org/10.2196/30422
%U http://www.ncbi.nlm.nih.gov/pubmed/34328420

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 4
%N 3
%P e30240
%T Mobile Technology Access and Use Among Adolescent Mothers in Lima, Peru: Mixed Methods Study
%A Levey,Elizabeth J
%A Onyeaka,Henry
%A Bartles,Sophia M
%A Sanchez Calderon,Elena
%A Sanchez,Sixto E
%A Prom,Maria C
%A Fesseha,Eden M
%A Gelaye,Bizu
%+ Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, 151 Merrimac St, Boston, MA, 02114, United States, 1 617 726 2000, elevey@mgh.harvard.edu
%K access to care
%K adolescent motherhood
%K LMICs
%K mobile phone
%K perinatal mental health
%K telehealth
%D 2021

%7 17.9.2021
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Research shows promise for the use of mobile health interventions to improve access to care for mothers and infants. Although adolescent mothers in particular are comfortable with technology and often face barriers to accessing care, data on the use of digital interventions with young mothers are limited. Objective: This study aims to examine technology access and use behavior among adolescent mothers in Lima, Peru, to inform the development of technology-mediated perinatal interventions for high-risk mothers and infants in low- and middle-income countries and other areas with limited access to care. Methods: This mixed methods study consisted of a phone survey about technology access (N=29), focus group discussions with clinicians (N=25), and semistructured in-depth interviews with adolescent mothers (N=10) and their family members (N=8) in Lima. Results: All adolescent mothers surveyed had access to a smartphone, and nearly half had access to a computer or tablet. However, participants reported a number of obstacles to consistent smartphone access related to the financial precarity of their situations. Examples of this included difficulty affording phone services, using shared plans, and losing smartphones because of theft. Conclusions: These findings indicate that adolescent mothers are connected to technology, highlighting the potential scalability of technology-based health interventions for adolescent mothers in low- and middle-income countries while identifying barriers that need to be addressed. 
%M 34533473
%R 10.2196/30240
%U https://pediatrics.jmir.org/2021/3/e30240
%U https://doi.org/10.2196/30240
%U http://www.ncbi.nlm.nih.gov/pubmed/34533473

%0 Journal Article
        
%@ 2368-7959
%I JMIR Publications
%V 8
%N 9
%P e26188
%T A Social Media Group Cognitive Behavioral Therapy Intervention to Prevent Depression in Perinatal Youth: Stakeholder Interviews and Intervention Design
%A Gewali,Anupa
%A Lopez,Alana
%A Dachelet,Kristin
%A Healy,Elise
%A Jean-Baptiste,Marimirca
%A Harridan,Holly
%A Evans,Yolanda
%A Unger,Jennifer A
%A Bhat,Amritha
%A Tandon,Darius
%A Ronen,Keshet
%+ Department of Global Health, University of Washington, 3980 15th Ave NE, Seattle, WA, , United States, 1 206 685 4363, keshet@uw.edu
%K depression
%K mental health
%K perinatal
%K pregnancy
%K postpartum
%K adolescent
%K youth
%K social media
%K group
%K mobile phone
%D 2021

%7 15.9.2021
%9 Original Paper
%J JMIR Ment Health
%G English
                
%X Background: Adolescents and young adults aged <25 years (youth) are at a higher risk of perinatal depression than older adults, and they experience elevated barriers to in-person care. Digital platforms such as social media offer an accessible avenue to deliver group cognitive behavioral therapy (CBT) to perinatal youth. Objective: We aim to develop the Interactive Maternal Group for Information and Emotional Support (IMAGINE) intervention, a facilitated social media group CBT intervention to prevent perinatal depression in youth in the United States, by adapting the Mothers and Babies (MB) course, an evidence-based in-person group CBT intervention. In this study, we report perspectives of youth and health care providers on perinatal youths’ mental health needs and document how they informed IMAGINE design. Methods: We conducted 21 semistructured in-depth individual interviews with 10 pregnant or postpartum youths aged 14-24 years and 6 health care workers. All interviews were recorded, transcribed, and analyzed using deductive and inductive approaches to characterize perceptions of challenges and facilitators of youth perinatal mental health. Using a human-centered design approach, stakeholder perspectives were incorporated into the IMAGINE design. We classified MB adaptations to develop IMAGINE according to the Framework for Modification and Adaptation, reporting the nature, timing, reason, and goal of the adaptations. Results: Youth and health care workers described stigma associated with young pregnancy and parenting, social isolation, and lack of material resources as significant challenges to youth mental wellness. They identified nonjudgmental support, peer companionship, and access to step-by-step guidance as facilitators of youth mental wellness. They endorsed the use of a social media group to prevent perinatal depression and recommended that IMAGINE facilitate peer support, deliver content asynchronously to accommodate varied schedules, use a confidential platform, and facilitate the discussion of topics beyond the MB curriculum, such as navigating support resources or asking medical questions. IMAGINE was adapted from MB to accommodate stakeholder recommendations and facilitate the transition to web-based delivery. Content was tailored to be multimodal (text, images, and video), and the language was shortened and simplified. All content was designed for asynchronous engagement, and redundancy was added to accommodate intermittent access. The structure was loosened to allow the intervention facilitator to respond in real time to topics of interest for youth. A social media platform was selected that allows multiple conversation channels and conceals group member identity. All adaptations sought to preserve the fidelity of the MB core components. Conclusions: Our findings highlight the effect of stigmatization of young pregnancy and social determinants of health on youth perinatal mental health. Stakeholders supported the use of a social media group to create a supportive community and improve access to evidence-based depression prevention. This study demonstrates how a validated intervention can be tailored to this unique group. 
%M 34524086
%R 10.2196/26188
%U https://mental.jmir.org/2021/9/e26188
%U https://doi.org/10.2196/26188
%U http://www.ncbi.nlm.nih.gov/pubmed/34524086

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 9
%P e30367
%T Adapting to the Pandemic: Protocol of a Web-Based Perinatal Health Study to Improve Maternal and Infant Outcomes
%A Tzilos Wernette,Golfo
%A Countryman,Kristina
%A Mmeje,Okeoma
%A Ngo,Quyen M
%A Zlotnick,Caron
%+ Department of Family Medicine, University of Michigan Medical School, 1018 Fuller Street, Ann Arbor, MI, 48104, United States, 1 17349987120, gtzilos@med.umich.edu
%K COVID-19
%K pregnancy
%K COVID-19 pandemic
%K alcohol use
%K drug use
%K sexually transmitted infections
%K technology-delivered interventions
%D 2021

%7 10.9.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The identification of interconnected health risks during the perinatal period offers an opportunity to prevent negative maternal and infant health outcomes. Marijuana, opioid, and other substance use during pregnancy is a rapidly growing public health concern with significant and costly health consequences for the woman and the developing fetus. Pregnant persons who misuse substances are disproportionately more likely to engage in risky sexual behaviors resulting in sexually transmitted infections (STIs), which are on the rise in this population and can lead to adverse effects on maternal health and on fetal development. Objective: Our goal is to continue testing an innovative and low-cost technology-delivered intervention, the Health Check-Up for Expectant Moms (HCEM), which simultaneously targets alcohol and drug use and STI risk during pregnancy, both of which are on the rise during the COVID-19 pandemic. Methods: We describe the ways in which we have adapted the web-based HCEM intervention to continue recruitment and study enrollment during the pandemic. Results: Study recruitment, visits, and participant safety assessments were all successfully modified during the initial year of the COVID-19 pandemic. Compared to in-person recruitment that occurred prepandemic, remote recruitment yielded a greater proportion of women enrolled in the study (83/136, 61.0% vs 43/52, 83%) in a shorter period (12 months vs 7 months). Conclusions: Despite study challenges related to the pandemic, including time and effort adapting to a remote protocol, remote recruitment and visits for this study were found to constitute a successful approach. Trial Registration: ClinicalTrials.gov NCT03826342; https://clinicaltrials.gov/ct2/show/NCT03826342 International Registered Report Identifier (IRRID): DERR1-10.2196/30367 
%M 34351867
%R 10.2196/30367
%U https://www.researchprotocols.org/2021/9/e30367
%U https://doi.org/10.2196/30367
%U http://www.ncbi.nlm.nih.gov/pubmed/34351867

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 9
%P e28600
%T Optimizing the Periconception Lifestyle of Women With Overweight Using a Blended Personalized Care Intervention Combining eHealth and Face-to-face Counseling (eFUSE): Protocol for a Randomized Controlled Trial
%A van der Windt,Melissa
%A Schoenmakers,Sam
%A Willemsen,Sten
%A van Rossem,Lenie
%A Steegers-Theunissen,Régine
%+ Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Wytemaweg 80, Rotterdam, 3015 CN, Netherlands, 31 107036815, r.steegers@erasmusmc.nl
%K eHealth
%K periconception period
%K lifestyle intervention
%K maternal and child health
%K pregnancy
%K birth outcomes
%K healthy lifestyle
%K psychotherapy
%K obesity
%K randomized controlled trial
%K behavior change
%D 2021

%7 3.9.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Maternal overweight has a substantial impact on reproductive, maternal, pregnancy, and neonatal outcomes with long-term and transgenerational health consequences. Interventions that aim to optimize periconception maternal lifestyle can improve maternal and fetal health during pregnancy and throughout the life course. However, it remains difficult to change and adopt adequate lifestyle behaviors. We hypothesize that additional psychological therapy targeting cognitive and affective factors substantially contribute to the effectiveness of these interventions. Objective: The proposed study aims to examine the feasibility and effectiveness of a blended personalized periconception lifestyle care intervention with additional psychological therapy aimed at women with a BMI≥25 and who are contemplating pregnancy or are already pregnant (≤12 weeks) in reducing inadequate lifestyle behaviors and improving early and late pregnancy outcome. Methods: The eHealth and Face-to-face Counseling (eFUSE) study follows a single-center two-arm randomized controlled trial design at the Erasmus MC, University Medical Center, with a multicenter regional referral. The female patients with overweight (BMI≥25), together with their male partner, will be stratified by pregnancy status (preconception vs pregnant) and randomized to receive either the blended personalized periconception lifestyle care intervention with additional psychological therapy (n=313) or usual care (n=313). The primary outcome is a change in the lifestyle risk score (between baseline and 24 weeks) between the randomization arms (difference in differences). Secondary outcomes include measurements defined as most relevant by the International Consortium for Health Outcomes Measurement, including behavioral determinants, patient satisfaction, provider feasibility, and maternal pregnancy and neonatal complications. Results: The study will be open for recruitment from Fall 2021 onward. Data collection is expected to be completed by the beginning of 2023, and the results are expected to be published by Fall 2023. Conclusions: This study will evaluate the feasibility and effectiveness of a blended periconception lifestyle intervention with additional psychological therapy, aimed at women with a BMI≥25. Positive results of this innovative care approach will be used for implementation in routine medical care of all women with overweight, with the ultimate aim to improve clinical outcomes of these high-risk pregnancies. Trial Registration: Netherlands Trial Register NL9264; https://www.trialregister.nl/trial/9264 International Registered Report Identifier (IRRID): PRR1-10.2196/28600 
%M 34477561
%R 10.2196/28600
%U https://www.researchprotocols.org/2021/9/e28600
%U https://doi.org/10.2196/28600
%U http://www.ncbi.nlm.nih.gov/pubmed/34477561

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 23
%N 8
%P e26786
%T The Influence of Web-Based Tools on Maternal and Neonatal Outcomes in Pregnant Adolescents or Adolescent Mothers: Mixed Methods Systematic Review
%A Wu,Jania J Y
%A Ahmad,Nurulhuda
%A Samuel,Miny
%A Logan,Susan
%A Mattar,Citra N Z
%+ Department of Obstetrics and Gynaecology, National University of Singapore, 1E Kent Ridge Rd, Singapore, Singapore, 65 67722672, citramattar@nus.edu.sg
%K pregnancy in adolescence
%K teenagers
%K adolescents
%K pregnancy
%K postpartum
%K internet
%K digital health
%K digital media
%K new digital media
%K eHealth
%K social media
%K social network
%K communications media
%D 2021

%7 26.8.2021
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Pregnant adolescent women increasingly seek support during pregnancy and the puerperium through digital platforms instead of the traditional support system of family, friends, and the community. However, it is uncertain whether digital, web-based tools are reliable and effective in providing information to the user on a variety of topics such as fetal development, pregnancy outcomes, delivery, and breastfeeding to improve maternal and infant outcomes. Objective: We aimed to identify web-based tools designed to promote knowledge, attitudes, and skills of pregnant adolescents or adolescent mothers and determine the efficacy of such web-based tools compared with conventional resources in promoting good pregnancy and infant outcomes. Methods: A systematic search was conducted using Medline, Scopus, CINAHL, and PsycINFO for articles published from January 2004 to November 2020 to identify randomized trials and observational studies that evaluated digital, web-based platforms to deliver resources to pregnant adolescents. All articles written in the author’s languages were included. Two authors independently reviewed abstracts and full-text articles for inclusion and assessed study quality. Risk of bias in each study was assessed using appropriate tools recommended by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) and the Joanna Briggs Institute. We adopted a qualitative synthesis and presented the results in a narrative format due to the heterogenous nature of the studies. Results: Seven articles met the inclusion criteria and were analyzed. The majority of the studies were graded to be of low to moderate risk for bias. The research methodologies represented were varied, ranging from randomized (n=1) and nonrandomized controlled trials (n=1) and prospective cohort studies (n=1) to mixed methods studies (n=1) and longitudinal surveys (n=3). Four studies included active web-based interventions, and 3 described exposure to web-based tools, including the use of social media and/or other internet content. Web-based tools positively influenced treatment-seeking intentions (intervention 17.1%, control 11.5%, P=.003) and actual treatment-seeking behavior for depression among postpartum adolescents (intervention 14.1%, control 6.5%, P<.001). In contrast, readily available information on the internet may leave adolescents with increased anxiety. The critical difference lies in information curated by health care professionals specifically to address targeted concerns versus self-acquired data sourced from various websites. Conclusions: Despite almost universal web use, few studies have used this platform for health promotion and disease prevention. Social media interventions or web-based tools have the potential to positively influence both maternal and infant outcomes in adolescent pregnancy, but there is a need for more well-conducted studies to demonstrate the effectiveness of these support programs. The vastness of the information available on the web limits the ability of health care professionals to monitor or control sources of information sought by patients. Thus, it is important to create professionally curated platforms to prevent or limit exposure to potentially misleading or harmful information on the internet while imparting useful knowledge to the user. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020195854; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=195854 
%M 34435961
%R 10.2196/26786
%U https://www.jmir.org/2021/8/e26786
%U https://doi.org/10.2196/26786
%U http://www.ncbi.nlm.nih.gov/pubmed/34435961

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 8
%P e25425
%T Mobile Apps as Audience-Centered Health Communication Platforms
%A Mackert,Michael
%A Mandell,Dorothy
%A Donovan,Erin
%A Walker,Lorraine
%A Henson-García,Mike
%A Bouchacourt,Lindsay
%+ Stan Richards School of Advertising and Public Relations, The University of Texas at Austin, 300 W Dean Keeton St, Austin, TX, 78712, United States, 1 512 348 8490, mackert@utexas.edu
%K health communication
%K mHealth
%K mobile apps
%K mobile health
%K prenatal health
%K pregnancy
%K audience-centered
%D 2021

%7 17.8.2021
%9 Viewpoint
%J JMIR Mhealth Uhealth
%G English
                
%X Health communication campaigns often suffer from the shortcomings of a limited budget and limited reach, resulting in a limited impact. This paper suggests a shift of these campaigns to audience-centered communication platforms—particularly, apps on mobile phones. By using a common platform, multiple interventions and campaigns can combine resources and increase user engagement, resulting in a larger impact on health behavior. Given the widespread use of mobile phones, mobile apps can be an effective and efficient tool to provide health interventions. One such platform is Father’s Playbook, a mobile app designed to encourage men to be more involved during their partner’s pregnancy. Health campaigns and interventions looking to reach expectant fathers can use Father’s Playbook as a vehicle for their messages.
%M 34402797
%R 10.2196/25425
%U https://mhealth.jmir.org/2021/8/e25425
%U https://doi.org/10.2196/25425
%U http://www.ncbi.nlm.nih.gov/pubmed/34402797

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 8
%P e28148
%T Effect of Preconception Care Intervention on Maternal Nutritional Status and Birth Outcome in a Low-Resource Setting: Proposal for a Nonrandomized Controlled Trial
%A Swain,Dharitri
%A Begum,Jasmina
%A Parida,Swayam Prangnan
%+ College of Nursing, All India Institute of Medical Sciences, Sijua, Dumduma, Bhubaneswar, 751019, India, 91 94 38884272, dhari79@yahoo.co.in
%K preconception care
%K maternal nutritional status
%K birth outcome
%K paternal preconception health
%K childbirth
%K birth outcomes
%K maternal and child health
%K maternal health
%K maternal and child nutrition
%K health education
%K pediatrics
%D 2021

%7 16.8.2021
%9 Proposal
%J JMIR Res Protoc
%G English
                
%X Background: The provision of preconception care approaches such as maternal assessments and education on healthy lifestyle (including physical activity, nutrition, and dietary supplements such as folic acid), general and sexual health, avoidance of high-risk behavior, and immunizations has been shown to identify and reduce the risk of adverse birth outcomes through appropriate management and preventive measures. Objective: The goal of the study is to determine the effect of an integrated preconception care intervention on delivery outcomes, which is a novel challenge for lowering unfavorable birth outcomes in India’s low-resource setting. The main objectives are to investigate the relationship of birth outcomes to both maternal and paternal preconception health and determine the effect of preconception care intervention on improvement of maternal nutritional status and reduction of the risk of adverse birth outcomes such as prematurity, low birth weight, and maternal and neonatal complications. Methods: A nonrandomized controlled trial design will be used for comparing 2 groups: preconception care with a standard maternal health care (MHC) program and an integrated MHC program (without preconception care). Two rural field areas of Khordha district, Odisha, will be selected for conducting the study. The study will enroll 782 married women between the ages of 18 and 35 years with their spouses, with 391 women in each group. The couples will receive preconception care based on their health circumstances, and they will be followed up at 3-month intervals before pregnancy. Following pregnancy, they will be followed up for 8 prenatal monitoring and care visits as well as 6 weeks after delivery as part of the standard MCH program. The preconception care intervention package includes couples counseling, contraceptive education and distribution, sex education, lifestyle modification, and nutritional supplementation of iron and folic acid, along with multivitamins if needed. Results: The proposal was approved by the institutional ethical committee for conducting the study in June 2020 (Ref No: T/EMF/Nursing/20/6). Participants were enrolled in phase 1 in April 2021, phase 2 of offering preconception services will begin in August 2021, and study outcomes will be measured from 2023 to 2024. Conclusions: Through preconception care and counseling, the eligible couples will recognize, embrace, and implement the actions to improve their preconception health. Finally, it is expected that maternal and paternal health will have a significant impact on enhancing maternal nutritional status and birth outcomes. Trial Registration: Clinical Trials Registry–India CTRI/2021/04/032836; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=48239&EncHid=&userName=CTRI/2021/04/032836 International Registered Report Identifier (IRRID): PRR1-10.2196/28148 
%M 34398798
%R 10.2196/28148
%U https://www.researchprotocols.org/2021/8/e28148
%U https://doi.org/10.2196/28148
%U http://www.ncbi.nlm.nih.gov/pubmed/34398798

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 23
%N 8
%P e29151
%T Gaps and Future Challenges of Italian Apps for Pregnancy and Postnatal Care: Systematic Search on App Stores
%A Brunelli,Laura
%A De Vita,Chiara
%A Cenedese,Fabrizio
%A Cinello,Michela
%A Paris,Marta
%A Samogizio,Francesca
%A Starec,Anja
%A Bava,Michele
%A Dal Cin,Margherita
%A Zanchiello,Sara
%A Stampalija,Tamara
%+ Department of Medical, Surgical and Health Sciences, University of Trieste, Via dell'Istria, 65, Trieste, 34137, Italy, 39 0432554768, laura.brunelli@phd.units.it
%K pregnancy
%K postnatal care
%K app
%K mHealth
%K mobile health
%K newborn
%D 2021

%7 10.8.2021
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Despite the availability of thousands of health apps worldwide, when considering those addressing children’s first 1000 days of life, most apps fail to consider the continuity between the prenatal and postnatal stages, and their joint impact on maternal and child health. The reliability, quality, and effectiveness of these apps are largely unknown, and the provided content seems questionable in terms of completeness, updating, and trustworthiness. Objective: This study evaluates available Italian pregnancy and postnatal care apps to highlight the main gaps to be overcome and the resulting future challenges to be met in this mobile health–related field. Methods: A systematic search was conducted on the Apple App Store and Google Play Store, and basic information was collected for all identified apps. After deduplication and further selection based on the exclusion criteria, an in-depth analysis of each app was performed by two researchers independently. A 71-item six-domain questionnaire about the desirable features of apps was used to assess information, functionalities, and technical features, while the Mobile Application Rating Scale (MARS) was employed for app quality evaluation. Results: From an initial sample of 684 apps, 22 were deeply analyzed. Most apps did not fulfill the expectations, as just one achieved 50% of all desirable aspects. Postnatal care and counselling for both the mother and child was the least accomplished domain. Moreover, the quality of app information was generally rated more negatively than the quality of their functionality and esthetic features. The lacking aspects were information about methods for postpartum family planning and birth spacing (1/22, 5%) and immunization (2/22, 9%). Conclusions: The identified gaps could serve as a basis for designing and implementing increasingly high-quality, targeted, and effective apps for pregnancy and postnatal health care, which provide comprehensive, reliable, and evidence-based information, as well as appropriate esthetic and functional characteristics, with relevant implications in terms of maternal and newborn health prevention and promotion. 
%M 34383668
%R 10.2196/29151
%U https://www.jmir.org/2021/8/e29151
%U https://doi.org/10.2196/29151
%U http://www.ncbi.nlm.nih.gov/pubmed/34383668

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 8
%P e28156
%T Effect of Community-Based Kangaroo Mother Care Package on Neonatal Mortality Among Preterm and Low Birthweight Infants in Rural Pakistan: Protocol for a Cluster Randomized Controlled Trial
%A Ariff,Shabina
%A Habib,Atif
%A Memon,Zahid
%A Arshad,Tayyaba
%A Samejo,Tariq
%A Maznani,Ikram
%A Umer,Muhammad
%A Hussain,Amjad
%A Rizvi,Arjumand
%A Ahmed,Imran
%A Soofi,Sajid Bashir
%A Bhutta,Zulfiqar A
%+ Center of Excellence in Women & Child Health, Aga Khan University, Stadium Road, P.O. Box 350​0, Karachi, 7480​0, Pakistan, 92 2134864798, zulfiqar.bhutta@aku.edu
%K community kangaroo mother care
%K low birth weight
%K KMC champions
%K neonatal mortality
%K RCT protocol
%K Pakistan
%D 2021

%7 10.8.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Neonatal mortality due to preterm birth and low birthweight remains a significant challenge in Pakistan. Kangaroo mother care (KMC) is a unique, low-cost intervention proven to reduce neonatal mortality and morbidity and increase exclusive breastfeeding rates. However, KMC has not been attempted in community settings in Pakistan. We aim to implement and evaluate the effectiveness of a community-based KMC package to reduce neonatal morbidity and mortality among preterm and low birthweight (LBW) infants, which will provide evidence for policy development and the large-scale implementation of KMC across the country. Objective: The primary objective of this trial is to reduce neonatal mortality among preterm and LBW infants. The secondary objectives are growth (measured as weight gain), reduced incidence of possible serious bacterial infection, and increased exclusive breastfeeding and continued breastfeeding practices. Methods: We designed a community-based cluster randomized controlled trial in one rural district of Pakistan. Stable, LBW babies (weighing 1200 grams to 2500 grams) are included in the study. The community KMC package, consisting of the KMC kit, information and counseling material, and community mobilization through KMC champions (village volunteers), was designed after preliminary research in the same geographical location and implemented in intervention clusters. The standard essential newborn care is offered in the control clusters. Infants are recruited and followed up by independent teams of data collectors. Data are collected on the duration of skin-to-skin contact, growth, breastfeeding practices, morbidities, neonatal mortality, and neurodevelopment status. Data analysis will be conducted based on the intention to treat principle. The Cox regression model will be used to assess the primary outcome of neonatal mortality. The secondary outcomes will be evaluated using linear or logistic regression. Results: The Ethics Review Committee of Aga Khan University, Pakistan, approved the study protocol in February 2017. Data collection began in August 2019 and will be completed in December 2021. Data analyses are yet to be completed. Conclusions: This intervention may be effective in preventing sepsis and subsequently improve survival in LBW newborns in Pakistan and other low-income and middle-income countries worldwide. Trial Registration: clinicaltrials.gov NCT03545204; https://clinicaltrials.gov/ct2/show/NCT03545204 International Registered Report Identifier (IRRID): DERR1-10.2196/28156 
%M 34170839
%R 10.2196/28156
%U https://www.researchprotocols.org/2021/8/e28156
%U https://doi.org/10.2196/28156
%U http://www.ncbi.nlm.nih.gov/pubmed/34170839

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 8
%P e28855
%T Design of the Maternal Website EMAeHealth That Supports Decision-Making During Pregnancy and in the Postpartum Period: Collaborative Action Research Study
%A Artieta-Pinedo,Isabel
%A Paz-Pascual,Carmen
%A Bully,Paola
%A Espinosa,Maite
%A ,
%+ Osakidetza-Basque Health Service, Biocruces-Bizkaia Health Research Institute, Osi Barakaldo-Sestao, Lurkizaga S/N, Barakaldo, 48901, Spain, 34 946006667, misabel.artieta@ehu.eus
%K prenatal education
%K women
%K patient decision aid
%K decision-making
%K clinical decision support systems
%K action research and pregnancy
%K implementation science
%K health service needs and demands
%D 2021

%7 9.8.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Despite the benefit maternal education has for women, it needs new tools to increase its effectiveness and scope, in tune with the needs of current users. Objective: We attempted to develop a multifunctional personalized eHealth platform aimed at the self-management of health in relation to maternity, which can be considered a flexible and adaptable maternal education tool. Methods: The International Patient Decision Aid Standards (IPDAS) were applied. A website prototype was developed for implementation in the public health system using a collaborative action research process, in which experts and patients participate, with qualitative research techniques, as well as focus groups, prioritization, and consensus techniques. Results: We have proposed a website that includes (1) systematically updated information related to clinical practice guidelines, (2) interaction between peers and users/professionals, (3) instruments for self-assessment of health needs as a basis for working on counseling, agreement on actions, help in the search for resources, support in decision-making, and monitoring and evaluation of results, and (4) access for women to their clinical data and the option of sharing the data with other health agents. These components, with different access requirements, would be reviewed through iterative cycles depending on the frequency and effectiveness resulting from their use and would be accessible from any digital device. Conclusions: A website that supports maternal education should contain not only information, but also resources for individual attention and social support. Its usefulness for the health and satisfaction of women should be evaluated in various different environments. 
%M 34383670
%R 10.2196/28855
%U https://formative.jmir.org/2021/8/e28855
%U https://doi.org/10.2196/28855
%U http://www.ncbi.nlm.nih.gov/pubmed/34383670

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 8
%P e24112
%T Mobile Health for Smoking Cessation Among Disadvantaged Young Women During and After Pregnancy: User-Centered Design and Usability Study
%A Derksen,Marloes E
%A Jaspers,Monique WM
%A van Strijp,Sander
%A Fransen,Mirjam P
%+ Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 20 5664494, m.e.derksen@amsterdamumc.nl
%K think aloud
%K heuristic evaluation
%K usability
%K mHealth
%K game elements
%K smoking prevention
%K user-centered design
%K mobile phone
%D 2021

%7 4.8.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged women. Mobile health (mHealth) apps with game and social support elements seem promising to support smoking cessation. Objective: This study aims to describe the user-centered design and usability evaluation of Kindle, an mHealth app with game and social support elements, to support disadvantaged young women during and after pregnancy through the first stages of smoking cessation. Methods: Disadvantaged women (n=9), members of their social networks (n=4), and nurses supporting these women (n=51) were informants throughout the iterative prototype development of Kindle according to the International Organization for Standardization 9241-11:2018. Specific phases included understanding the context of use through secondary analysis of qualitative interview data (phase 1), establishing the user and organizational requirements (phase 2), production of design solutions (phase 3), and usability inspection of the prototype through a heuristic evaluation (3 experts) along with user testing by a think aloud method (5 disadvantaged women and 5 nurses; phase 4). Usability problems were categorized according to the principles of the Healthcare Information and Management Systems Society. Results: Phase 1 resulted in an understanding of the VoorZorg program and the needs of VoorZorg nurses and clients (eg, focus on early stages of change and building new supportive networks to aid clients in smoking cessation). In phase 2, we established requirements (n=22; eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring at early stages of change in smoking cessation). Phase 3 resulted in a prototype of Kindle, combining the interface for nurses and clients, including the following functionalities: personal goal setting with earning points; secured chat function between nurses and other clients; and tips, diary, and profile creation. The heuristic evaluation and thinking aloud method in phase 4 revealed 78 usability problems in the interfaces. Most usability problems concerned simplicity (eg, unclear clickable button) and naturalness (eg, unclear icon). Conclusions: The user-centered design and usability testing of the mHealth app Kindle yielded useful insights. The involvement of end users, specifically socioeconomically disadvantaged women during and after their pregnancy, resulted in a prototype that met their needs and requirements (eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring to the early stages of change in smoking cessation) to achieve readiness for smoking cessation. Moreover, the usability evaluation by end users and experts revealed unique usability problems for this population. These insights allow for further optimization of Kindle and encourage future studies to engage disadvantaged populations in all phases of mHealth intervention design and usability testing. 
%M 34346895
%R 10.2196/24112
%U https://formative.jmir.org/2021/8/e24112
%U https://doi.org/10.2196/24112
%U http://www.ncbi.nlm.nih.gov/pubmed/34346895

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 7
%P e28680
%T Pregnant Women’s Attitudes Toward and Experiences With a Tablet Intervention to Promote Safety Behaviors in a Randomized Controlled Trial: Qualitative Study
%A Walter,Bente
%A Indreboe,Hege
%A Lukasse,Mirjam
%A Henriksen,Lena
%A Garnweidner-Holme,Lisa
%+ Department of Nursing and Health Promotion, Oslo Metropolitan University, St Olavs Plass, PO Box 4, Oslo, 0130, Norway, 47 +4748091956, lgarnwei@oslomet.no
%K intimate partner violence
%K eHealth
%K pregnancy
%K antenatal care, safety behaviors
%K tablet intervention
%D 2021

%7 20.7.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Intimate partner violence (IPV) is recognized as a global health problem. Women with low education and limited resources are more vulnerable, as are immigrant women. There is a lack of evidence on how health care professionals should communicate about and intervene against IPV during pregnancy. Earlier research has shown that when women manage digital questionnaires, they are more likely to disclose IPV. However, little is known about how women experience eHealth interventions with safety behaviors to prevent IPV. Objective: The aim of this study was to explore pregnant women’s attitudes toward and experiences with a tablet intervention to promote safety behaviors in a randomized controlled trial (RCT) in antenatal care. Methods: Individual semistructured interviews were conducted with 10 women who participated in the Safe Pregnancy Study. The Safe Pregnancy Study was a randomized controlled trial (RCT) using a tablet intervention containing IPV questions and a film to promote safety behaviors. Six women from the intervention group and four women from the control group were recruited. The content was available in Norwegian, Somali, and Urdu. Five of the women participating in the interviews spoke Norwegian at home and five spoke another language. The majority of the women who did not speak Norwegian at home perceived themselves as relatively well integrated. The interviews were conducted at different maternal and child health centers (MCHCs) in Norway between March 2020 and June 2020. The analysis was guided by thematic analysis. Results: Women who participated in the tablet intervention appreciated being asked questions about IPV on a tablet. However, it was important to supplement the tablet intervention with face-to-face communication with a midwife. The MCHC was regarded as a suitable place to answer questions and watch a film about safety behaviors. Women suggested making the tablet intervention available in other settings where women meet health care professionals. Some women expressed uncertainty about their anonymity regarding their answers in the questionnaire. We found no real differences between ethnic Norwegian and immigrant women’s attitudes toward and experiences with the tablet intervention. Conclusions: Questions about IPV and a film about safety behaviors on a tablet, as a supplement to face-to-face communication, might initiate and facilitate communication about IPV in antenatal care. Uncertainty regarding anonymity has to be addressed when questions about IPV are being asked on a tablet. Trial Registration: ClinicalTrials.gov NCT03397277; https://clinicaltrials.gov/ct2/show/NCT03397277 
%M 34283023
%R 10.2196/28680
%U https://formative.jmir.org/2021/7/e28680
%U https://doi.org/10.2196/28680
%U http://www.ncbi.nlm.nih.gov/pubmed/34283023

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 4
%N 3
%P e27733
%T Changes in Anxiety and Stress Among Pregnant Women During the COVID-19 Pandemic: Content Analysis of a Japanese Social Question-and-Answer Website
%A Shirabe,Ritsuko
%A Okuhara,Tsuyoshi
%A Yokota,Rie
%A Okada,Hiroko
%A Goto,Eiko
%A Kiuchi,Takahiro
%+ Department of Health Communication, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 3 5800 9754, rshirabe-tky@umin.ac.jp
%K anxiety
%K content analysis
%K COVID-19
%K health communication
%K health information
%K mental health
%K pregnancy
%K social question-and-answer website
%K social support
%K stress
%D 2021

%7 15.7.2021
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: The changing pattern of anxiety and stress experienced by pregnant women during the COVID-19 pandemic is unknown. Objective: We aimed to examine the sources of anxiety and stress in pregnant women in Japan during the COVID-19 pandemic. Methods: We performed content analysis of 1000 questions posted on the largest social website in Japan (Yahoo! Chiebukuro) from January 1 to May 25, 2020 (end date of the national state of emergency). The Gwet AC1 coefficient was used to verify interrater reliability. Results: A total 12 categories were identified. Throughout the study period, anxiety related to going outdoors appeared most frequent, followed by anxiety regarding employment and infection among family and friends. Following the declaration of the state of national emergency at the peak of the infection, infection-related anxiety decreased, whereas anxiety about social support and mood disorders increased. Stress regarding relationships appeared frequent throughout the pandemic. Conclusions: The sources of anxiety and stress in pregnant women in Japan changed during the pandemic. Our results suggest the need for rapid communications in the early phase of a pandemic as well as long-term psychosocial support to provide optimal support to pregnant women in Japan. Health care professionals should understand the changing pattern of requirements among pregnant women. 
%M 34156962
%R 10.2196/27733
%U https://pediatrics.jmir.org/2021/3/e27733
%U https://doi.org/10.2196/27733
%U http://www.ncbi.nlm.nih.gov/pubmed/34156962

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 6
%P e24353
%T Virtual Engagement in a Social Media Community of Mothers With Substance Use Disorders: Content Analysis
%A Mazel,Shayna
%A Zisman-Ilani,Yaara
%A Hennig,Shannon
%A Garnick,Deborah
%A Nicholson,Joanne
%+ Heller School for Social Policy and Management, Brandeis University, 415 South Street, Mailstop 035, Waltham, MA, 02454-9110, United States, 1 (781) 736 3820, mazel@brandeis.edu
%K virtual engagement
%K virtual community participation
%K social media
%K mental health
%K opioids
%K substance use
%D 2021

%7 24.6.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Co-occurring substance use disorder is common among pregnant and parenting women with mental illness, but their engagement with and utilization of relevant services and treatment is low. Social media has the potential to convey benefits and facilitate engagement among this target group. Objective: This study aimed to explore the reach and engagement of specific social media posts among pregnant women and mothers with substance use disorders. Methods: Eighteen posts providing content related to substance use (cannabis, opioids, or alcohol), varying in type of content (informational or experiential) and target (policy-, practice-, or perception-related), were posted in a closed Facebook community page comprising over 33,000 pregnant women and mothers between May 2019 and October 2019. Results: The overall level of reach of these Facebook posts ranged from 453 to 3045 community members. Engagement levels, measured via the number of likes, comments, or posts shared, varied based on the type of post content (ie, informational or experiential). Conclusions: Participation in a virtual community via social media platforms can facilitate engagement among pregnant women and mothers with mental illness by communicating relevant information about substance use, as well as potentially promoting awareness of, access to, and engagement with treatment services. 
%M 34184993
%R 10.2196/24353
%U https://formative.jmir.org/2021/6/e24353/
%U https://doi.org/10.2196/24353
%U http://www.ncbi.nlm.nih.gov/pubmed/34184993

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 6
%P e29208
%T Assessing the Pregnancy Protective Impact of Scheduled Nonadherence to a Novel Progestin-Only Pill: Protocol for a Prospective, Multicenter, Randomized, Crossover Study
%A Edelman,Alison
%A Hemon,Agnes
%A Creinin,Mitchell
%A Borensztein,Pascale
%A Scherrer,Bruno
%A Glasier,Anna
%+ Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson, UHN 50, Portland, OR, 97239, United States, 1 503 418 2585, edelmana@ohsu.edu
%K protocol
%K missed pill
%K progestin-only pills
%K contraception
%K pharmacokinetics
%D 2021

%7 8.6.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Progestin-only contraceptive pills (POP) are commonly reserved for women with medical comorbidities but in actuality, POPs can be safely used by anyone wanting to prevent pregnancy. This wide safety profile makes them an ideal candidate for being available over the counter without a prescription, but adherence issues may be more common with over-the-counter use. We need a better understanding of the ability of POPs to prevent pregnancy when adherence issues occur in the form of a missed or delayed pill. Objective: This study aims to determine cervical mucus characteristics following a 6-hour delayed pill intake or after one missed pill as compared to typical daily use of norgestrel 75 mcg. Methods: This prospective, multicenter, randomized, crossover study assesses the effect of norgestrel 75 mcg (Opill) on cervical mucus and ovarian activity during reported compliant daily use, after a 6-hour delayed intake mid cycle, and after a mid-cycle missed pill. Subject participation will last approximately 4.5 months. We will recruit at 2 US sites: Oregon Health & Science University, Portland, Oregon and University of California Davis Health, Sacramento, California. Reproductive-aged subjects with regular menstrual cycles (21-35 days), BMI <32 kg/m2, and proven ovulation (screening luteal phase progesterone >3 ng/mL [>10 nmol/L]) are eligible to enroll. Participants cannot be at risk for pregnancy during the study period and not use other hormonal methods. Norgestrel 75 mcg will be taken at the same time daily except for one day in each of treatment periods 2 and 3, when the pill will be taken either 6 hours late (delayed pill) or omitted completely (missed pill). Every 3-4 days, we will monitor subjects for follicular activity with transvaginal ultrasound (TVUS) examination, cervical mucus, and blood sampling for ovarian hormones and gonadotropins. Subjects will undergo serial cervical mucus sampling on the days with missed and delayed pill intake at 8 hours after pill intake on the day before the delayed or missed pill, 3 hours following the scheduled time of pill intake if intake was delayed, 6 hours after the scheduled time if intake was omitted, and on the next day 30 minutes before the time of scheduled pill intake. The primary objective of the study is to determine the effect of a delayed or omitted pill intake on cervical mucus characteristics based on a modified Insler score compared to reported daily use. Results: Our protocol was successfully approved by a central institutional review board (Advarra, Columbia, MD), received ethical approval on March 23, 2018, and was registered with ClinicalTrials.gov (NCT03585712). As of January 2020, the study completed enrollment of 52 subjects. Analyses are pending. Conclusions: Our protocol was approved by a central review board, and study procedures were successfully executed with completed proposed enrollment. Trial Registration: ClinicalTrials.gov NCT03585712; https://clinicaltrials.gov/ct2/show/NCT03585712 International Registered Report Identifier (IRRID): DERR1-10.2196/29208 
%M 33970869
%R 10.2196/29208
%U https://www.researchprotocols.org/2021/6/e29208
%U https://doi.org/10.2196/29208
%U http://www.ncbi.nlm.nih.gov/pubmed/33970869

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 23
%N 6
%P e28856
%T Reliable Prediction Models Based on Enriched Data for Identifying the Mode of Childbirth by Using Machine Learning Methods: Development Study
%A Ullah,Zahid
%A Saleem,Farrukh
%A Jamjoom,Mona
%A Fakieh,Bahjat
%+ Department of Computer Sciences, College of Computer and Information Sciences, Princess Nourah Bint Abdulrahman University, PO Box 84428, Riyadh, 11671, Saudi Arabia, 966 505273052, mmjamjoom@pnu.edu.sa
%K machine learning
%K prediction model
%K health care
%K cesarean
%K delivery
%K decision making
%D 2021

%7 4.6.2021
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: The use of artificial intelligence has revolutionized every area of life such as business and trade, social and electronic media, education and learning, manufacturing industries, medicine and sciences, and every other sector. The new reforms and advanced technologies of artificial intelligence have enabled data analysts to transmute raw data generated by these sectors into meaningful insights for an effective decision-making process. Health care is one of the integral sectors where a large amount of data is generated daily, and making effective decisions based on these data is therefore a challenge. In this study, cases related to childbirth either by the traditional method of vaginal delivery or cesarean delivery were investigated. Cesarean delivery is performed to save both the mother and the fetus when complications related to vaginal birth arise. Objective: The aim of this study was to develop reliable prediction models for a maternity care decision support system to predict the mode of delivery before childbirth. Methods: This study was conducted in 2 parts for identifying the mode of childbirth: first, the existing data set was enriched and second, previous medical records about the mode of delivery were investigated using machine learning algorithms and by extracting meaningful insights from unseen cases. Several prediction models were trained to achieve this objective, such as decision tree, random forest, AdaBoostM1, bagging, and k-nearest neighbor, based on original and enriched data sets. Results: The prediction models based on enriched data performed well in terms of accuracy, sensitivity, specificity, F-measure, and receiver operating characteristic curves in the outcomes. Specifically, the accuracy of k-nearest neighbor was 84.38%, that of bagging was 83.75%, that of random forest was 83.13%, that of decision tree was 81.25%, and that of AdaBoostM1 was 80.63%. Enrichment of the data set had a good impact on improving the accuracy of the prediction process, which supports maternity care practitioners in making decisions in critical cases. Conclusions: Our study shows that enriching the data set improves the accuracy of the prediction process, thereby supporting maternity care practitioners in making informed decisions in critical cases. The enriched data set used in this study yields good results, but this data set can become even better if the records are increased with real clinical data. 
%M 34085938
%R 10.2196/28856
%U https://www.jmir.org/2021/6/e28856
%U https://doi.org/10.2196/28856
%U http://www.ncbi.nlm.nih.gov/pubmed/34085938

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 5
%P e24108
%T Using Social Media for Qualitative Health Research in Danish Women of Reproductive Age: Online Focus Group Study on Facebook
%A Temmesen,Camilla Gry
%A Nielsen,Henriette Svarre
%A Andersen,Heidi Lene Myglegård
%A Birch Petersen,Kathrine
%A Clemensen,Jane
%+ Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3, Odense, 5000, Denmark, 45 26215135, ctemmesen@health.sdu.dk
%K internet
%K social media
%K Facebook
%K online focus groups
%K women
%K reproduction
%K reproductive age
%K motherhood
%K participatory design
%D 2021

%7 31.5.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Social media platforms provide new possibilities within health research. With Facebook being the largest social network in the world, it constitutes a potential platform for recruitment and data collection from women of reproductive age. Women in Denmark and in other Western countries postpone motherhood and risk infertility due to their advanced age when they try to conceive. To date, no study has explored Danish women’s reflections on the timing of motherhood within a social media setting. Objective: The aim of this study was to explore the challenges and opportunities of using Facebook as a platform for qualitative health research in Danish women of reproductive age. Methods: This study was a qualitative study based on 3 online focus groups on Facebook with 26 Danish women of reproductive age discussing the timing of motherhood in January 2020. Results: Conducting online focus groups on Facebook was successful in this study as the web-based approach was found suitable for developing qualitative data with women of reproductive age and made recruitment easy and free of charge. All participants found participating in an online focus group to be a positive experience. More than half of the women participating in the online focus groups found it advantageous to meet on Facebook instead of meeting face-to-face. Conclusions: Conducting online focus groups on Facebook is a suitable method to access qualitative data from women of reproductive age. Participants were positive toward being a part of an online focus group. Online focus groups on social media have the potential to give women of reproductive age a voice in the debate of motherhood. 
%M 34057418
%R 10.2196/24108
%U https://formative.jmir.org/2021/5/e24108
%U https://doi.org/10.2196/24108
%U http://www.ncbi.nlm.nih.gov/pubmed/34057418

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 5
%P e17189
%T Acceptability of the Pregnancy, Exercise, and Nutrition Research Study With Smartphone App Support (PEARS) and the Use of Mobile Health in a Mixed Lifestyle Intervention by Pregnant Obese and Overweight Women: Secondary Analysis of a Randomized Controlled Trial
%A Greene,Ellen M
%A O'Brien,Eileen C
%A Kennelly,Maria A
%A O'Brien,Orna A
%A Lindsay,Karen L
%A McAuliffe,Fionnuala M
%+ UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Dublin 2, Ireland, 353 637 3216, fionnuala.mcauliffe@ucd.ie
%K pregnancy
%K mHealth
%K nutrition
%K lifestyle
%K acceptability
%K app
%K mobile phone
%D 2021

%7 12.5.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Dietary interventions can improve pregnancy outcomes among women with increased BMI. Although the interest in mobile health interventions is growing, little is known about the acceptability of smartphone apps to support lifestyle interventions in such a cohort. Objective: We aimed to assess the acceptability of the pregnancy, exercise, and nutrition research study with smartphone app support (PEARS) and the use of mobile health in a mixed lifestyle intervention delivered to overweight and obese pregnant women. Methods: PEARS was a randomized controlled trial of a low glycemic index dietary intervention with exercise prescription and a smartphone app, which was delivered to pregnant women who were overweight or obese. Acceptability questionnaires were completed by the intervention group at 28 weeks of gestation (n=149) and at postintervention (n=123). Maternal characteristics were recorded (ie, age, ethnicity, BMI, socioeconomic status). Associations between maternal characteristics and acceptability of the intervention and app were analyzed using two-tailed t tests, Mann-Whitney U tests, chi-square test, and logistic regression. One-on-one semistructured interviews were conducted with a subcohort of the intervention participants (n=28) at 34 weeks of gestation, in which the participants shared their experiences of the PEARS intervention. Results: The intervention was generally accepted, with respondents agreeing that the diet was easy to follow (98/148, 68.5%), enjoyable (106/148, 74.1%), and affordable (110/148, 76.9%). Qualitative and quantitative results were consistent with each another, both demonstrating that app acceptability was high. The participants agreed that the app was enjoyable (96/120, 80.0%) and easy to use (116/119, 97.5%). Compared to those with tertiary education, those with lower education levels were more likely to enjoy the dietary changes (P=.04). Enjoyment of the app was associated with disadvantaged neighborhood deprivation index (P=.01) and higher BMI (P=.03). Conclusions: The PEARS intervention and use of a supportive smartphone app were accepted by pregnant women, particularly by those from vulnerable subgroups of this population. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 29316280; https://www.isrctn.com/ISRCTN29316280 
%M 33978597
%R 10.2196/17189
%U https://mhealth.jmir.org/2021/5/e17189
%U https://doi.org/10.2196/17189
%U http://www.ncbi.nlm.nih.gov/pubmed/33978597

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 4
%N 2
%P e16280
%T Leveraging Digital Technology in Conducting Longitudinal Research on Mental Health in Pregnancy: Longitudinal Panel Survey Study
%A McGee,Beth
%A Leonte,Marie
%A Wildenhaus,Kevin
%A Wilcox,Marsha
%A Reps,Jenna
%A LaCross,Lauren
%+ BabyCenter, LLC, 163 Freelon St, San Francisco, CA, 94107, United States, 1 415 237 9990, bethannmcgee@gmail.com
%K digital
%K longitudinal
%K pregnancy
%K postpartum
%K perinatal
%K panel
%K study design
%K mental health
%D 2021

%7 27.4.2021
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Collecting longitudinal data during and shortly after pregnancy is difficult, as pregnant women often avoid studies with repeated surveys. In contrast, pregnant women interact with certain websites at multiple stages throughout pregnancy and the postpartum period. This digital connection presents the opportunity to use a website as a way to recruit and enroll pregnant women into a panel study and collect valuable longitudinal data for research. These data can then be used to learn new scientific insights and improve health care. Objective: The objective of this paper is to describe the approaches applied and lessons learned from designing and conducting an online panel for health care research, specifically perinatal mood disorders. Our panel design and approach aimed to recruit a large sample (N=1200) of pregnant women representative of the US population and to minimize attrition over time. Methods: We designed an online panel to enroll participants from the pregnancy and parenting website BabyCenter. We enrolled women into the panel from weeks 4 to 10 of pregnancy (Panel 1) or from weeks 28 to 33 of pregnancy (Panel 2) and administered repeated psychometric assessments from enrollment through 3 months postpartum. We employed a combination of adaptive digital strategies to recruit, communicate with, and build trust with participants to minimize attrition over time. We were transparent at baseline about expectations, used monetary and information-based incentives, and sent personalized reminders to reduce attrition. The approach was participant-centric and leveraged many aspects of flexibility that digital methods afford. Results: We recruited 1179 pregnant women—our target was 1200—during a 26-day period between August 25 and September 19, 2016. Our strategy to recruit participants using adaptive sampling tactics resulted in a large panel that was similar to the US population of pregnant women. Attrition was on par with existing longitudinal observational studies in pregnant populations, and 79.2% (934/1179) of our panel completed another survey after enrollment. There were 736 out of 1179 (62.4%) women who completed at least one assessment in both the prenatal and postnatal periods, and 709 out of 1179 (60.1%) women who completed the final assessment. To validate the data, we compared participation rates and factors of perinatal mood disorders ascertained from this study with prior research, suggesting reliability of our approach. Conclusions: A suitably designed online panel created in partnership with a digital media source that reaches the target audience is a means to leverage a conveniently sized and viable sample for scientific research. Our key lessons learned are as follows: sampling tactics may need to be adjusted to enroll a representative sample, attrition can be reduced by adapting to participants’ needs, and study engagement can be boosted by personalizing interactions with the flexibility afforded by digital technologies. 
%M 33904826
%R 10.2196/16280
%U https://pediatrics.jmir.org/2021/2/e16280
%U https://doi.org/10.2196/16280
%U http://www.ncbi.nlm.nih.gov/pubmed/33904826

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 4
%P e26477
%T Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection (PROUDEST Trial): Protocol for a Multicenter, Prospective Cohort Study
%A Fernandes,Geraldo Magela
%A Motta,Felipe
%A Sasaki,Lizandra Moura Paravidine
%A Silva,Ângelo Pereira Da
%A Miranda,Andreza Monforte
%A Carvalho,Aleida Oliveira De
%A Gomides,Ana Paula Monteiro
%A Soares,Alexandre Anderson De Sousa Munhoz
%A Santos Jr,Agenor De Castro Moreira Dos
%A Alves,Caroline De Oliveira
%A Gomes,Ciro Martins
%A Siracusa,Clara Correia De
%A Araújo Jr,David Alves De
%A Mendonça-Silva,Dayde Lane
%A Jesus,José Alfredo Lacerda De
%A Costa,Karina Nascimento
%A Castro,Maria Eduarda Canellas De
%A Kurizky,Patricia Shu
%A França,Paulo Sérgio
%A Tristão,Rosana
%A Pereira,Yacara Ribeiro
%A Castro,Luiz Claudio Gonçalves De
%A Zaconeta,Alberto Moreno
%A Albuquerque,Cleandro Pires De
%A Mota,Licia Maria Henrique Da
%+ Faculty of Medicine, University of Brasília, Campus Universitário Darcy Ribeiro, UNB Área 1 - Asa Norte, Brasília - DF, 70910-900, Brazil, 55 61981070071, geraldomafer@gmail.com
%K SARS-CoV-2
%K COVID-19
%K pregnancy
%K neonate
%K children
%K outcome
%K development
%K prospective
%K cohort
%K women
%K fetus
%K baby
%K implication
%D 2021

%7 20.4.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: A growing body of evidence suggests that SARS-COV-2 infection during pregnancy may affect maternal-fetal outcomes and possibly result in implications for the long-term development of SARS-CoV-2–exposed children. Objective: The PROUDEST (Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection Study) is a multicenter, prospective cohort study designed to elucidate the repercussions of COVID-19 for the global health of mothers and their children. Methods: The PROUDEST trial comprises 2 prospective, sequential substudies. The PREGNANT substudy will clinically assess the effects of SARS-CoV-2 infection on pregnancy, childbirth, and puerperium from a mechanistic standpoint to elucidate the pregnancy-related inflammatory and immunological phenomena underlying COVID-19. Pregnant women aged 18-40 years who have been exposed (proven with laboratory tests) to SARS-CoV-2 (group A; n=300) will be compared to control subjects with no laboratory evidence of in-pregnancy exposure to the virus (group B; n=300). Subjects exposed to other infections during pregnancy will be excluded. The BORN substudy is a long-term follow-up study that will assess the offspring of women who enrolled in the prior substudy. It will describe the effects of SARS-CoV-2 exposure during pregnancy on children’s growth, neurodevelopment, and metabolism from birth up to 5 years of age. It includes two comparison groups; group A (exposed; n=300) comprises children born from SARS-CoV-2–exposed pregnancies, and group B (controls; n=300) comprises children born from nonexposed mothers. Results: Recruitment began in July 2020, and as of January 2021, 260 pregnant women who were infected with SARS-CoV-2 during pregnancy and 160 newborns have been included in the study. Data analysis is scheduled to start after all data are collected. Conclusions: Upon completion of the study, we expect to have comprehensive data that will provide a better understanding of the effects of SARS-CoV-2 infection and related inflammatory and immunological processes on pregnancy, puerperium, and infancy. Our findings will inform clinical decisions regarding the care of SARS-CoV-2–exposed mothers and children and support the development of evidence-based public health policies. Trial Registration: Brazilian Register of Clinical Trials RBR65QXS2; https://ensaiosclinicos.gov.br/rg/RBR-65qxs2 International Registered Report Identifier (IRRID): DERR1-10.2196/26477 
%M 33793409
%R 10.2196/26477
%U https://www.researchprotocols.org/2021/4/e26477
%U https://doi.org/10.2196/26477
%U http://www.ncbi.nlm.nih.gov/pubmed/33793409

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 4
%P e27382
%T Development and Implementation of a Mobile Tool for High-Risk Pregnant Women to Deliver Effective Caregiving for Neonatal Abstinence Syndrome: Protocol for a Mixed Methods Study
%A Burduli,Ekaterina
%A Jones,Hendrée E
%A Brooks,Olivia
%A Barbosa-Leiker,Celestina
%A Johnson,Ron Kim
%A Roll,John
%A McPherson,Sterling Marshall
%+ College of Nursing, Washington State University, 412 E Spokane Falls Blvd, Spokane, WA, 99202, United States, 1 509 324 7368, eburduli@wsu.edu
%K neonatal abstinence syndrome
%K opioid use disorder
%K mHealth
%K maternal child outcomes
%D 2021

%7 15.4.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The United States continues to experience an alarming rise in opioid use that includes women who become pregnant and related neonatal abstinence syndrome (NAS) in newborns. Most newborns experiencing NAS require nonpharmacological care, which entails, most importantly, maternal involvement with the newborn. To facilitate positive maternal-newborn interactions, mothers need to learn effective caregiving NAS strategies when they are pregnant; however, an enormous gap exists in the early education of mothers on the symptoms and progression of NAS, partly because no education, training, or other interventions exist to prepare future mothers for the challenges of caring for their newborns at risk for NAS. Objective: In this paper, we describe a mixed methods, multistage study to adapt an existing mobile NAS tool for high-risk pregnant women and assess its usability, acceptability, and feasibility in a small randomized controlled trial. Methods: Stage 1 will include 20 semistructured interviews with a panel of neonatology experts, NAS care providers, and mothers with experience caring for NAS-affected newborns to gather their recommendations on the management of NAS and explore their perspectives on the care of these newborns. The findings will guide the adaptation of existing mobile NAS tools for high-risk pregnant women. In stage 2, we will test the usability, acceptability, and feasibility of the adapted mobile tool via surveys with 10 pregnant women receiving opioid agonist therapy (OAT). Finally, in stage 3, we will randomize 30 high-risk pregnant women receiving OAT to either receive the adapted mobile NAS caregiving tool or usual care. We will compare these women on primary outcomes—maternal drug relapse and OAT continuation—and secondary outcomes—maternal-newborn bonding; length of newborn hospital stays; readmission rates; breastfeeding initiation and duration; and postpartum depression and anxiety at 4, 8, and 12 weeks postpartum. Results: This project was funded in July 2020 and approved by the institutional review board in April 2020. Data collection for stage 1 began in December 2020, and as of January 2021, we completed 18 semistructured interviews (10 with NAS providers and 8 with perinatal women receiving OAT). Common themes from all interviews will be analyzed in spring 2021 to inform the adaptation of the NAS caregiving tool. The results from stage 1 are expected to be published in summer 2021. Stage 2 data collection will commence in fall 2021. Conclusions: The findings of this study have the potential to improve NAS care and maternal-newborn outcomes and lead to commercialized product development. If effective, our new tool will be well suited to tailoring for other high-risk perinatal women with substance use disorders. Trial Registration: ClinicalTrials.gov NCT04783558; https://clinicaltrials.gov/ct2/show/NCT04783558 International Registered Report Identifier (IRRID): DERR1-10.2196/27382 
%M 33856360
%R 10.2196/27382
%U https://www.researchprotocols.org/2021/4/e27382
%U https://doi.org/10.2196/27382
%U http://www.ncbi.nlm.nih.gov/pubmed/33856360

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 4
%N 2
%P e24579
%T Impact of a Face-To-Face Versus Smartphone App Versus Combined Breastfeeding Intervention Targeting Fathers: Randomized Controlled Trial
%A Scott,Jane Anne
%A Burns,Sharyn K
%A Hauck,Yvonne L
%A Giglia,Roslyn C
%A Jorgensen,Anita M
%A White,Becky Kate
%A Martin,Annegret
%A Robinson,Suzanne
%A Dhaliwal,Satvinder S
%A Binns,Colin W
%A Maycock,Bruce R
%+ School of Population Health, Curtin University, Kent Street, Bentley, Perth, Australia, 61 040 413 0489, jane.scott@curtin.edu.au
%K breastfeeding
%K fathers
%K peer support
%K mHealth, smartphone app
%K infants
%K social support
%K feeding
%K smartphone
%D 2021

%7 12.4.2021
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Despite the recognized health and economic benefits of exclusive breastfeeding, few Australian infants are exclusively breastfed beyond 5 months of age. Social support for breastfeeding, in particular the support of an infant’s father, has been identified as a crucial element for successful breastfeeding. Objective: The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. Methods: The study was a 4-arm, factorial, randomized controlled trial conducted in Perth, Australia. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions. Expecting couples were recruited from hospital-based antenatal classes and block randomized to 1 of the 4 arms. Each partner completed surveys at recruitment and at 6 weeks and 26 weeks postpartum. Primary outcomes were duration of exclusive and any breastfeeding. Secondary outcomes included age of introduction of formula and complementary foods, maternal breastfeeding self-efficacy, and partner postpartum support. Results: A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers. Conclusions: This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000605695 International Registered Report Identifier (IRRID): RR2-10.1186/s12884-015-0601-5 
%M 33843604
%R 10.2196/24579
%U https://pediatrics.jmir.org/2021/2/e24579
%U https://doi.org/10.2196/24579
%U http://www.ncbi.nlm.nih.gov/pubmed/33843604

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 4
%P e23649
%T Quality, Features, and Presence of Behavior Change Techniques in Mobile Apps Designed to Improve Physical Activity in Pregnant Women: Systematic Search and Content Analysis
%A Hayman,Melanie
%A Alfrey,Kristie-Lee
%A Cannon,Summer
%A Alley,Stephanie
%A Rebar,Amanda L
%A Williams,Susan
%A Short,Camille E
%A Altazan,Abby
%A Comardelle,Natalie
%A Currie,Sinead
%A Denton,Caitlin
%A Harrison,Cheryce L
%A Lamerton,Tayla
%A Mena,Gabriela P
%A Moran,Lisa
%A Mottola,Michelle
%A Nagpal,Taniya S
%A Vincze,Lisa
%A Schoeppe,Stephanie
%+ School of Health, Medical and Applied Sciences, CQUniversity, Bruce Highway, Rockhampton, 4701, Australia, 61 49306912 ext 56912, m.j.hayman@cqu.edu.au
%K pregnancy
%K exercise
%K physical activity
%K mobile health (mHealth)
%K applications
%K MARS
%K behavior change techniques
%K mobile phone
%D 2021

%7 7.4.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Physical activity during pregnancy is associated with several health benefits for the mother and child. However, very few women participate in regular physical activity during pregnancy. eHealth platforms (internet and mobile apps) have become an important information source for pregnant women. Although the use of pregnancy-related apps has significantly increased among pregnant women, very little is known about their theoretical underpinnings, including their utilization of behavior change techniques (BCTs). This is despite research suggesting that inclusion of BCTs in eHealth interventions are important for promoting healthy behaviors, including physical activity. Objective: The aim of this study was to conduct a systematic search and content analysis of app quality, features, and the presence of BCTs in apps designed to promote physical activity among pregnant women. Methods: A systematic search in the Australian App Store and Google Play store using search terms relating to exercise and pregnancy was performed. App quality and features were assessed using the 19-item Mobile App Rating Scale (MARS), and a taxonomy of BCTs was used to determine the presence of BCTs (26 items). BCTs previously demonstrating efficacy in behavior changes during pregnancy were also identified from a literature review. Spearman correlations were used to investigate the relationships between app quality, app features, and number of BCTs identified. Results: Nineteen exercise apps were deemed eligible for this review and they were accessed via Google Play (n=13) or App Store (n=6). The MARS overall quality scores indicated moderate app quality (mean 3.5 [SD 0.52]). Functionality was the highest scoring MARS domain (mean 4.2 [SD 0.5]), followed by aesthetics (mean 3.7 [SD 0.6]) and information quality (mean 3.16 [SD 0.42]). Subjective app quality (mean 2.54 [SD 0.64]) and likelihood for behavioral impact (mean 2.5 [SD 0.6]) were the lowest scoring MARS domains. All 19 apps were found to incorporate at least two BCTs (mean 4.74, SD 2.51; range 2-10). However, only 11 apps included BCTs that previously demonstrated efficacy for behavior change during pregnancy, the most common being provide opportunities for social comparison (n=8) and prompt self-monitoring of behavior (n=7). There was a significant positive correlation between the number of BCTs with engagement and aesthetics scores, but the number of BCTs was not significantly correlated with functionality, information quality, total MARS quality, or subjective quality. Conclusions: Our findings showed that apps designed to promote physical activity among pregnant women were functional and aesthetically pleasing, with overall moderate quality. However, the incorporation of BCTs was low, with limited prevalence of BCTs previously demonstrating efficacy in behavior change during pregnancy. Future app development should identify and adopt factors that enhance and encourage user engagement, including the use of BCTs, especially those that have demonstrated efficacy for promoting physical activity behavior change among pregnant women. 
%M 33825693
%R 10.2196/23649
%U https://mhealth.jmir.org/2021/4/e23649
%U https://doi.org/10.2196/23649
%U http://www.ncbi.nlm.nih.gov/pubmed/33825693

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 3
%P e18935
%T Mapping Evidence of Neonatal Resuscitation Training on the Practices of Unskilled Birth Attendants in Low-Resource Countries: Protocol for a Scoping Review
%A Olaniyi,Adenike Adebola
%A Ncama,Busisiwe Purity
%A Amod,Hafaza
%+ School of Nursing and Public Health, College of Health Sciences, University of Kwazulu-Natal, 238 Mazisi Kunene Rd, Durban, South Africa, 27 633580128, nikyniyi2007@yahoo.com
%K neonatal resuscitation
%K newborn
%K neonatal
%K low- and middle-resource countries
%K training
%K birth
%K infant
%K baby
%K obstetrics
%K protocol
%K review
%D 2021

%7 31.3.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Competence in neonatal resuscitation of the newborn is very critical to ensure the safety and well-being of newborn infants. The acquisition of neonatal resuscitation skills by birth attendants improves self-efficacy, thereby reducing neonatal mortality as a result of asphyxia. Approximately one-quarter of all neonatal deaths globally are caused by birth asphyxia. The need for neonatal resuscitation is most imperative in resource-constrained settings, where access to intrapartum obstetric care is inadequate. Objective: This protocol describes the methodology of a scoping review on evidence of training in neonatal resuscitation and its association with practice in low-resource countries. The aim of the review is to map the available evidence of neonatal resuscitation training on the practices of unskilled birth attendants. Methods: The scoping review will use the Population, Concept, and Context (PCC) framework proposed by Arksey and O’Malley, refined by Levac et al, and published by Joanna Briggs Institute, while following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The search strategy was developed with the assistance of the college librarian. A number of databases of peer-reviewed research (PsycINFO and Wiley Online Library [via EBSCOhost], PubMed, MEDLINE with full text, Google Scholar [via ScienceDirect], and CINAHL Plus with full text [via EBSCOhost]) and databases committed to grey literature sources will be searched, and reference extraction will be performed. Two independent reviewers will screen and extract data, and discrepancies will be resolved by a third reviewer. The extracted data will undergo a descriptive analysis of contextual data and a quantitative analysis using appropriate statistical methods. Results: Data relating to neonatal resuscitation training and practices in low-resource settings will be extracted and included for analysis. We expect that the review will be completed 12 months from the publication of this protocol. Conclusions: This scoping review will focus on the review of evidence and provide an insight into the existing literature to guide further research and identify implementation strategies to improve the practices of unskilled birth attendants through the acquisition of skills and self-efficacy in neonatal resuscitation. The results of this review will be presented at relevant conferences related to newborn and child health and neonatal nursing studies and published in a peer-reviewed journal. International Registered Report Identifier (IRRID): DERR1-10.2196/18935 
%M 33787506
%R 10.2196/18935
%U https://www.researchprotocols.org/2021/3/e18935
%U https://doi.org/10.2196/18935
%U http://www.ncbi.nlm.nih.gov/pubmed/33787506

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 23
%N 3
%P e18517
%T Attitudes and Engagement of Pregnant and Postnatal Women With a Web-Based Emotional Health Tool (Mummatters): Cross-sectional Study
%A Reilly,Nicole
%A Austin,Marie-Paule
%+ Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, Building 234 (iC Enterprise 1), Innovation Campus, Wollongong, 2522, Australia, 61 0242218045, nreilly@uow.edu.au
%K pregnancy
%K postpartum
%K self-assessment
%K depression
%K risk
%D 2021

%7 26.3.2021
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Mummatters is a web-based health tool that allows women to self-assess the symptoms of depression and the presence of psychosocial risk factors throughout pregnancy and the postnatal period. It aims to increase women’s awareness of their own symptoms or risk factors and their knowledge of the available support options, to encourage engagement with these support options (as appropriate), and to facilitate communication about emotional health issues between women and their health care providers. Objective: The aim of this study is to report the uptake of mummatters; the sociodemographic and psychosocial risk profiles of a subsample of users; and the acceptability, credibility, perceived effect, and motivational appeal of the tool. The help-seeking behaviors of the subsample of users and barriers to help seeking were also examined. Methods: Mummatters was launched in November 2016. Women who completed the mummatters baseline assessment were invited to complete a web-based follow-up survey 1 month later. Results: A total of 2817 women downloaded and used mummatters between November 13, 2016, and May 22, 2018, and 140 women participated in the follow-up study. Approximately half of these women (51%; 72/140) were Whooley positive (possible depression), and 43% (60/140) had an elevated psychosocial risk score on the Antenatal Risk Questionnaire. Mummatters was rated favorably by pregnant and postnatal women in terms of its acceptability (94%-99%), credibility (93%-97%), appeal (78%-91%), and potential to affect a range of health behaviors specific to supporting emotional wellness during the perinatal period (78%-93%). Whooley-positive women were more likely to speak with their families than with a health care provider about their emotional health. Normalizing symptoms and stigma were key barriers to seeking help. Conclusions: Although mummatters was rated positively by consumers, only 53% (19/36) to 61% (22/36) of women with possible depression reported speaking to their health care providers about their emotional health. There was a trend for more prominent barriers to seeking help among postnatal women than among pregnant women. Future studies that investigate whether social barriers to seeking help are greater once a woman has an infant are warranted. Such barriers potentially place these women at greater risk of remaining untreated, as the demands on them are greater. 
%M 33769302
%R 10.2196/18517
%U https://www.jmir.org/2021/3/e18517
%U https://doi.org/10.2196/18517
%U http://www.ncbi.nlm.nih.gov/pubmed/33769302

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 3
%P e27196
%T Implementation of the Living Well During Pregnancy Telecoaching Program for Women at High Risk of Excessive Gestational Weight Gain: Protocol for an Effectiveness-Implementation Hybrid Study
%A de Jersey,Susan
%A Meloncelli,Nina
%A Guthrie,Taylor
%A Powlesland,Hilary
%A Callaway,Leonie
%A Chang,Angela T
%A Wilkinson,Shelley
%A Comans,Tracy
%A Eakin,Elizabeth
%+ Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Building 71/918, RBWH Herston, Brisbane, Australia, 61 424949217, susan.dejersey@health.qld.gov.au
%K implementation study
%K pregnancy
%K weight
%K nutrition
%K lifestyle intervention
%K physical activity
%D 2021

%7 18.3.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Despite comprehensive guidelines for healthy gestational weight gain (GWG) and evidence for the efficacy of dietary counseling coupled with weight monitoring on reducing excessive GWG, reporting on the effectiveness of interventions translated into routine antenatal care is limited. Objective: This study aims to implement and evaluate the Living Well during Pregnancy (LWdP) program in a large Australian antenatal care setting. Specifically, the LWdP program will be incorporated into usual care and delivered to a population of pregnant women at risk of excessive GWG through a dietitian-delivered telephone coaching service. Methods: Metrics from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework will guide the evaluation in this hybrid effectiveness-implementation study. All women aged ≥16 years without pre-exiting diabetes with a prepregnancy BMI >25 kg/m2 and gaining weight above recommendations at <20 weeks’ gestation who are referred for dietetic care during the 12-month study period will be eligible for participation. The setting is a metropolitan hospital at which approximately 6% of the national births in Australia take place each year. Eligible participants will receive up to 10 telecoaching calls during their pregnancy. Primary outcomes will be service level indicators of reach, adoption, and implementation that will be compared with a retrospective control group, and secondary effectiveness outcomes will be participant-reported anthropometric and behavioral outcomes; all outcomes will be assessed pre- and postprogram completion. Additional secondary outcomes relate to the costs associated with program implementation and pregnancy outcomes gathered through routine clinical service data. Results: Data collection of all variables was completed in December 2020, with results expected to be published by the end of 2021. Conclusions: This study will evaluate the implementation of an evidence-based intervention into routine health service delivery and will provide the practice-based evidence needed to inform decisions about its incorporation into routine antenatal care. International Registered Report Identifier (IRRID): DERR1-10.2196/27196 
%M 33734093
%R 10.2196/27196
%U https://www.researchprotocols.org/2021/3/e27196
%U https://doi.org/10.2196/27196
%U http://www.ncbi.nlm.nih.gov/pubmed/33734093

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 3
%P e26091
%T Effectiveness of a Smartphone App to Promote Healthy Weight Gain, Diet, and Physical Activity During Pregnancy (HealthyMoms): Randomized Controlled Trial
%A Sandborg,Johanna
%A Söderström,Emmie
%A Henriksson,Pontus
%A Bendtsen,Marcus
%A Henström,Maria
%A Leppänen,Marja H
%A Maddison,Ralph
%A Migueles,Jairo H
%A Blomberg,Marie
%A Löf,Marie
%+ Department of Biosciences and Nutrition, Karolinska Institutet, Group/MLÖ, Huddinge, SE-141 83, Sweden, 46 733285912, johanna.sandborg@ki.se
%K gestational weight gain
%K physical activity
%K diet
%K pregnancy
%K mHealth
%K smartphone app
%K mobile phone app
%K telemedicine
%K randomized controlled trial
%D 2021

%7 11.3.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Excessive gestational weight gain (GWG) during pregnancy is a major public health concern associated with negative health outcomes for both mother and child. Scalable interventions are needed, and digital interventions have the potential to reach many women and promote healthy GWG. Most previous studies of digital interventions have been small pilot studies or have not included women from all BMI categories. We therefore examined the effectiveness of a smartphone app in a large sample (n=305) covering all BMI categories. Objective: To investigate the effectiveness of a 6-month intervention (the HealthyMoms app) on GWG, body fatness, dietary habits, moderate-to-vigorous physical activity (MVPA), glycemia, and insulin resistance in comparison to standard maternity care. Methods: A 2-arm parallel randomized controlled trial was conducted. Women in early pregnancy at maternity clinics in Östergötland, Sweden, were recruited. Eligible women who provided written informed consent completed baseline measures, before being randomized in a 1:1 ratio to either an intervention (n=152) or control group (n=153). The control group received standard maternity care while the intervention group received the HealthyMoms smartphone app for 6 months (which includes multiple features, eg, information; push notifications; self-monitoring; and feedback features for GWG, diet, and physical activity) in addition to standard care. Outcome measures were assessed at Linköping University Hospital at baseline (mean 13.9 [SD 0.7] gestational weeks) and follow-up (mean 36.4 [SD 0.4] gestational weeks). The primary outcome was GWG and secondary outcomes were body fatness (Bod Pod), dietary habits (Swedish Healthy Eating Index) using the web-based 3-day dietary record Riksmaten FLEX, MVPA using the ActiGraph wGT3x-BT accelerometer, glycemia, and insulin resistance. Results: Overall, we found no statistically significant effect on GWG (P=.62); however, the data indicate that the effect of the intervention differed by pre-pregnancy BMI, as women with overweight and obesity before pregnancy gained less weight in the intervention group as compared with the control group in the imputed analyses (–1.33 kg; 95% CI –2.92 to 0.26; P=.10) and completers-only analyses (–1.67 kg; 95% CI –3.26 to –0.09; P=.031]). Bayesian analyses showed that there was a 99% probability of any intervention effect on GWG among women with overweight and obesity, and an 81% probability that this effect was over 1 kg. The intervention group had higher scores for the Swedish Healthy Eating Index at follow-up than the control group (0.27; 95% CI 0.05-0.50; P=.017). We observed no statistically significant differences in body fatness, MVPA, glycemia, and insulin resistance between the intervention and control group at follow up (P≥.21). Conclusions: Although we found no overall effect on GWG, our results demonstrate the potential of a smartphone app (HealthyMoms) to promote healthy dietary behaviors as well as to decrease weight gain during pregnancy in women with overweight and obesity. Trial Registration: ClinicalTrials.gov NCT03298555; https://clinicaltrials.gov/ct2/show/NCT03298555 International Registered Report Identifier (IRRID): RR2-10.2196/13011 
%M 33704075
%R 10.2196/26091
%U https://mhealth.jmir.org/2021/3/e26091
%U https://doi.org/10.2196/26091
%U http://www.ncbi.nlm.nih.gov/pubmed/33704075

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 3
%P e23994
%T Bovine Lactoferrin to Prevent Neonatal Infections in Low-Birth-Weight Newborns in Pakistan: Protocol for a Three-Arm Double-Blind Randomized Controlled Trial
%A Ariff,Shabina
%A Soofi,Sajid
%A Aamir,Almas
%A D'Almeida,Michelle
%A Aziz Ali,Arzina
%A Alam,Ashraful
%A Dibley,Michael
%+ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Rm 328, Edward Ford Building A27, New South Wales, Sydney, 2006, Australia, 61 407616500, michael.dibley@sydney.edu.au
%K bovine lactoferrin
%K low birth weight
%K sepsis
%K human milk
%K premature
%K mortality
%D 2021

%7 11.3.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Sepsis is a common and severe complication in premature neonates, particularly those born with low birth weights (<2500 g). Neonatal sepsis is steadily emerging as a leading cause of neonatal mortality in Pakistan. Lactoferrin is a natural product with broad-spectrum antimicrobial properties and glycoprotein that is actively involved in innate immune host responses. Clinical trials have revealed its protective effect on sepsis, but lactoferrin dosage, duration, and role in the prevention of sepsis are still uncertain. Objective: We aimed to establish the efficacy of bovine lactoferrin in the prevention of late-onset sepsis and to determine the optimal dose and method of administering bovine lactoferrin that may contribute to improvement in overall survival of low birth weight infants. Methods: We will implement the study in 2 phases at the Aga Khan University Hospital. The first phase, which we have completed, was formative research. This phase mainly focused on a qualitative exploration of perceptions about feeding and caring practices of low birth weight newborns and a trial of improved practices for the preparation and administration of bovine lactoferrin to newborns. The second phase is a 3-arm double-blind randomized controlled trial. In this phase, we randomly allocated 2 different daily oral prophylactic doses of bovine lactoferrin (150 mg or 300 mg) and placebo to 300 low–birth weight neonates starting within the first 72 hours of birth and continuing for the first 28 days of life. Results: The study protocol was approved by the Ethics Review Committee of Aga Khan University on August 16, 2017. Data collection began in April 2018 and was completed in September 2020. Data analyses are yet to be completed. We expect the results to be published in peer-reviewed journals by autumn of 2021. Conclusions: This intervention, if effective, has the potential to be translated into a safe, affordable, and widely utilized treatment to prevent sepsis and, subsequently, may improve the survival outcomes of low birth weight neonates in Pakistan and other low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT03431558; https://clinicaltrials.gov/ct2/show/NCT03431558 International Registered Report Identifier (IRRID): PRR1-10.2196/23994 
%M 33704071
%R 10.2196/23994
%U https://www.researchprotocols.org/2021/3/e23994
%U https://doi.org/10.2196/23994
%U http://www.ncbi.nlm.nih.gov/pubmed/33704071

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 3
%P e22771
%T Mobile App-Based Intervention for Pregnant Women With Stress Urinary Incontinence: Protocol for a Hybrid Effectiveness-Implementation Trial
%A Li,Tiantian
%A Chen,Xiaomin
%A Wang,Jia
%A Chen,Ling
%A Cai,Wenzhi
%+ Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoán District Shenzhen, Guangdong, Shenzhen, 518101, China, 86 13078484316, caiwzh@smu.edu.cn
%K mHealth
%K stress urinary incontinence
%K pregnancy
%K randomized controlled trial
%K process evaluation
%K mixed methods
%K study protocol
%D 2021

%7 10.3.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Stress urinary incontinence (SUI) is a common source of distress among women during and after pregnancy. It has a negative effect on quality of life but with poor care-seeking. Mobile health (mHealth) may be a promising solution with potential advantages. However, there is uncertainty whether a mobile app is effective for SUI symptom improvement during and after pregnancy. The implementation is also unclear. We developed an app named UIW (Urinary Incontinence for Women) aimed at improving perinatal incontinence. Objective: The objective of this study is to evaluate the effectiveness of the UIW app-based intervention in improving SUI symptoms among pregnant women and explore the facilitators and barriers to using the UIW app to help refine and optimize the intervention. Methods: This study is a hybrid effectiveness-implementation trial with a randomized controlled trial alongside a mixed-methods process evaluation according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Pregnant women with SUI (n=336) will be recruited from a university-affiliated hospital in China. They will be randomly allocated (1:1) to either the intervention group that receive usual care plus UIW app or control group that receive usual care alone. The intervention period will last 2 months. The 5 dimensions of the RE-AIM framework will be evaluated at recruitment (-T1), baseline (T0), immediately after intervention (T1), 42 days after delivery (T2), 3 months after delivery (T3), and 6 months after delivery (T4) through project documents, online questionnaires and a pelvic floor muscle training diary, surface electromyography, log data in the background management system, and qualitative interviews. Data analysis will follow the intention-to-treat principle. Descriptive statistics, t tests, chi-square tests, and a linear mixed model will be used to analyze the quantitative data. Deductive and inductive content analysis will be used to analyze the qualitative data. Results: The effectiveness-implementation trial started in June 2020, trial recruitment was completed in October 2020, and the intervention will last for a 2-month period. Completion of the 6-month follow-up will be in July 2021, and we anticipate that the results of this study will be published in December 2021. Conclusions: This study will evaluate both effectiveness and implementation of the UIW app-based intervention among pregnant women. The hybrid effectiveness-implementation trial design according to the RE-AIM framework with a mixed-methods approach will give valuable insights into the effects as well as facilitators and barriers to the implementation that will influence the effects of the UIW app-based intervention. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800016171; http://www.chictr.org.cn/showproj.aspx?proj=27455 International Registered Report Identifier (IRRID): PRR1-10.2196/22771 
%M 33688842
%R 10.2196/22771
%U https://www.researchprotocols.org/2021/3/e22771
%U https://doi.org/10.2196/22771
%U http://www.ncbi.nlm.nih.gov/pubmed/33688842

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 3
%P e26159
%T Participants’ Engagement and Satisfaction With a Smartphone App Intended to Support Healthy Weight Gain, Diet, and Physical Activity During Pregnancy: Qualitative Study Within the HealthyMoms Trial
%A Sandborg,Johanna
%A Henriksson,Pontus
%A Larsen,Erica
%A Lindqvist,Anna-Karin
%A Rutberg,Stina
%A Söderström,Emmie
%A Maddison,Ralph
%A Löf,Marie
%+ Department of Biosciences and Nutrition, Karolinska Institutet, Group/MLÖ, Huddinge, SE-141 83, Sweden, 46 733285912, johanna.sandborg@ki.se
%K pregnancy
%K gestational weight gain
%K mHealth
%K telemedicine
%K digital health
%K mobile health
%K eHealth
%K smartphone intervention
%K mobile application
%K smartphone application
%K engagement
%K physical activity
%K exercise
%K nutrition
%K diet
%K qualitative
%K thematic analysis
%D 2021

%7 5.3.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Excessive gestational weight gain (GWG) is common and associated with negative health outcomes for both mother and child. Mobile health–delivered lifestyle interventions offer the potential to mitigate excessive GWG. The effectiveness of a smartphone app (HealthyMoms) was recently evaluated in a randomized controlled trial. To explore the users’ experiences of using the app, a qualitative study within the HealthyMoms trial was performed. Objective: This qualitative study explored participants’ engagement and satisfaction with the 6-month usage of the HealthyMoms app. Methods: A total of 19 women (mean age: 31.7, SD 4.4 years; mean BMI: 24.6, SD 3.4 kg/m2; university degree attainment: 13/19, 68%; primiparous: 11/19, 58%) who received the HealthyMoms app in a randomized controlled trial completed semistructured exit interviews. The interviews were audiorecorded and fully transcribed, coded, and analyzed using thematic analysis with an inductive approach. Results: Thematic analysis revealed a main theme and 2 subthemes. The main theme, “One could suit many: a multifunctional tool to strengthen women’s health during pregnancy,” and the 2 subthemes, “Factors within and beyond the app influence app engagement” and “Trust, knowledge, and awareness: aspects that can motivate healthy habits,” illustrated that a trustworthy and appreciated health and pregnancy app that is easy to use can inspire a healthy lifestyle during pregnancy. The first subtheme discussed how factors within the app (eg, regular updates and feedback) were perceived to motivate both healthy habits and app engagement. Additionally, factors beyond the app were described to both motivate (eg, interest, motivation, and curiosity) and limit (eg, pregnancy-related complications, lack of time) app engagement. The second subtheme reflected important aspects, such as high trustworthiness of the app, increased knowledge, and awareness from using the app, which motivated participants to improve or maintain healthy habits during pregnancy. Conclusions: The HealthyMoms app was considered a valuable and trustworthy tool to mitigate excessive GWG, with useful features and relevant information to initiate and maintain healthy habits during pregnancy. Trial Registration: ClinicalTrials.gov NCT03298555; https://clinicaltrials.gov/ct2/show/NCT03298555 International Registered Report Identifier (IRRID): RR2-10.2196/13011 
%M 33666554
%R 10.2196/26159
%U https://mhealth.jmir.org/2021/3/e26159
%U https://doi.org/10.2196/26159
%U http://www.ncbi.nlm.nih.gov/pubmed/33666554

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 2
%P e23514
%T Development of a Breech-Specific Integrated Care Pathway for Pregnant Women: Protocol for a Mixed Methods Study
%A Morris,Sara
%A Geraghty,Sadie
%A Sundin,Deborah
%+ Edith Cowan University, Building 21, Level 4, Room 449, 270 Joondalup Drive, Joondalup, 6027, Australia, 61 9399 6190, s_cardona@live.com.au
%K breech presentation
%K midwifery
%K methodology
%K Delphi technique
%D 2021

%7 23.2.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The development of an integrated care pathway with multidisciplinary input to standardize and streamline care for pregnant women experiencing breech presentation at 36 or more weeks of gestation poses several challenges because of the divisive and contentious nature of the phenomenon. Although many clinicians are interested in obtaining the skills required to safely support women desiring a vaginal breech birth, the primary trend in most health care facilities is to recommend a cesarean section. Objective: This paper aims to discuss the mixed methods approach used in a doctoral study conducted to generate new knowledge regarding women’s experiences of breech birth in Western Australia and professional recommendations regarding the care of women experiencing breech presentation close to or at term. This study was designed to inform the development of an integrated care pathway for women experiencing a breech presentation. This mixed methods approach situated within the pragmatic paradigm was determined to be the optimal way for incorporating multidisciplinary recommendations with current clinical practice guidelines and consumer feedback. Methods: A mixed methods study utilizing semistructured interviews, an electronic Delphi (e-Delphi) study, and clinical practice guideline appraisal was conducted to generate new data. The interviews were designed to provide insights and understanding of the experiences of women in Western Australia who are diagnosed with a breech presentation. The e-Delphi study explored childbirth professionals’ knowledge, opinions, and recommendations for the care of women experiencing breech presentation close to or at term. The clinical practice guideline appraisal will examine the current national and professional breech management and care guidelines. This study has the potential to highlight areas in practice that may need improvement and enable clinicians to better support women through what can be a difficult time. Results: Data collection for this study began in November 2018 and concluded in March 2020. Data analysis is currently taking place, and the results will be disseminated through publication when the analysis is complete. Conclusions: The results of this study will guide the development of an integrated care pathway for women experiencing a breech presentation close to or at term, with the hope of moving toward standardized breech care for women in Western Australia. This study protocol has the potential to be used as a research framework for future studies of a similar nature. International Registered Report Identifier (IRRID): DERR1-10.2196/23514 
%M 33620329
%R 10.2196/23514
%U https://www.researchprotocols.org/2021/2/e23514
%U https://doi.org/10.2196/23514
%U http://www.ncbi.nlm.nih.gov/pubmed/33620329

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 4
%N 1
%P e25388
%T Investigation of Digital Technology Use in the Transition to Parenting: Qualitative Study
%A Donelle,Lorie
%A Hall,Jodi
%A Hiebert,Bradley
%A Jackson,Kimberley
%A Stoyanovich,Ewelina
%A LaChance,Jessica
%A Facca,Danica
%+ Arthur Labatt Family School of Nursing, Faculty of Health Science, Western University, FNB Rm. 2356, 1115 Richmond St., London, ON, N6A 5B9, Canada, 1 5196612111 ext 86565, ldonelle@uwo.ca
%K parenting
%K digital health
%K technology
%K health literacy
%K information seeking
%D 2021

%7 17.2.2021
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: The transition to parenting—that is, the journey from preconception through pregnancy and postpartum periods—is one of the most emotionally charged and information-intense times for individuals and families. While there is a developing body of literature on the use and impact of digital technology on the information behaviors of children, adolescents, and young adults, personal use of digital technology during the transition to parenting and in support of infants to 2 years of age is relatively understudied. Objective: The purpose of this study was to enhance our understanding of the ways digital technologies contribute to the experience of the transition to parenting, particularly the role these technologies play in organizing and structuring emerging pregnancy and early parenting practices. Methods: A qualitative descriptive study was conducted to understand new parents’ experiences with and uses of digital technology during 4 stages—prenatal, pregnancy, labor, and postpartum—of their transition to becoming a new parent. A purposive sampling strategy was implemented using snowball sampling techniques to recruit participants who had become a parent within the previous 24 months. Focus groups and follow-up interviews were conducted using semistructured interview guides that inquired about parents’ type and use of technologies for self and family health. Transcribed audio recordings were thematically analyzed. Results: A total of 10 focus groups and 3 individual interviews were completed with 26 participants. While recruitment efforts targeted parents of all genders and sexual orientations, all participants identified as heterosexual women. Participants reported prolific use of digital technologies to direct fertility (eg, ovulation timing), for information seeking regarding development of their fetus, to prepare for labor and delivery, and in searching for a sense of community during postpartum. Participants expressed their need for these technologies to assist them in the day-to-day demands of preparing for and undertaking parenting, yet expressed concerns about their personal patterns of use and the potential negative impacts of their use. The 3 themes generated from the data included: “Is this normal; is this happening to you?!”, “Am I having a heart attack; what is this?”, and “Anyone can put anything on Wikipedia”: Managing the Negative Impacts of Digital Information. Conclusions: Digital technologies were used by mothers to track menstrual cycles during preconception; monitor, document, and announce a pregnancy during the prenatal stage; prepare for delivery during labor/birth stage; and to help babies sleep, document/announce their birth, and connect to parenting resources during the postpartum stage. Mothers used digital technologies to reassure themselves that their experiences were normal or to seek help when they were abnormal. Digital technologies provided mothers with convenient means to access health information from a range of sources, yet mothers were apprehensive about the credibility and trustworthiness of the information they retrieved. Further research should seek to understand how men and fathers use digital technologies during their transition to parenting. Additionally, further research should critically examine how constant access to information affects mothers’ perceived need to self-monitor and further understand the unintended health consequences of constant surveillance on new parents. 
%M 33595440
%R 10.2196/25388
%U https://pediatrics.jmir.org/2021/1/e25388
%U https://doi.org/10.2196/25388
%U http://www.ncbi.nlm.nih.gov/pubmed/33595440

%0 Journal Article
        
%@ 2368-7959
%I JMIR Publications
%V 8
%N 2
%P e24162
%T Intentions to Seek Mental Health Services During the COVID-19 Pandemic Among Chinese Pregnant Women With Probable Depression or Anxiety: Cross-sectional, Web-Based Survey Study
%A Wang,Qian
%A Song,Bo
%A Di,Jiangli
%A Yang,Xue
%A Wu,Anise
%A Lau,Joseph
%A Xin,Meiqi
%A Wang,Linhong
%A Mo,Phoenix Kit-Han
%+ Center for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, JC School of Public Health and Primary Care, Room 508, 30-32 Ngan Shing St, Hong Kong, Hong Kong, 852 22528765, phoenix.mo@cuhk.edu.hk
%K pregnant women
%K COVID-19
%K depression
%K anxiety
%K help-seeking
%K mental health services
%K social support
%K trust
%K intention
%K mental health
%K pregnancy
%K survey
%D 2021

%7 11.2.2021
%9 Original Paper
%J JMIR Ment Health
%G English
                
%X Background: Mental health problems are prevalent among pregnant women, and it is expected that their mental health will worsen during the COVID-19 pandemic. Furthermore, the underutilization of mental health services among pregnant women has been widely documented. Objective: We aimed to identify factors that are associated with pregnant women’s intentions to seek mental health services. We specifically assessed pregnant women who were at risk of mental health problems in mainland China. Methods: A web-based survey was conducted from February to March, 2020 among 19,515 pregnant women who were recruited from maternal health care centers across various regions of China. A subsample of 6248 pregnant women with probable depression (ie, those with a score of ≥10 on the 9-item Patient Health Questionnaire) or anxiety (ie, those with a score of ≥5 on the 7-item General Anxiety Disorder Scale) was included in our analysis. Results: More than half (3292/6248, 52.7%) of the participants reported that they did not need mental health services. Furthermore, 28.3% (1770/6248) of participants felt that they needed mental health services, but had no intentions of seeking help, and only 19% (1186/6248) felt that they needed mental health services and had intentions of seek help. The results from our multivariate logistic regression analysis showed that age, education level, and gestational age were factors of not seeking help. However, COVID-19–related lockdowns in participants’ cities of residence, social support during the COVID-19 pandemic, and trust in health care providers were protective factors of participants’ intentions to seek help from mental health services. Conclusions: Interventions that promote seeking help for mental health problems among pregnant women should also promote social support from health care providers and trust between pregnant women and their care providers. 
%M 33570500
%R 10.2196/24162
%U http://mental.jmir.org/2021/2/e24162/
%U https://doi.org/10.2196/24162
%U http://www.ncbi.nlm.nih.gov/pubmed/33570500

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 2
%P e19243
%T Attitudes Toward a Proposed GPS-Based Location Tracking Smartphone App for Improving Engagement in HIV Care Among Pregnant and Postpartum Women in South Africa: Focus Group and Interview Study
%A Clouse,Kate
%A Phillips,Tamsin K
%A Mogoba,Phepo
%A Ndlovu,Linda
%A Bassett,Jean
%A Myer,Landon
%+ Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN, 37240, United States, 1 (615) 343 5351, kate.clouse@vanderbilt.edu
%K HIV/AIDS
%K South Africa
%K smartphone
%K mobile health
%K pregnancy
%K GPS tracking
%D 2021

%7 8.2.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Peripartum women living with HIV in South Africa are at high risk of dropping out of care and are also a particularly mobile population, which may impact their engagement in HIV care. With the rise in mobile phone use worldwide, there is an opportunity to use smartphones and GPS location software to characterize mobility in real time. Objective: The aim of this study was to propose a smartphone app that could collect individual GPS locations to improve engagement in HIV care and to assess potential users’ attitudes toward the proposed app. Methods: We conducted 50 in-depth interviews (IDIs) with pregnant women living with HIV in Cape Town and Johannesburg, South Africa, and 6 focus group discussions (FGDs) with 27 postpartum women living with HIV in Cape Town. Through an open-ended question in the IDIs, we categorized “positive,” “neutral,” or “negative” reactions to the proposed app and identified key quotations. For the FGD data, we grouped the text into themes, then analyzed it for patterns, concepts, and associations and selected illustrative quotations. Results: In the IDIs, the majority of participants (76%, 38/50) responded favorably to the proposed app. Favorable comments were related to the convenience of facilitated continued care, a sense of helpfulness on the part of the researchers and facilities, and the difficulties of trying to maintain care while traveling. Among the 4/50 participants (8%) who responded negatively, their comments were primarily related to the individual’s responsibility for their own health care. The FGDs revealed four themes: facilitating connection to care, informed choice, disclosure (intentional or unintentional), and trust in researchers. Conclusions: Women living with HIV were overwhelmingly positive about the idea of a GPS-based smartphone app to improve engagement in HIV care. Participants reported that they would welcome a tool to facilitate connection to care when traveling and expressed trust in researchers and health care facilities. Within the context of the rapid increase of smartphone use in South Africa, these early results warrant further exploration and critical evaluation following real-world experience with the app. 
%M 33555261
%R 10.2196/19243
%U https://formative.jmir.org/2021/2/e19243
%U https://doi.org/10.2196/19243
%U http://www.ncbi.nlm.nih.gov/pubmed/33555261

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 23
%N 2
%P e18296
%T Identifying Self-Management Support Needs for Pregnant Women With Opioid Misuse in Online Health Communities: Mixed Methods Analysis of Web Posts
%A Liang,Ou Stella
%A Chen,Yunan
%A Bennett,David S
%A Yang,Christopher C
%+ College of Computing and Informatics, Drexel University, 3675 Market St, Philadelphia, PA, United States, 1 215 895 1631, chris.yang@drexel.edu
%K self-management
%K online health community
%K opioid use disorder
%K pregnancy
%D 2021

%7 4.2.2021
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: The current opioid crisis in the United States impacts broad population groups, including pregnant women. Opioid use during pregnancy can affect the health and wellness of both mothers and their infants. Understanding women’s efforts to self-manage opioid use or misuse in pregnancy is needed to identify intervention points for improving maternal outcomes. Objective: This study aims to identify the characteristics of women in an online health community (OHC) with opioid use or misuse during pregnancy and the self-management support needs of these mothers. Methods: A total of 200 web posts by pregnant women with opioid use participating in an OHC were double coded. Concepts and their thematic connections were identified through an inductive process until theoretical saturation was reached. Statistical tests were performed to identify patterns. Results: The majority of pregnant women (150/200, 75.0%) in the OHC exhibited signs of misuse, and 62.5% (125/200) of the participants were either contemplating or pursuing dosage reduction. Self-managed withdrawal was more common (P<.001) than professional treatment among the population. A total of 5 themes of self-management support needs were identified as women sought information about the potential adverse effects of gestational opioid use, protocols for self-managed withdrawal, pain management safety during pregnancy, hospital policies and legal procedures related to child protection, and strategies for navigating offline support systems. In addition, 58.5% (117/200) of the pregnant women expressed negative emotions, of whom only 10.2% (12/117) sought to address their emotional needs with the help of the OHC. Conclusions: OHCs provide vital self-management support for pregnant women with opioid use or misuse. Women pursuing self-managed dosage reduction are prone to misinformation and repeated relapses, which can result in extreme measures to avoid testing positive for drug use at labor. The study findings provide evidence for public policy considerations, including universal screening of substance use for pregnant women, emphasis on treatment rather than legal punishment, and further expansion of the Drug Addiction Treatment Act waiver training program. The improvement of web-based platforms that can organize geo-relevant information, dispense clinically validated withdrawal schedules, and offer structured peer support is envisioned for harm reduction among pregnant women who opt for self-management of opioid misuse. 
%M 33538695
%R 10.2196/18296
%U https://www.jmir.org/2021/2/e18296
%U https://doi.org/10.2196/18296
%U http://www.ncbi.nlm.nih.gov/pubmed/33538695

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 1
%P e18154
%T He Korowai Manaaki (Pregnancy Wraparound Care): Protocol for a Cluster Randomized Clinical Trial
%A Lawton,Beverley
%A Storey,Francesca
%A Sibanda,Nokuthaba
%A Bennett,Matthew
%A Lambert,Charles
%A Geller,Stacie
%A Edmonds,Liza
%A Cram,Fiona
%+ Centre for Women's Health Research, Victoria University of Wellington, 44 Kelburn Parade, Wellington, 6140, New Zealand, 64 021463762, bev.lawton@vuw.ac.nz
%K maternity
%K inequity
%K Indigenous health
%K Māori
%K pregnancy
%K Kaupapa Māori
%K socioeconomic
%K primary health care
%K methodology
%D 2021

%7 29.1.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Maternal and infant health inequities between Māori (the Indigenous peoples of Aotearoa New Zealand) and New Zealand European women are well documented and cannot be explained solely by socioeconomic status. A research center-iwi (tribal group) partnership aims to address these disparities and improve maternal and infant health outcomes by implementing an augmented maternity care pathway (He Korowai Manaaki) to improve access to services and evidence-informed care. Objective: The objective of this study is to test whether an augmented maternity care pathway improves Māori infant health outcomes. Methods: This is a Kaupapa Māori (by, with, and for Māori) cluster randomized clinical trial involving 8 primary care practices allocated to either an intervention arm or control arm. The intervention arm comprises an augmented maternity care pathway (He Korowai Manaaki) offering clinical care through additional paid health care appointments and improved access to social support (eg, housing, transport). The control arm is usual care. The primary outcome is increased timely vaccination for Māori infants, defined as all age-appropriate vaccinations completed by 6 months of age. Results: Recruitment commenced in November 2018 and was completed in June 2020, with 251 enrolled women recruited in intervention primary care practices before 20 weeks of pregnancy. Publication of results is anticipated in late 2023. Conclusions: The results will inform primary health care policy including whether the provision of augmented maternal care pathways reduces disparities in the structural determinants of health. If effective, He Korowai Manaaki will strengthen the health and well-being of pregnant Māori women and their babies and improve their health outcomes, laying a strong foundation for lifelong health and well-being. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001155189; https://tinyurl.com/yypbef8q International Registered Report Identifier (IRRID): DERR1-10.2196/18154 
%M 33512321
%R 10.2196/18154
%U http://www.researchprotocols.org/2021/1/e18154/
%U https://doi.org/10.2196/18154
%U http://www.ncbi.nlm.nih.gov/pubmed/33512321

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 4
%N 12
%P e21602
%T Grocery Delivery of Healthy Foods to Pregnant Young Women With Low Incomes: Feasibility and Acceptability Mixed Methods Study
%A Locher,Ione
%A Waselewski,Marika
%A Sonneville,Kendrin
%A Resnicow,Ken
%A Chang,Tammy
%+ University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, United States, 1 734 730 4636, tachang@med.umich.edu
%K pregnancy
%K adolescent
%K young adult
%K female
%K gestational weight gain
%K diet
%K food preferences
%K text messaging
%K feasibility studies
%D 2020

%7 24.12.2020
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Poor maternal diets increase the risk of excess gestational weight gain which can contribute to serious intergenerational morbidity for both the mother and infant. Pregnant young women with low incomes have disproportionately high rates of inadequate fruit and vegetable consumption as well as excess weight gains during pregnancy. Objective: Our aim was to describe the feasibility and acceptability of Special Delivery, a longitudinal nutrition intervention that delivers healthy foods to pregnant youth (aged 14-24 years) with low incomes. Methods: The Special Delivery pilot study, conducted in Michigan, enrolled pregnant young women with low incomes. Study participants were sent twice-monthly grocery deliveries consisting of US $35 worth of healthy foods, primarily fruits and vegetables. Between grocery deliveries, participants received daily SMS text message prompts to confirm receipt of delivery and document diet and weight. Program feasibility was assessed by the number of grocery orders placed, delivered, and confirmed by participants. Qualitative interviews and SMS text message data were used to determine acceptability by assessing participants’ perspectives on grocery delivery, participants’ perspectives on dietary impact of the program, and foods consumed by participants. Results: A total of 27 participants were enrolled in the pilot study. The mean age was 20.3 years (SD 2.0), and 59.3% (16/27) were African American or Black. During the pilot, 263 deliveries were sent with 98.5% (259/263) successful deliveries and 89.4% (235/263) deliveries confirmed by participants. Participants reported that grocery delivery was convenient; that delivered foods were high quality; and that the program improved their diet, increased access to healthy foods, and promoted healthy habits during pregnancy. Conclusions: A grocery delivery–based weight gain and nutrition intervention is both feasible and acceptable among low-income pregnant youth. Grocery deliveries were successfully completed and participants were willing and able to receive grocery deliveries, eat the healthy foods that were delivered, and communicate via SMS text message with study coordinators. The Special Delivery program warrants further evaluation for efficacy in promoting healthy weight gain for low-income youth during pregnancy. 
%M 33361055
%R 10.2196/21602
%U http://formative.jmir.org/2020/12/e21602/
%U https://doi.org/10.2196/21602
%U http://www.ncbi.nlm.nih.gov/pubmed/33361055

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 12
%P e23157
%T Experiences, Attitudes, and Needs of Users of a Pregnancy and Parenting App (Baby Buddy) During the COVID-19 Pandemic: Mixed Methods Study
%A Rhodes,Alexandra
%A Kheireddine,Sara
%A Smith,Andrea D
%+ Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 20 7679 2000, alexandra.rhodes.15@ucl.ac.uk
%K pregnancy
%K parenting
%K app
%K COVID-19
%K pregnancy support
%K postnatal support
%K perinatal
%K mental well-being
%K physical well-being
%K support
%K well-being
%K experience
%K attitude
%K needs
%D 2020

%7 9.12.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The COVID-19 pandemic has impacted the lives of expectant parents and parents of young babies, with disruptions in health care provision and loss of social support. Objective: This study investigated the impact of the COVID-19 pandemic and its associated lockdown on this population through the lens of users of the UK National Health Service–approved pregnancy and parenting smartphone app, Baby Buddy. The study aims were threefold: to gain insights into the attitudes and experiences of expectant and recent parents (with babies under 24 weeks of age) during the COVID-19 pandemic; to investigate whether Baby Buddy is meeting users’ needs during this time; and to identify ways to revise the content of Baby Buddy to better support its users now and in future. Methods: A mixed methods study design combining a web-based survey with semistructured telephone interviews among Baby Buddy users in the United Kingdom was applied. Data were collected from April 15 to mid-June 2020, corresponding to weeks 4-13 of the lockdown in the United Kingdom. Results: A total of 436 expectant (n=244, 56.0%) and recent (n=192, 44.0%) parents responded to the web-based survey, of which 79.1% (n=345) were aged 25-39 years and 17.2% (n=75) spoke English as their second language. Of the 436 respondents, 88.5% (386/436) reported increased levels of anxiety around pregnancy, birth, and being a new parent, and 58.0% (253/436) were concerned about their emotional and mental health. Of the 244 pregnant respondents, 43.4% (n=106) were concerned about their physical health. Telephone interviews with 13 pregnant women and 19 recent parents revealed similarly increased levels of anxiety due to reduced health care provision and loss of support from friends and family. Although a minority of respondents identified some positive outcomes of lockdown, such as family bonding, many telephone interviewees reported feeling isolated, disregarded, and overwhelmed. Recent parents were particularly anxious about the impact of the lockdown on their baby’s development and socialization. Many interviewees were also concerned about their physical health as a consequence of both limited access to face-to-face medical appointments and their own poorer dietary and physical activity behaviors. Across both samples, 97.0% (423/436) of respondents reported that Baby Buddy was currently helping them, with many commenting that its role was even more important given the lack of face-to-face support from health care and parenting organizations. Greater speed in updating digital content to reflect changes due to the pandemic was suggested. Conclusions: The COVID-19 pandemic has created heightened anxiety and stress among expectant parents and those with a young baby, and for many, lockdown has had an adverse impact on their physical and mental well-being. With reductions in health care and social support, expectant and new parents are increasingly relying on web-based resources. As a free, evidence-based app, Baby Buddy is well positioned to meet this need. The app could support its users even more by actively directing them to the wealth of existing content relevant to their concerns and by adding content to give users the knowledge and confidence to meet new challenges. 
%M 33264100
%R 10.2196/23157
%U http://mhealth.jmir.org/2020/12/e23157/
%U https://doi.org/10.2196/23157
%U http://www.ncbi.nlm.nih.gov/pubmed/33264100

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 11
%P e18809
%T Evaluation of the MoMba Live Long Remote Smoking Detection System During and After Pregnancy: Development and Usability Study
%A Valencia,Stephanie
%A Callinan,Laura
%A Shic,Frederick
%A Smith,Megan
%+ Department of Psychiatry, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, 06519, United States, 1 203 764 8655, megan.smith@yale.edu
%K breath carbon monoxide
%K contingency management
%K smoking cessation
%K pregnancy
%K mobile-based sensor
%K mobile phone
%D 2020

%7 24.11.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The smoking relapse rate during the first 12 months after pregnancy is around 80% in the United States. Delivering remote smoking cessation interventions to women in the postpartum period can reduce the burden associated with frequent office visits and can enable remote communication and support. Developing reliable, remote, smoking measuring instruments is a crucial step in achieving this vision. Objective: The study presents the evaluation of the MoMba Live Long system, a smartphone-based breath carbon monoxide (CO) meter and a custom iOS smartphone app. We report on how our smoking detection system worked in a controlled office environment and in an out-of-office environment to examine its potential to deliver a remote contingency management intervention. Methods: In-office breath tests were completed using both the MoMba Live Long system and a commercial monitor, the piCO+ Smokerlyzer. In addition, each participant provided a urine test for smoking status validation through cotinine. We used in-office test data to verify the validity of the MoMba Live Long smoking detection system. We also collected out-of-office tests to assess how the system worked remotely and enabled user verification. Pregnant adult women in their second or third trimester participated in the study for a period of 12 weeks. This study was carried out in the United States. Results: Analyses of in-office tests included 143 breath tests contributed from 10 participants. CO readings between the MoMba Live Long system and the piCO+ were highly correlated (r=.94). In addition, the MoMba Live Long system accurately distinguished smokers from nonsmokers with a sensitivity of 0.91 and a specificity of 0.94 when the piCO+ was used as a gold standard, and a sensitivity of 0.81 and specificity of 1.0 when cotinine in urine was used to confirm smoking status. All participants indicated that the system was easy to use. Conclusions: Relatively inexpensive portable and internet-connected CO monitors can enable remote smoking status detection in a wide variety of nonclinical settings with reliable and valid measures comparable to a commercially available CO monitor. Trial Registration: ClinicalTrials.gov NCT02237898; https://clinicaltrials.gov/ct2/show/NCT02237898 
%M 33231550
%R 10.2196/18809
%U https://mhealth.jmir.org/2020/11/e18809
%U https://doi.org/10.2196/18809
%U http://www.ncbi.nlm.nih.gov/pubmed/33231550

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 22
%N 11
%P e22440
%T Outcomes of Equity-Oriented, Web-Based Parenting Information in Mothers of Low Socioeconomic Status Compared to Other Mothers: Participatory Mixed Methods Study
%A Pluye,Pierre
%A El Sherif,Reem
%A Gonzalez-Reyes,Araceli
%A Turcotte,Emmanuelle
%A Schuster,Tibor
%A Bartlett,Gillian
%A Grad,Roland M
%A Granikov,Vera
%A Barwick,Melanie
%A Doray,Geneviève
%A Lagarde,François
%A Loignon,Christine
%+ Department of Family Medicine, McGill University, 5858 Cote des neiges, Rm 300, Montreal, QC, H3S 1Z1, Canada, 1 514 398 8483, pierre.pluye@mcgill.ca
%K consumer health information
%K child development
%K child health
%K literacy
%K information outcomes
%D 2020

%7 10.11.2020
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Typically, web-based consumer health information is considered more beneficial for people with high levels of education and income. No evidence shows that equity-oriented information offers equal benefits to all. This is important for parents of low socioeconomic status (SES; low levels of education and income and usually a low level of literacy). Objective: This study is based on a conceptual framework of information outcomes. In light of this, it aims to compare the perception of the outcomes of web-based parenting information in low-SES mothers with that of other mothers and explore the perspective of low-SES mothers on contextual factors and information needs and behavior associated with these outcomes. Methods: A participatory mixed methods research was conducted in partnership with academic researchers and Naître et grandir (N&G) editors. N&G is a magazine, website, and newsletter that offers trustworthy parenting information on child development, education, health, and well-being in a format that is easy to read, listen, or watch. Quantitative component (QUAN) included a 3-year longitudinal observational web survey; participants were mothers of 0- to 8-year-old children. For each N&G newsletter, the participants’ perception regarding the outcomes of specific N&G webpages was gathered using a content-validated Information Assessment Method (IAM) questionnaire. Differences between participants of low SES versus others were estimated. Qualitative component (QUAL) was interpretive; participants were low-SES mothers. The thematic analysis of interview transcripts identified participants’ characteristics and different sources of information depending on information needs. Findings from the two components were integrated (QUAN+QUAL integration) through the conceptual framework and assimilated into the description of an ideal-typical mother of low SES (Kate). A narrative describes Kate’s perception of the outcomes of web-based parenting information and her perspective on contextual factors, information needs, and behavior associated with these outcomes. Results: QUAN—a total of 1889 participants completed 2447 IAM responses (50 from mothers of low SES and 2397 from other mothers). N&G information was more likely to help low-SES participants to better understand something, decrease worries, and increase self-confidence in decision making. QUAL—the 40 participants (21 N&G users and 19 nonusers) used 4 information sources in an iterative manner: websites, forums, relatives, and professionals. The integration of QUAN and QUAL findings provides a short narrative, Kate, which summarizes the main findings. Conclusions: This is the first study comparing perceptions of information outcomes in low-SES mothers with those of other mothers. Findings suggest that equity-oriented, web-based parenting information can offer equal benefits to all, including low-SES mothers. The short narrative, Kate, can be quickly read by decision policy makers, for example, web editors, and might encourage them to reach the underserved and provide and assess trustworthy web-based consumer health information in a format that is easy to read, listen, or watch. 
%M 33170125
%R 10.2196/22440
%U https://www.jmir.org/2020/11/e22440
%U https://doi.org/10.2196/22440
%U http://www.ncbi.nlm.nih.gov/pubmed/33170125

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 10
%P e17066
%T Costing and Cost-Effectiveness of a Mobile Health Intervention (ImTeCHO) in Improving Infant Mortality in Tribal Areas of Gujarat, India: Cluster Randomized Controlled Trial
%A Modi,Dhiren
%A Saha,Somen
%A Vaghela,Prakash
%A Dave,Kapilkumar
%A Anand,Ankit
%A Desai,Shrey
%A Shah,Pankaj
%+ Indian Institute of Public Health Gandhinagar, NH-147, Palaj Village, opp. New Air Force Station HQ, Gandhinagar, 382042, India, 91 9687207549, ssaha@iiphg.org
%K mHealth, cost-effectiveness
%K life-years saved
%K India, ASHA
%D 2020

%7 14.10.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: During 2013, a mobile health (mHealth) program, Innovative Mobile Technology for Community Health Operation (ImTeCHO), was launched in predominantly tribal and rural communities of Gujarat, India. ImTeCHO was developed as a job aid for Accredited Social Health Activists (ASHAs) and staff of primary health centers to increase coverage of maternal, neonatal, and child health care. Objective: In this study, we assessed the incremental cost per life-years saved as a result of the ImTeCHO intervention as compared to routine maternal, neonatal, and child health care  programs. Methods: A two-arm, parallel, stratified cluster randomized trial with 11 clusters (primary health centers) randomly allocated to the intervention (280 ASHAs, n=2,34,134) and control (281 ASHAs, n=2,42,809) arms was initiated in 2015 in a predominantly tribal and rural community of Gujarat. A system of surveillance assessed all live births and infant deaths in the intervention and control areas. All costs, including those required during the start-up and implementation phases, were estimated from a program perspective. Incremental cost-effectiveness ratios were estimated by dividing the incremental cost of the intervention with the number of deaths averted to estimate the cost per infant death averted. This was further analyzed to estimate the cost per life-years saved for the purpose of comparability. Sensitivity analysis was undertaken to account for parameter uncertainties. Results: Out of a total of 5754 live births (3014 in the intervention arm, 2740 in the control arm) reported in the study area, per protocol analysis showed that the implementation of ImTeCHO resulted in saving 11 infant deaths per 1000 live births in the study area at an annual incremental cost of US $163,841, which is equivalent to US $54,360 per 1000 live births. Overall, ImTeCHO is a cost-effective intervention from a program perspective at an incremental cost of US $74 per life-years saved or US $5057 per death averted. In a realistic environment with district scale-up, the program is expected to become even more cost-effective. Conclusions: Overall, the findings of our study strongly suggest that the mHealth intervention as part of the ImTeCHO program is cost-effective and should be considered for replication elsewhere in India. Trial Registration: Clinical Trials Registry of India CTRI/2015/06/005847; http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=11820&EncHid=&modid=&compid=%27,%2711820det%27 
%M 33052122
%R 10.2196/17066
%U https://mhealth.jmir.org/2020/10/e17066
%U https://doi.org/10.2196/17066
%U http://www.ncbi.nlm.nih.gov/pubmed/33052122

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 10
%P e17377
%T Challenges in Acceptance and Compliance in Digital Health Assessments During Pregnancy: Prospective Cohort Study
%A Brusniak,Katharina
%A Arndt,Hannah Maria
%A Feisst,Manuel
%A Haßdenteufel,Kathrin
%A Matthies,Lina Maria
%A Deutsch,Thomas Maximilian
%A Hudalla,Hannes
%A Abele,Harald
%A Wallwiener,Markus
%A Wallwiener,Stephanie
%+ Department of Gynecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, Heidelberg, 69120, Germany, 49 6221 5637551, Stephanie.Wallwiener@med.uni-heidelberg.de
%K eHealth
%K compliance
%K pregnancy
%K digital assessments
%D 2020

%7 14.10.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Pregnant women are increasingly using mobile apps to access health information during the antenatal period. Therefore, digital health solutions can potentially be used as monitoring instruments during pregnancy. However, a main factor of success is high user engagement. Objective: The aim of this study was to analyze engagement and factors influencing compliance in a longitudinal study targeting pregnant women using a digital health app with self-tracking. Methods: Digitally collected data concerning demographics, medical history, technical aspects, and mental health from 585 pregnant women were analyzed. Patients filling out ≥80% of items at every study visit were considered to be highly compliant. Factors associated with high compliance were identified using logistic regression. The effect of a change in mental and physical well-being on compliance was assessed using a one-sample t test. Results: Only 25% of patients could be considered compliant. Overall, 63% left at least one visit blank. Influential variables for higher engagement included higher education, higher income, private health insurance, nonsmoking, and German origin. There was no relationship between a change in the number of physical complaints or depressive symptoms and study dropout. Conclusions: Maintaining high engagement with digital monitoring devices over a long time remains challenging. As cultural and socioeconomic background factors had the strongest influence, more effort needs to be directed toward understanding the needs of patients from different demographic backgrounds to ensure high-quality care for all patients. More studies need to report on compliance to disclose potential demographic bias. 
%M 33052134
%R 10.2196/17377
%U https://mhealth.jmir.org/2020/10/e17377
%U https://doi.org/10.2196/17377
%U http://www.ncbi.nlm.nih.gov/pubmed/33052134

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 22
%N 9
%P e19378
%T Impact of a Blended Periconception Lifestyle Care Approach on Lifestyle Behaviors: Before-and-After Study
%A van der Windt,Melissa
%A van der Kleij,Rianne Maria
%A Snoek,Katinka Marianne
%A Willemsen,Sten Paul
%A Dykgraaf,Ramon Henny Maria
%A Laven,Joop Stephanus Elisabeth
%A Schoenmakers,Sam
%A Steegers-Theunissen,Régine Patricia Maria
%+ Department of Obstetrics and Gynecology, Erasmus University Medical Center, PO Box 2040, Rotterdam, 3000CA, Netherlands, +31 107038255, r.steegers@erasmusmc.nl
%K eHealth
%K periconception period
%K lifestyle intervention
%D 2020

%7 30.9.2020
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Periconception lifestyle behaviors affect maternal, paternal, offspring, and transgenerational health outcomes. Previous research in other target populations has shown that personalized lifestyle interventions, in which face-to-face counseling and eHealth (“blended care”) are combined, may effectively target these lifestyle behaviors. Objective: We aimed to assess the effectiveness of a periconceptional lifestyle intervention on the improvement of specific lifestyle components. Methods: A blended periconception lifestyle care approach was developed, combining the outpatient lifestyle counseling service “Healthy Pregnancy” with the eHealth platform “Smarter Pregnancy” (www.smarterpregnancy.co.uk) in which lifestyle was coached for 24 weeks. All couples contemplating pregnancy or already pregnant (≤12 weeks of gestation) who visited the outpatient clinics of the Department of Obstetrics and Gynecology at the Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands, between June and December 2018, were invited to participate. We measured changes in lifestyle behaviors at weeks 12 and 24 compared with baseline. Generalized estimating equations were used to analyze the changes in lifestyle behaviors over time. Subgroup analyses were performed for women with obesity (BMI ≥30 kg/m2), women pregnant at the start of the intervention, and those participating as a couple. Results: A total of 539 women were screened for eligibility, and 450 women and 61 men received the blended periconception intervention. Among the participating women, 58.4% (263/450) were included in the preconception period. Moreover, 78.9% (403/511) of the included participants completed the online lifestyle coaching. At baseline, at least one poor lifestyle behavior was present in most women (379/450, 84.2%) and men (58/61, 95.1%). In the total group, median fruit intake increased from 1.8 to 2.2 pieces/day (P<.001) and median vegetable intake increased from 151 to 165 grams/day (P<.001) after 24 weeks of online coaching. The probability of taking folic acid supplementation among women increased from 0.97 to 1 (P<.001), and the probability of consuming alcohol and using tobacco in the total group decreased from 0.25 to 0.19 (P=.002) and from 0.20 to 0.15 (P=.63), respectively. Overall, the program showed the strongest effectiveness for participating couples. Particularly for vegetable and fruit intake, their consumption increased from 158 grams/day and 1.8 pieces/day at baseline to 190 grams/day and 2.7 pieces/day at the end of the intervention, respectively. Conclusions: We succeeded in including most participating women in the preconception period. A high compliance rate was achieved and users demonstrated improvements in several lifestyle components. The blended periconception lifestyle care approach seems to be an effective method to improve lifestyle behaviors. The next step is to further disseminate this approach and to perform a randomized trial to compare the use of blended care with the provision of only eHealth. Additionally, the clinical relevance of these results will need to be substantiated further. 
%M 32996885
%R 10.2196/19378
%U http://www.jmir.org/2020/9/e19378/
%U https://doi.org/10.2196/19378
%U http://www.ncbi.nlm.nih.gov/pubmed/32996885

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 22
%N 9
%P e20632
%T Real-World Evidence on the Effect of Missing an Oral Contraceptive Dose: Analysis of Internet Search Engine Queries
%A Hochberg,Irit
%A Orshalimy,Sharon
%A Yom-Tov,Elad
%+ Microsoft Research, 13 Shenkar st, Herzeliya, 46733, Israel, 972 747111359, eladyt@microsoft.com
%K search engines
%K birth control
%K abortion
%K miscarriage
%D 2020

%7 15.9.2020
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Oral contraceptives (OCs) are a unique chronic medication with which a memory slip may result in a threat that could change a person’s life course. Subjective concerns of missed OC doses among women have been addressed infrequently. Anonymized queries to internet search engines provide unique access to concerns and information gaps faced by a large number of internet users. Objective: We aimed to quantitate the frequency of queries by women seeking information in an internet search engine, after missing one or more doses of an OC; their further queries on emergency contraception, abortion, and miscarriage; and their rate of reporting a pregnancy timed to the cycle of missing an OC. Methods: We extracted all English-language queries submitted to Bing in the United States during 2018, which mentioned a missed OC and subsequent queries of the same users on miscarriage, abortion, emergency contraceptives, and week of pregnancy. Results: We identified 26,395 Bing users in the United States who queried about missing OC pills and the fraction that further queried about miscarriage, abortion, emergency contraceptive, and week of pregnancy. Users under the age of 30 years who asked about forgetting an OC dose were more likely to ask about abortion (1.5 times) and emergency contraception (1.7 times) (P<.001 for both), while users at ages of 30-34 years were more likely to query about pregnancy (2.1 times) and miscarriage (5.4 times) (P<.001 for both). Conclusions: Our data indicate that many women missing a dose of OC might not have received sufficient information from their health care providers or chose to obtain it online. Queries about abortion and miscarriage peaking in the subsequent days indicate a common worry of possible pregnancy. These results reinforce the importance of providing comprehensive written information on missed pills when prescribing an OC. 
%M 32930672
%R 10.2196/20632
%U http://www.jmir.org/2020/9/e20632/
%U https://doi.org/10.2196/20632
%U http://www.ncbi.nlm.nih.gov/pubmed/32930672

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 22
%N 9
%P e19436
%T Use of Decision Support Tools to Empower Pregnant Women: Systematic Review
%A Ngo,Elin
%A Truong,Maria Bich-Thuy
%A Nordeng,Hedvig
%+ PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Postboks 1068 Blindern, Oslo, 0316, Norway, 47 93849866, e.t.p.ngo@farmasi.uio.no
%K decision support tools
%K pregnancy
%K mobile application
%K empowerment
%D 2020

%7 14.9.2020
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Women face many health-related decisions during pregnancy. Digitalization, new technology, and a greater focus on empowering patients have driven the development of patient-centered decision support tools. Objective: This systematic review provides an overview of studies investigating the effect of patient-centered decision support tools for pregnant women. Methods: We searched 5 online databases, MEDLINE, EMBASE, Web of Science, PsycINFO, and Scopus, from inception to December 1, 2019. Two independent researchers screened titles, abstracts, and full-texts against the inclusion criteria. All studies investigating the effect of patient-centered decision support tools for health-related issues among pregnant women were included. Study characteristics and results were extracted using the review management tool Rayyan and analyzed according to topic, type of decision support tools, control group, outcome measurements, and results. Results: The 25 eligible studies covered a range of health topics, including prenatal screening (n=10), gestational diabetes and weight gain (n=7), lifestyle (n=3), blood pressure and preeclampsia (n=2), depression (n=1), asthma (n=1), and psychological well-being (n=1). In general, the use of decision support tools increased women's knowledge, and recording symptoms enhanced satisfaction with maternity care. Conclusions: The opportunities created by digitalization and technology should be used to develop innovative patient-centered decision support tools tailored to support pregnant women. Effect on clinical outcomes should be documented. 
%M 32924961
%R 10.2196/19436
%U http://www.jmir.org/2020/9/e19436/
%U https://doi.org/10.2196/19436
%U http://www.ncbi.nlm.nih.gov/pubmed/32924961

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 9
%N 8
%P e16697
%T The Effect of Improved Access to Family Planning on Postpartum Women: Protocol for a Randomized Controlled Trial
%A Karra,Mahesh
%A Canning,David
%+ Frederick S Pardee School of Global Studies, Boston University, 152 Bay State Road, Room G04C, Boston, MA, 02215, United States, 1 617 358 0197, mvkarra@bu.edu
%K postpartum family planning
%K contraceptive use
%K birth spacing
%K women’s well-being
%K randomized controlled trial
%K Malawi
%K Sub-Saharan Africa
%D 2020

%7 14.8.2020
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The World Health Organization recommends that a woman waits at least 24 months after a live birth before getting pregnant again; however, an estimated 25% of birth intervals in low-income countries do not meet this recommendation for adequate birth spacing, and the unmet need for postpartum family planning (PPFP) services is high. Few randomized controlled trials have assessed the causal impact of access to PPFP services, and even fewer evaluations have investigated how such interventions may affect postpartum contraceptive use, birth spacing, and measures of health and well-being. Objective: This protocol paper aims to describe a randomized controlled trial that is being conducted to identify the causal impact of an intervention to improve access to PPFP services on contraceptive use, pregnancy, and birth spacing in urban Malawi. The causal effect of the intervention will be determined by comparing outcomes for respondents who are randomly assigned to an intervention arm against outcomes for respondents who are randomly assigned to a control arm. Methods: Married women aged 18-35 years who were either pregnant or had recently given birth were randomly assigned to either the intervention arm or control arm. Women assigned to the intervention arm received a package of services over a 2-year intervention period. Services included a brochure and up to 6 home visits from trained family planning counselors; free transportation to a high-quality family planning clinic; and financial reimbursement for family planning services, consultations, and referrals for services. Two follow-up surveys were conducted 1 and 2 years after the baseline survey. Results: A total of 2143 women were randomly assigned to either the intervention arm (n=1026) or the control arm (n=1117). Data collection for the first follow-up survey began in August 2017 and was completed in February 2018. A total of 1773 women, or 82.73% of women who were eligible for follow-up, were successfully contacted and reinterviewed at the first follow-up. Data collection for the second follow-up survey began in August 2018 and was completed in February 2019. A total of 1669 women, or 77.88% of women who were eligible for follow-up, were successfully contacted and reinterviewed at the second follow-up. The analysis of the primary outcomes is ongoing and is expected to be completed in 2021. Conclusions: The results of this trial seek to fill the current knowledge gaps in the effectiveness of family planning interventions on improving fertility and health outcomes. The findings also show that the benefits of improving access to family planning are likely to extend beyond the fertility and health domain by improving other measures of women’s well-being. Trial Registration: American Economics Association Registry Trial Number AEARCTR-0000697; https://www.socialscienceregistry.org/trials/697 Registry for International Development Impact Evaluations (RIDIE) Trial Number RIDIE-STUDY-ID-556784ed86956; 
         https://ridie.3ieimpact.org/index.php?r=search/detailView&id=320 International Registered Report Identifier (IRRID): DERR1-10.2196/16697 
%M 32795987
%R 10.2196/16697
%U http://www.researchprotocols.org/2020/8/e16697/
%U https://doi.org/10.2196/16697
%U http://www.ncbi.nlm.nih.gov/pubmed/32795987

%0 Journal Article
        
%@ 2371-4379
%I JMIR Publications
%V 5
%N 3
%P e17794
%T Evaluation of a Text Messaging Intervention to Support Self-Management of Diabetes During Pregnancy Among Low-Income, Minority Women: Qualitative Study
%A Yee,Lynn
%A Taylor,Shaneah
%A Young,Maria
%A Williams,Makayla
%A Niznik,Charlotte
%A Simon,Melissa
%+ Northwestern University, 250 E Superior Street, #5-2145, Chicago, IL, 60611, United States, 1 3124724685, lynn.yee@northwestern.edu
%K gestational diabetes mellitus
%K type 2 diabetes mellitus
%K mobile health
%K text messaging
%K mobile phone
%K pregnancy
%D 2020

%7 10.8.2020
%9 Original Paper
%J JMIR Diabetes
%G English
                
%X Background: Given the growing burden of diabetes in underserved communities and the complexity of diabetes self-management during pregnancy, the development of interventions to support low-income pregnant women with diabetes is urgently needed. Objective: This study aims to develop and pilot test a theory-driven curriculum of SMS text messaging for diabetes support and education during pregnancy. Methods: This was a prospective pilot investigation of a novel SMS text messaging intervention offered to pregnant women with pregestational or gestational diabetes mellitus and publicly funded prenatal care. Prior work yielded a conceptual model of diabetes self-management barriers and support factors in this population, which was used to guide curriculum development along with health behavior theories. Participants received three supportive or educational one-way text messages per week during pregnancy. In-depth semistructured interviews were performed at study exit to solicit feedback on the program. Narrative data were analyzed using the constant comparative technique to identify themes and subthemes. Results: Participants (N=31 enrolled and n=26 completed both interviews) consistently reported that SMS text messaging provided enhanced motivation for diabetes self-care, reduced diabetes-related social isolation, increased perceived diabetes-associated knowledge, enhanced comfort with the health care team, and reduced logistical burdens of diabetes during pregnancy. Participants requested enhanced interactive and customizable features in future intervention iterations. Conclusions: Pregnant women with diabetes who were enrolled in this pilot study of an SMS text messaging curriculum for diabetes support described enhanced motivation, knowledge, and comfort with diabetes self-care activities as a result of the health education intervention. The next steps include enriching the interactive features of the intervention and investigating the effect of the intervention on perinatal outcomes. 
%M 32773367
%R 10.2196/17794
%U http://diabetes.jmir.org/2020/3/e17794/
%U https://doi.org/10.2196/17794
%U http://www.ncbi.nlm.nih.gov/pubmed/32773367

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 8
%P e17271
%T User Experiences With and Recommendations for Mobile Health Technology for Hypertensive Disorders of Pregnancy: Mixed Methods Study
%A Jongsma,Karin Rolanda
%A van den Heuvel,Josephus F M
%A Rake,Jasmijn
%A Bredenoord,Annelien L
%A Bekker,Mireille N
%+ Department of Medical Humanities, University Medical Center Utrecht, Utrecht University, PO Box 85500, Utrecht, 3508 GA, Netherlands, 31 88 75 51351, k.r.jongsma@umcutrecht.nl
%K mobile health
%K hypertension
%K telemonitoring
%K ethics
%K high-risk pregnancy
%K preeclampsia
%K digital health
%D 2020

%7 4.8.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Hypertensive disorders of pregnancy (HDP) are a primary cause of adverse maternal and neonatal outcomes worldwide. For women at risk of hypertensive complications, guidelines recommend frequent surveillance of blood pressure and signs of preeclampsia. Clinic visits range from every 2 weeks to several times a week. Given the wide ubiquity of smartphones and computers in most countries and a growing attention for self-management, digital technologies, including mobile health (mHealth), constitute a promising component of monitoring (self-measured) blood pressure during pregnancy. Currently, little is known about the experiences of women using such platforms and how mHealth can be aligned with their needs and preferences. Objective: The objectives were twofold: (1) to explore the experiences of Dutch women who had an increased risk of HDP with a blended care approach (mHealth combined with face-to-face care) for remote self-monitoring of blood pressure and preeclampsia symptoms and (2) to formulate recommendations for the use and integration of mHealth in clinical care. Methods: Alongside a prospective blended care study (SAFE@home study) that monitors pregnant women at increased risk of HPD with mHealth technology, a mixed methods study was conducted, including questionnaires (n=52) and interviews (n=11). Results were analyzed thematically. Results: Of the 4 themes, 2 themes were related to the technologies themselves (expectations, usability), and 2 themes were related to the interaction and use of mHealth (autonomy and responsibilities of patients, responsibilities of health care professionals). First, the digital platform met the expectations of patients, which contributed to user satisfaction. Second, the platform was considered user-friendly, and patients favored different moments and frequencies for measuring their blood pressure. Third, patient autonomy was mentioned in terms of increased insight about their own condition and being able to influence clinical decision making. Fourth, clinical expertise of health care professionals was considered essential to interpret the data, which translates to subsequent responsibilities for clinical management. Data from the questionnaires and interviews corresponded. Conclusions: Blended care using an mHealth tool to monitor blood pressure in pregnancy was positively evaluated by its users. Insights from participants led to 7 recommendations for designing and implementing similar interventions and to enhance future, morally sound use of digital technologies in clinical care. 
%M 32749225
%R 10.2196/17271
%U https://mhealth.jmir.org/2020/8/e17271
%U https://doi.org/10.2196/17271
%U http://www.ncbi.nlm.nih.gov/pubmed/32749225

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 7
%P e13686
%T Maternal Parenting Electronic Diary in the Context of a Home Visit Intervention for Adolescent Mothers in an Urban Deprived Area of São Paulo, Brazil: Randomized Controlled Trial
%A Fatori,Daniel
%A Argeu,Adriana
%A Brentani,Helena
%A Chiesa,Anna
%A Fracolli,Lislaine
%A Matijasevich,Alicia
%A Miguel,Euripedes C
%A Polanczyk,Guilherme
%+ Department of Psychiatry, University of Sao Paulo Medical School, 785 R Dr Ovídio Pires de Campos, Sao Paulo, Brazil, 55 11961626183, daniel.fatori@gmail.com
%K mHealth
%K early childhood development
%K maternal care
%K randomized clinical trial
%K daily diary
%K ambulatory assessment
%D 2020

%7 28.7.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Pregnancy during adolescence is prevalent in low- and middle-income countries (LMICs), which is associated with various adverse outcomes that can be prevented with home visiting programs. However, testing these interventions in LMICs can be challenging due to limited resources. The use of electronic data collection via smartphones can be an alternative and ideal low-cost method to measure outcomes in an environment with adverse conditions. Objective: Our study had two objectives: to test the efficacy of a nurse home visiting intervention on maternal parenting and well-being measured by an electronic daily diary (eDiary), and to investigate the compliance rate of the eDiary measurement method. Methods: We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse home visiting program, for adolescent mothers living in an urban deprived area of São Paulo, Brazil. A total of 169 pregnant adolescents were assessed for eligibility criteria, 80 of whom were included and randomized to the intervention (n=40) and control group (care as usual, n=40). Primeiros Laços is a home visiting intervention delivered by trained nurses tailored to first-time pregnant adolescents and their children, starting during the first 16 weeks of pregnancy until the child reaches 24 months of age. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and when the child was 3, 6, and 12 months of age. At 18 months, participants were assessed regarding maternal parenting and parental well-being using a 7-consecutive-day eDiary. The smartphone app was programmed to notify participants every day at 9:00 PM over a period of seven days. Results: We were able to contact 57/80 (71%) participants (29 from the intervention group and 28 from the control group) when the child was 18 months of age. Forty-eight of the 57 participants (84%) completed at least one day of the eDiary protocol. The daily compliance rate ranged from 49% to 70%. Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, 95% CI [0.06, 0.58], P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, 95% CI [1.20, 4.50], P=.01).Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, P=.01). Conclusions: The Primeiros Laços intervention improved maternal parenting and parental well-being, demonstrating its promise for low-income adolescent mothers. The compliance rate of the eDiary assessment showed that it was generally accepted by adolescent mothers with limited resources. Future studies can implement ambulatory assessment in LMICs via smartphones to measure mother and child behaviors. Trial Registration: ClinicalTrials.gov NCT02807818; https://clinicaltrials.gov/ct2/show/NCT02807818 
%M 32720906
%R 10.2196/13686
%U https://mhealth.jmir.org/2020/7/e13686
%U https://doi.org/10.2196/13686
%U http://www.ncbi.nlm.nih.gov/pubmed/32720906

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 4
%N 7
%P e12417
%T Continuous 7-Month Internet of Things–Based Monitoring of Health Parameters of Pregnant and Postpartum Women: Prospective Observational Feasibility Study
%A Saarikko,Johanna
%A Niela-Vilen,Hannakaisa
%A Ekholm,Eeva
%A Hamari,Lotta
%A Azimi,Iman
%A Liljeberg,Pasi
%A Rahmani,Amir M
%A Löyttyniemi,Eliisa
%A Axelin,Anna
%+ School of Nursing and Department of Computer Science, University of California, 106D Berk Hall, Irvine, CA, 92697-3959, United States, 1 949 824 3590, a.rahmani@uci.edu
%K prenatal care
%K postnatal care
%K wearable electronics
%K biosensing
%K cloud computing
%K mHealth
%K physical activity
%K sleep
%K heart rate
%D 2020

%7 24.7.2020
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Monitoring during pregnancy is vital to ensure the mother’s and infant’s health. Remote continuous monitoring provides health care professionals with significant opportunities to observe health-related parameters in their patients and to detect any pathological signs at an early stage of pregnancy, and may thus partially replace traditional appointments. Objective: This study aimed to evaluate the feasibility of continuously monitoring the health parameters (physical activity, sleep, and heart rate) of nulliparous women throughout pregnancy and until 1 month postpartum, with a smart wristband and an Internet of Things (IoT)–based monitoring system. Methods: This prospective observational feasibility study used a convenience sample of 20 nulliparous women from the Hospital District of Southwest Finland. Continuous monitoring of physical activity/step counts, sleep, and heart rate was performed with a smart wristband for 24 hours a day, 7 days a week over 7 months (6 months during pregnancy and 1 month postpartum). The smart wristband was connected to a cloud server. The total number of possible monitoring days during pregnancy weeks 13 to 42 was 203 days and 28 days in the postpartum period. Results: Valid physical activity data were available for a median of 144 (range 13-188) days (75% of possible monitoring days), and valid sleep data were available for a median of 137 (range 0-184) days (72% of possible monitoring days) per participant during pregnancy. During the postpartum period, a median of 15 (range 0-25) days (54% of possible monitoring days) of valid physical activity data and 16 (range 0-27) days (57% of possible monitoring days) of valid sleep data were available. Physical activity decreased from the second trimester to the third trimester by a mean of 1793 (95% CI 1039-2548) steps per day (P<.001). The decrease continued by a mean of 1339 (95% CI 474-2205) steps to the postpartum period (P=.004). Sleep during pregnancy also decreased from the second trimester to the third trimester by a mean of 20 minutes (95% CI –0.7 to 42 minutes; P=.06) and sleep time shortened an additional 1 hour (95% CI 39 minutes to 1.5 hours) after delivery (P<.001). The mean resting heart rate increased toward the third trimester and returned to the early pregnancy level during the postpartum period. Conclusions: The smart wristband with IoT technology was a feasible system for collecting representative data on continuous variables of health parameters during pregnancy. Continuous monitoring provides real-time information between scheduled appointments and thus may help target and tailor pregnancy follow-up. 
%M 32706696
%R 10.2196/12417
%U http://formative.jmir.org/2020/7/e12417/
%U https://doi.org/10.2196/12417
%U http://www.ncbi.nlm.nih.gov/pubmed/32706696

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 7
%P e17665
%T The Effect of Women’s Differential Access to Messages on Their Adoption of Mobile Health Services and Pregnancy Behavior  in Bangladesh: Retrospective Cross-Sectional Study
%A Alam,Mafruha
%A Banwell,Cathy
%A Lokuge,Kamalini
%+ Australian National University, 62 Mills Road, National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, ACT, 2601, Australia, 61 6125 5602, mafruha.alam@gmail.com
%K mHealth
%K inequality
%K access
%K pregnancy
%D 2020

%7 20.7.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Text or voice messages have been used as a popular method for improving women’s knowledge on birth preparedness and newborn health care practices worldwide. The Aponjon service in Bangladesh provides twice-weekly messages to female subscribers about their pregnancy and newborn care on mobile phones that they own or share with family members. It is important to understand whether women’s singular access to a phone affects their service satisfaction and the adoption of health messages before deploying such interventions in resource-limited settings. Objective: This study aims to evaluate the effect of women’s singular and shared access to mobile phone messages on their service utilization and perceived behavioral change around birth preparedness and pregnancy care. Methods: In 2014, Aponjon conducted a retrospective cross-sectional survey of 459 female subscribers who received text or voice messages during their pregnancy by themselves (n=253) or with family members (n=206). We performed multivariable regression analyses to investigate the association between pregnant women’s differential access to messages and other socioeconomic factors and outcomes of service satisfaction, ability to recall service short code, ability to identify danger signs of pregnancy, preference for skilled delivery, arrangement of a blood donor for delivery and pregnancy complications, maternal nutrition, use of potable drinking water, and washing hands with soap for hygiene. Results: In the multivariable analysis, women who had singular access to messages had higher odds of reporting high satisfaction (odds ratio [OR] 1.72, 95% CI 1.12-2.63; P=.01), recalling the service short code (OR 2.88, 95% CI 1.90-4.36; P<.001), consuming nutritious food 5 times a day (OR 1.58, 95% CI 1.04-2.40; P=.03), and following the instructions of Aponjon on drinking potable water (OR 1.90, 95% CI 1.17-3.09; P=.01) than women who shared access with family members. Women’s differential access to messages did not affect their knowledge of danger signs and preparedness around delivery. Adolescent women and women aged 20-24 years had lower odds of planning safe deliveries than older women (aged≥25 years). Secondary education was statistically significantly associated with women’s ability to recall the short code and pregnancy danger signs, plan safe delivery, and select blood donors for emergencies. Higher family income was associated with women’s satisfaction, recognition of danger signs, and arrangement of blood donors and nutritious diet. Women who received more than 4 antenatal care visits had higher odds of liking the service, preferring skilled delivery, recalling danger signs, and consuming nutritious food. Conclusions: The capacity of women to independently access mobile phone messages can improve their adoption of mobile health services and some pregnancy health care practices. A holistic approach and equitable support are required to improve access to resources and knowledge of delivery preparedness among low-literate and younger women in low-income households. 
%M 32706694
%R 10.2196/17665
%U https://mhealth.jmir.org/2020/7/e17665
%U https://doi.org/10.2196/17665
%U http://www.ncbi.nlm.nih.gov/pubmed/32706694

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 7
%P e18255
%T Exclusively Digital Health Interventions Targeting Diet, Physical Activity, and Weight Gain in Pregnant Women: Systematic Review and Meta-Analysis
%A Rhodes,Alexandra
%A Smith,Andrea D
%A Chadwick,Paul
%A Croker,Helen
%A Llewellyn,Clare H
%+ University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 207679 1720, alexandra.rhodes.15@ucl.ac.uk
%K gestational weight gain
%K digital interventions
%K behavior change techniques
%K user engagement
%K smartphone
%K mobile phone
%D 2020

%7 10.7.2020
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Interventions to promote a healthy diet, physical activity, and weight management during pregnancy are increasingly embracing digital technologies. Although some interventions have combined digital with interpersonal (face-to-face or telephone) delivery, others have relied exclusively on digital delivery. Exclusively digital interventions have the advantages of greater cost-effectiveness and broader reach and as such can be a valuable resource for health care providers. Objective: This systematic review aims to focus on exclusively digital interventions to determine their effectiveness, identify behavior change techniques (BCTs), and investigate user engagement. Methods: A total of 6 databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulated Index to Nursing and Allied Health Literature [CINAHL] Plus, Web of Science, and ProQuest) were searched for randomized controlled trials or pilot control trials of exclusively digital interventions to encourage healthy eating, physical activity, or appropriate weight gain during pregnancy. The outcome measures were gestational weight gain (GWG) and changes in physical activity and dietary behaviors. Study quality was assessed using the Cochrane Risk of Bias tool 2.0. Where possible, pooled effect sizes were calculated using a random effects meta-analysis. Results: In total, 11 studies met the inclusion criteria. The risk of bias was mostly high (n=5) or moderate (n=3). Of the 11 studies, 6 reported on GWG as the primary outcome, 4 of which also measured changes in physical activity and dietary behaviors, and 5 studies focused either on dietary behaviors only (n=2) or physical activity only (n=3). The meta-analyses showed no significant benefit of interventions on total GWG for either intention-to-treat data (−0.28 kg; 95% CI −1.43 to 0.87) or per-protocol data (−0.65 kg; 95% CI −1.98 to 0.67). Substantial heterogeneity in outcome measures of change in dietary behaviors and physical activity precluded further meta-analyses. BCT coding identified 7 BCTs that were common to all effective interventions. Effective interventions averaged over twice as many BCTs from the goals and planning, and feedback and monitoring domains as ineffective interventions. Data from the 6 studies reporting on user engagement indicated a positive association between high engagement with key BCTs and greater intervention effectiveness. Interventions using proactive messaging and feedback appeared to have higher levels of engagement. Conclusions: In contrast to interpersonal interventions, there is little evidence of the effectiveness of exclusively digital interventions to encourage a healthy diet, physical activity, or weight management during pregnancy. In this review, effective interventions used proactive messaging, such as reminders to engage in BCTs, feedback on progress, or tips, suggesting that interactivity may drive engagement and lead to greater effectiveness. Given the benefits of cost and reach of digital interventions, further research is needed to understand how to use advancing technologies to enhance user engagement and improve effectiveness. 
%M 32673251
%R 10.2196/18255
%U https://mhealth.jmir.org/2020/7/e18255
%U https://doi.org/10.2196/18255
%U http://www.ncbi.nlm.nih.gov/pubmed/32673251

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 7
%P e18543
%T Improving the Quality of Antenatal Care Using Mobile Health in Madagascar: Five-Year Cross-Sectional Study
%A Benski,Anne Caroline
%A Schmidt,Nicole C
%A Viviano,Manuela
%A Stancanelli,Giovanna
%A Soaroby,Adelia
%A Reich,Michael R
%+ Takemi Program in International Health, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States, 1 787397261, cbenski@hsph.harvard.edu
%K mobile health
%K maternal health
%K antenatal care
%K quality of care
%K mobile phone
%D 2020

%7 8.7.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Despite many efforts, maternal mortality remains a major burden in most developing countries. Mobile health (mHealth) has the potential to improve access to obstetric care through apps that help patients and providers. Objective: This study aimed to use mHealth to provide antenatal care (ANC) to 1446 pregnant women in a rural area in Madagascar and evaluate the quality of ANC provided by an mHealth system designed to change the behaviors of providers and patients. Methods: We included 1446 women who attended ANC visits in rural Madagascar from 2015 to 2019 using an mHealth system called Pregnancy and Newborn Diagnostic Assessment (PANDA). This cross-sectional study used data from different participants, with information collected over several years, to analyze the outputs related to the quality of ANC over time. Specifically, we examined the timing of the first ANC visit, the relationship between the visit duration and the risk factors among pregnant women, and the number of ANC visits per woman. Results: Following the implementation of the mHealth system in 2015, we observed that women started to come earlier for their first ANC visit; more women attended their first ANC visit in the second trimester of pregnancy in 2019 than in the previous years (P<.001). In 2019, fewer women attended their first ANC visit in the third trimester (57/277, 20.6%) than in 2015 (147/343, 42.9%). There were statistically significant associations between the ANC visit durations and the risk factors, including age (>35 years; 25.0 min, 95% CI 24.0-25.9), educational level (longer visit for women with lower than primary education and for women who attended university and shorter for women with primary school–level education; 40.7 min, 95% CI 30.2-51.3 and 25.3 min, 95% CI 24.4-26.3 vs 23.3 min, 95% CI 22.9-23.8; P=.001), experience of domestic violence during pregnancy, gravidity, parity, infectious diseases (HIV, malaria, and syphilis), and level of anemia. Statistically significant associations were observed for all quality indicator variables. We observed a statistically significant increase in the number of ANC visits per woman over time from 2015 to 2017; the number of ANC visits per woman then became stable after the third year of implementing the PANDA mHealth system. Conclusions: This study shows the potential of an mHealth system to improve the quality of ANC, change provider behavior by standardizing ANC visits, and change patient behavior by increasing the willingness to return for subsequent visits and encouraging ANC attendance early in pregnancy. As this is an exploratory study, further studies are necessary to better understand how mHealth can change behavior and identify the conditions required for behavioral changes to persist over time. 
%M 32673263
%R 10.2196/18543
%U https://mhealth.jmir.org/2020/7/e18543
%U https://doi.org/10.2196/18543
%U http://www.ncbi.nlm.nih.gov/pubmed/32673263

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 7
%P e17183
%T Effect of a Health System–Sponsored Mobile App on Perinatal Health Behaviors: Retrospective Cohort Study
%A Cawley,Caroline
%A Buckenmeyer,Hannelore
%A Jellison,Trina
%A Rinaldi,Joseph B
%A Vartanian,Keri B
%+ Center for Outcomes Research and Education, Providence Portland Medical Center, 5251 NE Glisan Street, Portland, OR, 97213, United States, 1 503 215 2594, Keri.Vartanian@providence.org
%K mobile health
%K perinatal health
%K health behaviors
%D 2020

%7 6.7.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Pregnancy mobile apps are becoming increasingly popular, with parents-to-be seeking information related to their pregnancy and their baby through mobile technology. This increase raises the need for prenatal apps with evidence-based content that is personalized and reliable. Previous studies have looked at whether prenatal apps impact health and behavior outcomes among pregnant and postpartum individuals; however, research has been limited. Objective: The primary objective of this study is to assess whether the use of a health system–sponsored mobile app—Circle by Providence—aimed at providing personalized and reliable health information on pregnancy, postpartum recovery, and infant care is associated with improved health outcomes and increased healthy behaviors and knowledge among users. Methods: This observational study compared app users and app nonusers using a self-reported survey and electronic medical records. The study took place over 18 months and was conducted at Providence St. Joseph Health in Portland, Oregon. The sample included patients who received prenatal care at one of seven Providence clinics and had a live birth at a Providence hospital. Recruitment occurred on a rolling basis and only those who completed the survey were included. Survey respondents were separated into app users and app nonusers, and survey responses and clinical outcomes were compared across groups using univariate and adjusted multivariate logistic regression. Results: A total of 567 participants were enrolled in the study—167 in the app user group and 400 in the nonuser group. We found statistically significant differences between the two groups for certain behavior outcomes: subjects who used the app had 75% greater odds of breastfeeding beyond 6 months postpartum (P=.012), were less likely to miss prenatal appointments (P=.046), and were 50% more likely to exercise 3 or more times a week during pregnancy (P=.04). There were no differences in nutritional measures, including whether they took prenatal vitamins, ate 5 fruits or vegetables a day, or drank caffeine. We found no differences in many of the infant care outcomes; however, there was an increase in awareness of “purple crying.” Finally, there were no significant differences in measured clinical health outcomes, including cesarean births, length of hospital stays (in minutes), low birth weight infants, preterm births, small-for-gestational-age births, large-for-gestational-age births, and neonatal intensive care unit stays. Conclusions: The use of the Circle app, which provides access to personalized and evidence-based health information, was associated with an increase in certain healthy behaviors and health knowledge, although there was no impact on clinical health outcomes. More research is needed to determine the impact of mobile prenatal apps on healthy pregnancies, clinical health outcomes, and infant care. 
%M 32628123
%R 10.2196/17183
%U https://mhealth.jmir.org/2020/7/e17183
%U https://doi.org/10.2196/17183
%U http://www.ncbi.nlm.nih.gov/pubmed/32628123

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 7
%N 2
%P e14078
%T The Mobile Alliance for Maternal Action Text Message–Based mHealth Intervention for Maternal Care in South Africa: Qualitative User Study
%A Coleman,Jesse
%A Eriksen,Jaran
%A Black,Vivian
%A Thorson,Anna
%A Hatcher,Abigail
%+ Wits Reproductive Health & HIV Institute, School of Medicine, University of Witwatersrand, 22 Esselen Street, Hillbrow, Johannesburg, 2001, South Africa, 27 833991066, denots@gmail.com
%K maternal health
%K text messaging
%K focus groups
%K South Africa
%K mHealth
%K reproductive health
%K limited resource settings
%K public health
%K prenatal care
%K postnatal care
%D 2020

%7 29.6.2020
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: Using mobile technology to support health care (mobile health [mHealth]) has been shown to improve health outcomes across a multitude of health specialties and across the world. Exploring mHealth user experiences can aid in understanding how and why an intervention was successful. The Mobile Alliance for Maternal Action (MAMA) was a free maternal mHealth SMS text messaging service that was offered to pregnant women in Johannesburg, South Africa, with the goal of improving maternal, fetal, and infant health outcomes. We conducted focus group discussions with MAMA users to learn about their experiences with the program. Objective: The aim of this qualitative study was to gather opinions of participants of the MAMA maternal mHealth service regarding health care atmosphere, intervention use, and intervention feedback. Methods: Prenatal and postnatal women (N=15) from public antenatal and postnatal care sites in central Johannesburg who were receiving free maternal health text messages (MAMA) participated in 3 focus group discussions. Predefined discussion topics included personal background, health care system experiences, MAMA program recruitment, acceptability, participant experiences, and feedback. Results: The feedback regarding experiences with the health system were comprised of a few reports of positive experiences and many more reports of negative experiences such as long wait times, understaffed facilities, and poor service. Overall acceptability for the maternal text message intervention was high. Participants reflected that the messages were timely, written clearly, and felt supportive. Participants also reported sharing messages with friends and family. Conclusions: These findings suggest that maternal mHealth interventions delivered through text messages can provide timely, relevant, useful, and supportive information to pregnant women and new mothers especially in settings where there may be mistrust of the health care system. 
%M 32459628
%R 10.2196/14078
%U http://humanfactors.jmir.org/2020/2/e14078/
%U https://doi.org/10.2196/14078
%U http://www.ncbi.nlm.nih.gov/pubmed/32459628

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 22
%N 6
%P e17845
%T Evaluating Engagement in a Digital and Dietetic Intervention Promoting Healthy Weight Gain in Pregnancy: Mixed Methods Study
%A Willcox,Jane C
%A Chai,Daniel
%A Beilin,Lawrence J
%A Prescott,Susan L
%A Silva,Desiree
%A Neppe,Cliff
%A Huang,Rae-Chi
%+ Telethon Kids Institute, Hospital Avenue, Nedlands, Perth, 6009, Australia, 61 0402131555, rae-chi.huang@telethonkids.org.au
%K pregnancy
%K internet-based intervention
%K patient participation
%K qualitative research
%K eHealth
%K body weight
%K obesity
%D 2020

%7 26.6.2020
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Early excess and inadequate gestational weight gain (GWG) have been associated with negative outcomes for mother and child. The use of digital media to deliver pregnancy lifestyle interventions is increasing, but there is little data on participant engagement. The Pregnancy Lifestyle Activity and Nutrition (PLAN) intervention pilot study was an electronic health and dietetic-delivered intervention program promoting healthy GWG in early pregnancy. Objective: This study aims to explore the interactions of participants with the program and to assess its acceptability. Methods: This study uses both quantitative and qualitative methods using data from parent randomized controlled trial (ACTRN12617000725369). Quantitative data from 22 participants in the intervention arm who completed the study provided measures of the interactions participants had with the digital components of the program and with dietetic consultations. A descriptive qualitative analysis employed semistructured interviews with 9 participants to elicit views on the acceptability of the intervention and its components. Results: The electronic delivery of information and recording of weight from 8 to 20 weeks of gestation were universally accepted. Component (face-to-face dietitian, weight tracker, website information delivery, and SMS goal prompting) acceptability and engagement differed between individuals. A total of 4 key themes emerged from the qualitative analysis: supporting lifestyle change, component acceptability and value, delivery platforms, and engagement barriers. Conclusions: The PLAN intervention and its delivery via a blend of personal dietetic consultations and digital program delivery was found to be acceptable and valuable to pregnant women. Individuals responded differently to various components, emphasizing the importance of including women in the development of lifestyle interventions and allowing participants to choose and tailor programs. Larger randomized controlled trials using these insights in a broader section of the community are needed to inform the iterative development of practical, time-efficient, and cost-effective ways of supporting optimal GWG with the potential to optimize outcomes for pregnant women and their child. 
%M 32442153
%R 10.2196/17845
%U http://www.jmir.org/2020/6/e17845/
%U https://doi.org/10.2196/17845
%U http://www.ncbi.nlm.nih.gov/pubmed/32442153

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 6
%P e15890
%T Promoting Antenatal Care Attendance Through a Text Messaging Intervention in Samoa: Quasi-Experimental Study
%A Watterson,Jessica L
%A Castaneda,Diego
%A Catalani,Caricia
%+ School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, United States, 1 3602014410, jessica.watterson@gmail.com
%K mHealth
%K antenatal care
%K maternal health
%K text messages
%D 2020

%7 2.6.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Antenatal care (ANC) has the potential to improve maternal health, but it remains underutilized and unevenly implemented in many low- and middle-income countries. Increasingly, text messaging programs for pregnant women show evidence that they can improve the utilization of ANC during pregnancy; however, gaps remain regarding how implementation affects outcomes. Objective: This study aimed to assess facilitators and barriers to implementation of an SMS text messaging intervention for pregnant women in Samoa and to assess its impact on ANC attendance. Methods: This study took place in Upolu, Samoa, from March to August 2014 and employed a quasi-experimental design. Half (n=3) of the public antenatal clinics on the island offered adult pregnant women the SMS text messaging intervention, with 552 women registering for the messages. At the comparison clinics (n=3), 255 women registered and received usual care. The intervention consisted of unidirectional text messages containing health tips and appointment reminders. The outcome of interest was the number of attended antenatal visits. Implementation data were also collected through a survey of the participating midwives (n=7) and implementation notes. Data analysis included a comparison of women’s baseline characteristics between the two groups, followed by the use of negative binomial regressions to test for associations between participation in the intervention and increased ANC attendance, controlling for individual characteristics and accounting for the clustering of women within clinics. Results: The comparison of ANC attendance rates found that women receiving the SMS text messaging intervention attended 15% fewer ANC visits than the comparison group (P=.004), controlling for individual characteristics and clustering. Data analysis of the implementation process suggests that barriers to successful implementation include women registering very late in pregnancy, sharing their phone with others, and inconsistent explanation of the intervention to women. Conclusions: These results suggest that unidirectional text messages do not encourage, and might even discourage, ANC attendance in Samoa. Interpreted with other evidence in the literature, these results suggest that SMS text messaging interventions are more effective when they facilitate better communication between patients and health workers. This study is an important contribution to our understanding of when SMS text messaging interventions are and are not effective in improving maternal health care utilization. 
%M 32484446
%R 10.2196/15890
%U https://mhealth.jmir.org/2020/6/e15890
%U https://doi.org/10.2196/15890
%U http://www.ncbi.nlm.nih.gov/pubmed/32484446

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 5
%P e15111
%T Mobile Phone–Based Behavioral Interventions in Pregnancy to Promote Maternal and Fetal Health in High-Income Countries: Systematic Review
%A Hussain,Tasmeen
%A Smith,Patricia
%A Yee,Lynn M
%+ Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, #5-2145, Chicago, IL, United States, 1 312 472 4685, lynn.yee@northwestern.edu
%K mHealth
%K mobile health
%K pregnancy
%K smartphone
%K text messaging
%K mobile applications
%K software
%K chronic disease
%K health behavior
%D 2020

%7 28.5.2020
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Chronic diseases have recently had an increasing effect on maternal-fetal health, especially in high-income countries. However, there remains a lack of discussion regarding health management with technological approaches, including mobile health (mHealth) interventions. Objective: This study aimed to systematically evaluate mHealth interventions used in pregnancy in high-income countries and their effects on maternal health behaviors and maternal-fetal health outcomes. Methods: This systematic review identified studies published between January 1, 2000, and November 30, 2018, in MEDLINE via PubMed, Cochrane Library, EMBASE, CINAHL, PsycINFO, Web of Science, and gray literature. Studies were eligible for inclusion if they included only pregnant women in high-income countries and evaluated stand-alone mobile phone 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 source, study design, intervention and control, duration, participant age, attrition rate, 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 before initiation. Results: Of the 2225 records examined, 28 studies were included and categorized into 4 themes: (1) gestational weight gain, obesity and physical activity (n=9); (2) smoking cessation (n=9); (3) influenza vaccination (n=2); and (4) general prenatal health, preventive strategies, and miscellaneous topics (n=8). Reported sample sizes ranged from 16 to 5243 with a median of 91. Most studies were performed in the United States (18/28, 64%) and were randomized controlled trials (21/28, 75%). All participants in the included studies were pregnant at the time of study initiation. Overall, 14% (4/28) of studies showed association between intervention use and improved health outcomes; all 4 studies focused on healthy gestational weight. Among those, 3 studies showed intervention use was associated with less overall gestational weight gain. These 3 studies involved interventions with 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. Data and interventions were heterogeneous, precluding a meta-analysis. Conclusions: In high-income countries, utilization of mobile phone–based health behavior interventions in pregnancy demonstrates some correlation with positive beliefs, behaviors, and health outcomes. More effective interventions are multimodal in terms of features and tend to focus on healthy gestational weight gain. 
%M 32463373
%R 10.2196/15111
%U https://mhealth.jmir.org/2020/5/e15111
%U https://doi.org/10.2196/15111
%U http://www.ncbi.nlm.nih.gov/pubmed/32463373

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 5
%P e15112
%T A Pedometer-Guided Physical Activity Intervention for Obese Pregnant Women (the Fit MUM Study): Randomized Feasibility Study
%A Darvall,Jai N
%A Wang,Andrew
%A Nazeem,Mohamed Nusry
%A Harrison,Cheryce L
%A Clarke,Lauren
%A Mendoza,Chennelle
%A Parker,Anna
%A Harrap,Benjamin
%A Teale,Glyn
%A Story,David
%A Hessian,Elizabeth
%+ Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne, 3050, Australia, 61 393427000, jai.darvall@mh.org.au
%K gestational weight gain
%K pregnancy
%K maternal obesity
%K lifestyle intervention
%K pedometer
%D 2020

%7 26.5.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Obesity in pregnancy is a growing problem worldwide, with excessive gestational weight gain (GWG) occurring in the majority of pregnancies. This significantly increases risks to both mother and child. A major contributor to both prepregnancy obesity and excessive GWG is physical inactivity; however, past interventions targeting maternal weight gain and activity levels during the antenatal period have been ineffective in women who are already overweight. Pedometer-guided activity may offer a novel solution for increasing activity levels in this population. Objective: This initial feasibility randomized controlled trial aimed to test a pedometer-based intervention to increase activity and reduce excessive GWG in pregnant women. Methods: We supplied 30 pregnant women with obesity a Fitbit Zip pedometer and randomized them into 1 of 3 groups: control (pedometer only), app (pedometer synced to patients’ personal smartphone, with self-monitoring of activity), or app-coach (addition of a health coach–delivered behavioral change program). Feasibility outcomes included participant compliance with wearing pedometers (days with missing pedometer data), data syncing, and data integrity. Activity outcomes (step counts and active minutes) were analyzed using linear mixed models and generalized estimating equations. Results: A total of 30 participants were recruited within a 10-week period, with a dropout rate of 10% (3/30; 2 withdrawals and 1 stillbirth); 27 participants thus completed the study. Mean BMI in all groups was ≥35 kg/m2. Mean (SD) percentage of missing data days were 23.4% (20.6%), 39.5% (32.4%), and 21.1% (16.0%) in control, app group, and app-coach group patients, respectively. Estimated mean baseline activity levels were 14.5 active min/day and 5455 steps/day, with no significant differences found in activity levels between groups, with mean daily step counts in all groups remaining in the sedentary (5000 steps/day) or low activity (5000-7499 steps/day) categories for the entire study duration. There was a mean decrease of 7.8 steps/day for each increase in gestation day over the study period (95% CI 2.91 to 12.69, P=.002). Conclusions: Activity data syncing with a personal smartphone is feasible in a cohort of pregnant women with obesity. However, our results do not support a future definitive study in its present form. Recruitment and retention rates were adequate, as was activity data syncing to participants’ smartphones. A follow-up interventional trial seeking to reduce GWG and improve activity in this population must focus on improving compliance with activity data recording and behavioral interventions delivered. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12617000038392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370884 
%M 32348280
%R 10.2196/15112
%U http://mhealth.jmir.org/2020/5/e15112/
%U https://doi.org/10.2196/15112
%U http://www.ncbi.nlm.nih.gov/pubmed/32348280

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 22
%N 5
%P e15773
%T A Mobile App Lifestyle Intervention to Improve Healthy Nutrition in Women Before and During Early Pregnancy: Single-Center Randomized Controlled Trial
%A van Dijk,Matthijs R
%A Koster,Maria P H
%A Oostingh,Elsje C
%A Willemsen,Sten P
%A Steegers,Eric A P
%A Steegers-Theunissen,Régine P M
%+ Department of Obstetrics and Gynaecology, Erasmus Medical Center, University Medical Center Rotterdam, PO Box 2040, Rotterdam, Netherlands, 31 107038254, r.steegers@erasmusmc.nl
%K mHealth
%K preconception care
%K nutrition
%K pregnancy
%D 2020

%7 15.5.2020
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Unhealthy nutrition contributes to the worldwide rising prevalence of noncommunicable diseases. As most adverse reproductive outcomes originate during the periconception period, effective interventions targeting this period are needed. Therefore, we developed the lifestyle intervention Smarter Pregnancy to empower women to adapt a healthy diet prior to conception and during early pregnancy and performed a randomized controlled trial. Objective: The objectives of this trial were to investigate compliance and effectiveness in women using the Smarter Pregnancy program. Methods: Women aged between 18 and 45 years who were contemplating pregnancy or <13 weeks pregnant and their male partners living in the urban area of Rotterdam, the Netherlands, were eligible for participation. After baseline screening, the intervention group received personal online coaching based on identified inadequate intakes of vegetables, fruits, and folic acid supplements. The sum of these risk factors was used as a dietary risk score (DRS), ranging from 0 (healthy) to 9 (unhealthy). The control group did not receive coaching. We applied an intention-to-treat principle and used a multivariable linear regression model to evaluate the change in DRS after 24 weeks. Compliance was defined as the percentage of women who completed the screening questionnaire at 24 weeks. Results: Of women recruited, 81.2% (177/218) completed the program (intervention: 91/218, 83.5%; control: 86/218, 78.9%; P=.95). After 24 weeks, the reduction in DRS of women in the intervention group was significantly larger than in the control group (β=.75, 95% CI 0.18-1.34). This reduction was mainly due to increased vegetable intake (β=.55, 95% CI 0.25-0.86). Conclusions: The high compliance and the larger improvements in nutritional behaviors, especially vegetable intake, in women in the intervention group emphasizes the effectiveness of empowering women by using the lifestyle change intervention Smarter Pregnancy. Trial Registration: Netherlands Trial Register: NL3927; https://www.trialregister.nl/trial/3927 International Registered Report Identifier (IRRID): RR2-10.1186/s12884-017-1228-5 
%M 32412417
%R 10.2196/15773
%U https://www.jmir.org/2020/5/e15773
%U https://doi.org/10.2196/15773
%U http://www.ncbi.nlm.nih.gov/pubmed/32412417

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 3
%N 1
%P e14109
%T Quality of Pregnancy Dating and Obstetric Interventions During Labor: Retrospective Database Analysis
%A Reis,Zilma Silveira Nogueira
%A Gaspar,Juliano De Souza
%A Vitral,Gabriela Luiza Nogueira
%A Abrantes,Vitor Barbosa
%A de-Souza,Ingrid Michelle Fonseca
%A Moreira,Maria Tereza Silveira
%A Lopes Pessoa Aguiar,Regina Amélia
%+ Center of Health Informatics, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 601, Belo Horizonte, 30130100, Brazil, 55 31 3409 9467, zilma.medicina@gmail.com
%K gestational age
%K parturition
%K ultrasound
%K pregnancy dating
%K information systems
%D 2020

%7 15.4.2020
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: The correct dating of pregnancy is critical to support timely decisions and provide obstetric care during birth. The early obstetric ultrasound assessment before 14 weeks is considered the best reference to assist in determining gestational age (GA), with an accuracy of ±5 to 7 days. However, this information is limited in many settings worldwide. Objective: The aim of this study is to analyze the association between the obstetric interventions during childbirth and the quality of GA determination, according to the first antenatal ultrasound assessment, which assisted the calculation. Methods: This is a hospital-based cohort study using medical record data of 2113 births at a perinatal referral center. The database was separated into groups and subgroups of analyses based on the reference used by obstetricians to obtain GA at birth. Maternal and neonatal characteristics, mode of delivery, oxytocin augmentation, and forceps delivery were compared between groups of pregnancies with GA determination at different reference points: obstetric ultrasound assessment 14 weeks, 20 weeks, and ≥20 weeks or without antenatal ultrasound (suboptimal dating). Ultrasound-based GA information was associated with outcomes between the interest groups using chi-square tests, odds ratios (OR) with 95% CI, or the Mann-Whitney statistical analysis. Results: The chance of nonspontaneous delivery was higher in pregnancies with 14 weeks ultrasound-based GA (OR 1.64, 95% CI 1.35-1.98) and 20 weeks ultrasound-based GA (OR 1.58, 95% CI 1.31-1.90) when compared to the pregnancies with ≥20 weeks ultrasound-based GA or without any antenatal ultrasound. The use of oxytocin for labor augmentation was higher for 14 weeks and 20 weeks ultrasound-based GA, OR 1.41 (95% CI 1.09-1.82) and OR 1.34 (95% CI 1.04-1.72), respectively, when compared to those suboptimally dated. Moreover, maternal blood transfusion after birth was more frequent in births with suboptimal ultrasound-based GA determination (20/657, 3.04%) than in the other groups (14 weeks ultrasound-based GA: 17/1163, 1.46%, P=.02; 20 weeks ultrasound-based GA: 25/1456, 1.71%, P=.048). Cesarean section rates between the suboptimal dating group (244/657, 37.13%) and the other groups (14 weeks: 475/1163, 40.84%, P=.12; 20 weeks: 584/1456, 40.10%, P=.20) were similar. In addition, forceps delivery rates between the suboptimal dating group (17/657, 2.6%) and the other groups (14 weeks: 42/1163, 3.61%, P=.24; 20 weeks: 46/1456, 3.16%, P=.47) were similar. Neonatal intensive care unit admission was more frequent in newborns with suboptimal dating (103/570, 18.07%) when compared with the other groups (14 weeks: 133/1004, 13.25%, P=.01; 20 weeks: 168/1263, 13.30%, P=.01), excluding stillbirths and major fetal malformations. Conclusions: The present analysis highlighted relevant points of health care to improve obstetric assistance, confirming the importance of early access to technologies for pregnancy dating as an essential component of quality antenatal care. 
%M 32293572
%R 10.2196/14109
%U http://pediatrics.jmir.org/2020/1/e14109/
%U https://doi.org/10.2196/14109
%U http://www.ncbi.nlm.nih.gov/pubmed/32293572

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 4
%N 4
%P e16151
%T Development and Modification of a Mobile Health Program to Promote Postpartum Weight Loss in Women at Elevated Risk for Cardiometabolic Disease: Single-Arm Pilot Study
%A Nicklas,Jacinda M
%A Leiferman,Jenn A
%A Lockhart,Steven
%A Daly,Kristen M
%A Bull,Sheana S
%A Barbour,Linda A
%+ Division of General Internal Medicine, University of Colorado School of Medicine, 12348 E Montview Blvd, Aurora, CO, 80045, United States, 1 3037249028, Jacinda.Nicklas@cuanschutz.edu
%K mobile health
%K postpartum
%K chronic disease
%K prevention
%K weight loss
%D 2020

%7 9.4.2020
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Pregnancy complications in combination with postpartum weight retention lead to significant risks of cardiometabolic disease and obesity. The majority of traditional face-to-face interventions have not been effective in postpartum women. Mobile technology enables the active engagement of postpartum women to promote lifestyle changes to prevent chronic diseases. Objective: We sought to employ an interactive, user-centered, and participatory method of development, evaluation, and iteration to design and optimize the mobile health (mHealth) Fit After Baby program. Methods: For the initial development, a multidisciplinary team integrated evidence-based approaches for health behavior, diet and physical activity, and user-centered design and engagement. We implemented an iterative feedback and design process via 3 month-long beta pilots in which postpartum women with cardiometabolic risk factors participated in the program and provided weekly and ongoing feedback. We also conducted two group interviews using a structured interview guide to gather additional feedback. Qualitative data were recorded, transcribed, and analyzed using established qualitative methods. Modifications based on feedback were integrated into successive versions of the app. Results: We conducted three pilot testing rounds with a total of 26 women. Feedback from each pilot cohort informed changes to the functionality and content of the app, and then a subsequent pilot group participated in the program. We optimized the program in response to feedback through three iterations leading to a final version. Conclusions: This study demonstrates the feasibility of using an interactive, user-centered, participatory method of rapid, iterative design and evaluation to develop and optimize a mHealth intervention program for postpartum women. Trial Registration: ClinicalTrials.gov NCT02384226; https://www.clinicaltrials.gov/ct2/show/NCT02384226 
%M 32271149
%R 10.2196/16151
%U https://formative.jmir.org/2020/4/e16151
%U https://doi.org/10.2196/16151
%U http://www.ncbi.nlm.nih.gov/pubmed/32271149

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 4
%P e17122
%T Patterns of Mobile Phone Ownership and Use Among Pregnant Women in Southern Tanzania: Cross-Sectional Survey
%A Vasudevan,Lavanya
%A Ostermann,Jan
%A Moses,Sara Marwerwe
%A Ngadaya,Esther
%A Mfinanga,Sayoki Godfrey
%+ Department of Family Medicine and Community Health, School of Medicine, Duke University, DUMC 104006, Durham, NC, 27710, United States, 1 9196131423, lavanya.vasudevan@duke.edu
%K digital health
%K mobile health
%K pregnant women
%K Tanzania
%D 2020

%7 8.4.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: There is a paucity of subnational data on patterns of mobile phone ownership and use in Tanzania to inform the development of digital health interventions. Objective: The aim of this study is to assess patterns of mobile phone ownership and use in pregnant women to inform the feasibility and design of digital health interventions for promoting timely uptake of childhood vaccines in southern Tanzania. Methods: Between August and November 2017, pregnant women in their third trimester were enrolled at health facilities and from surrounding communities, and asked about their patterns of mobile phone ownership and use in an interviewer administered survey. Results: Of 406 women, only 3 had never used a phone. Most women (>98%) could make and receive phone calls. Compared to urban women, rural women reported higher mobile phone use rates but were less likely to be sole owners of phones, and less likely to send or receive SMS, transact money, browse the internet, or use social media via mobile phones. Conclusions: The findings suggest high feasibility for digital health interventions delivered via mobile phones to pregnant women in southern Tanzania. The feasibility of smartphone-based interventions or strategies relying on the use of social media or the internet is limited. 
%M 32267240
%R 10.2196/17122
%U https://mhealth.jmir.org/2020/4/e17122
%U https://doi.org/10.2196/17122
%U http://www.ncbi.nlm.nih.gov/pubmed/32267240

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 22
%N 3
%P e15172
%T The Effectiveness of a Guided Internet-Based Tool for the Treatment of Depression and Anxiety in Pregnancy (MamaKits Online): Randomized Controlled Trial
%A Heller,Hanna M
%A Hoogendoorn,Adriaan W
%A Honig,Adriaan
%A Broekman,Birit F P
%A van Straten,Annemieke
%+ Department of Psychiatry, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, 1081 HV, Netherlands, 31 204440196, hm.heller@amsterdamumc.nl
%K pregnancy
%K depression
%K anxiety
%K internet
%K pregnancy outcome
%K treatment
%D 2020

%7 23.3.2020
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Pregnant women with symptoms of depression or anxiety often do not receive adequate treatment. In view of the high incidence of these symptoms in pregnancy and their impact on pregnancy outcomes, getting treatment is of the utmost importance. A guided internet self-help intervention may help to provide more women with appropriate treatment. Objective: This study aimed to examine the effectiveness of a guided internet intervention (MamaKits online) for pregnant women with moderate to severe symptoms of anxiety or depression. Assessments took place before randomization (T0), post intervention (T1), at 36 weeks of pregnancy (T2), and 6 weeks postpartum (T3). We also explored effects on perinatal child outcomes 6 weeks postpartum. Methods: This randomized controlled trial included pregnant women (<30 weeks) with depressive symptoms above threshold (ie, Center for Epidemiological Studies Depression scale [CES-D] >16) or anxiety above threshold (ie, Hospital Anxiety and Depression Scale-Anxiety subscale [HADS-A] >8) or both of them. Participants were recruited via general media and flyers in prenatal care waiting rooms or via obstetricians and midwives. After initial assessment, women were randomized to (1) MamaKits online in addition to treatment as usual or (2) treatment as usual (control condition). MamaKits online is a 5-week guided internet intervention based on problem solving treatment. Guidance was was provided by trained students pursuing a Master's in Psychology. Outcomes were based on a Web-based self-report. Women in the control condition were allowed to receive the intervention after the last assessment (6 weeks postpartum). Results: Of the 159 included women, 79 were randomized to MamaKits online, 47% (79/37) of whom completed the intervention. Both groups showed a substantial decrease in affective symptoms on the CES-D, HADS-A, and Edinburgh Postnatal Depression Scale over time. In the intervention group, affective symptoms decreased more than that in the control group, but between-group effect sizes were small to medium (Cohen d at T3=0.45, 0.21, and 0.23 for the 3 questionnaires, respectively) and statistically not significant. Negative perinatal child outcomes did not differ between the 2 groups (χ21=0.1; P=.78). Completer analysis revealed no differences in outcome between the treatment completers and the control group. The trial was terminated early for reasons of futility based on the results of an interim analysis, which we performed because of inclusion problems. Conclusions: Our study did show a significant reduction in affective symptoms in both groups, but the differences in reduction of affective symptoms between the intervention and control groups were not significant. There were also no differences in perinatal child outcomes. Future research should examine for which women these interventions might be effective or if changes in the internet intervention might make the intervention more effective. Trial Registration: Netherlands Trial Register NL4162; https://tinyurl.com/sdckjek 
%M 32202505
%R 10.2196/15172
%U http://www.jmir.org/2020/3/e15172/
%U https://doi.org/10.2196/15172
%U http://www.ncbi.nlm.nih.gov/pubmed/32202505

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 22
%N 3
%P e14095
%T Medical Help-Seeking Strategies for Perinatal Women With Obstetric and Mental Health Problems and Changes in Medical Decision Making Based on Online Health Information: Path Analysis
%A Chung,Kyungmi
%A Cho,Hee Young
%A Kim,Young Ran
%A Jhung,Kyungun
%A Koo,Hwa Seon
%A Park,Jin Young
%+ Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, , Republic of Korea, 82 2 2228 0972, empathy@yuhs.ac
%K perinatal care
%K obstetrics
%K mental health
%K information seeking behavior
%K help-seeking behavior
%K self efficacy
%K health literacy
%K consultation
%K decision making
%K internet
%D 2020

%7 4.3.2020
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Previous studies have revealed that most pregnant women rarely discuss informal information found on the internet with health professionals and have frequently expressed concerns for medical experts’ reactions to the online information they shared, as well as the lack of time to consult the medical experts in general. To date, little information is available on the effect of individual differences in utilizing medical help-seeking strategies on their medical decisions during the perinatal period. Objective: The objectives of this study were (1) to determine associations among perinatal women’s medical help-seeking strategies, changes in medical decision making, and online health information utilization with a focus on the mediating effect of self-efficacy in perinatal health literacy on the intent to consult health professionals, and (2) to clarify these associations in perinatal women with two different medical problems: obstetric and mental health. Methods: A total of 164 perinatal women aged 24 to 47 years (mean 34.64, SD 3.80) repeatedly completed the Problem Solving in Medicine and Online Health Information Utilization questionnaires to examine the moderating effect of two types of medical problems on their decision-making processes. To validate the hypothesized relationships in the proposed conceptual model encompassing obstetric and mental health problem-solving models, path analyses were performed. Results: This study found that some perinatal women, who use an online informal medical help-seeking (OIMH) strategy, would be more likely to change their medical decisions based only on internet-based information without consulting health professionals (P<.001), compared to other women using different medical help-seeking strategies. Particularly, this concern is significantly prevalent when encountering obstetric problems during the perinatal period (obstetric problem-solving: P<.001; mental health problem-solving: P=.02). Furthermore, perinatal women with mental health issues using the OIMH strategy showed a significant difference in intent to consult health professionals based on online health information when the medical problem they had to solve was different (obstetric problem-solving: P=.94; mental health problem-solving: P=.003). Conclusions: Despite the positive mediating effects of perinatal women’s enhanced health literacy on the intent to discuss personal medical issues with health professionals based on online health information, the strategy used is of fundamental importance for understanding their help-seeking and decision-making processes during the perinatal period. Beyond a short consultation to steer patients quickly and authoritatively towards an obstetric doctor’s choice of action, it is recommended in this study that obstetricians attempt to provide their patients with needed context for the information found online. To fully explain this information with an open mind, they should actively develop or support information and communications technology (ICT)-based health information services. 
%M 32130139
%R 10.2196/14095
%U https://www.jmir.org/2020/3/e14095
%U https://doi.org/10.2196/14095
%U http://www.ncbi.nlm.nih.gov/pubmed/32130139

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 4
%N 2
%P e16090
%T Development and Field Evaluation of the INTER-ACT App, a Pregnancy and Interpregnancy Coaching App to Reduce Maternal Overweight and Obesity: Mixed Methods Design
%A Bogaerts,Annick
%A Bijlholt,Margriet
%A Mertens,Lotte
%A Braeken,Marijke
%A Jacobs,Bart
%A Vandenberghe,Bert
%A Ameye,Lieveke
%A Devlieger,Roland
%+ Department of Development and Regeneration, University of Leuven, O&N IV Herestraat 49 - bus 805, Leuven, 3000, Belgium, 32 16 19 31 27, annick.bogaerts@kuleuven.be
%K pregnancy
%K postpartum
%K coaching
%K lifestyle
%K mobile app
%D 2020

%7 14.2.2020
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The interpregnancy and pregnancy periods are important windows of opportunity to prevent excessive gestational weight retention. Despite an overwhelming number of existing health apps, validated apps to support a healthy lifestyle between and during pregnancies are lacking. Objective: To describe the development and evaluation of the INTER-ACT app, which is part of an interpregnancy and pregnancy lifestyle coaching module, to prevent excessive weight gain in pregnancy and enhance optimal weight and a healthy lifestyle in the interpregnancy period. Methods: A mixed methods design was used to identify the needs of health care providers and end users, according to 15 semistructured interviews, two focus groups, and two surveys. The user interface was evaluated in a pilot study (N=9). Results: Health care providers indicated that a mobile app can enhance a healthy lifestyle in pregnant and postpartum women. Pregnant women preferred graphic displays in the app, weekly notifications, and support messages according to their own goals. Both mothers and health care providers reported increased awareness and valued the combination of the app with face-to-face coaching. Conclusions: The INTER-ACT app was valued by its end users because it was offered in combination with face-to-face contact with a caregiver. 
%M 32130109
%R 10.2196/16090
%U http://formative.jmir.org/2020/2/e16090/
%U https://doi.org/10.2196/16090
%U http://www.ncbi.nlm.nih.gov/pubmed/32130109

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 2
%P e14737
%T Using Text Messaging to Improve Access to Prenatal Health Information in Urban African American and Afro-Caribbean Immigrant Pregnant Women: Mixed Methods Analysis of Text4baby Usage
%A Blackwell,Tenya M
%A Dill,LeConte J
%A Hoepner,Lori A
%A Geer,Laura A
%+ Department of Environmental and Occupational Health Sciences, SUNY Downstate Health Sciences University, School of Public Health, 450 Clarkson Avenue, Brooklyn, NY, United States, 1 7182703101, tblackwell@arthurasheinstitute.org
%K Text4baby
%K mHealth
%K pregnancy
%K text messaging
%K health information
%K prenatal health
%K disparities
%D 2020

%7 13.2.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The Text4baby (T4B) mobile health (mHealth) program is acclaimed to provide pregnant women with greater access to prenatal health care, resources, and information. However, little is known about whether urban African American and Afro-Caribbean immigrant pregnant women in the United States are receptive users of innovative health communication methods or of the cultural and systematic barriers that inhibit their behavioral intent to use T4B. Objective: This study aimed to understand the lived experiences of urban African American and Afro-Caribbean immigrant pregnant women with accessing quality prenatal health care and health information; to assess usage of mHealth for seeking prenatal health information; and to measure changes in participants’ knowledge, perceptions, and behavioral intent to use the T4B mHealth educational intervention. Methods: An exploratory sequential mixed methods study was conducted among pregnant women and clinical professionals for a phenomenological exploration with focus groups, key informants, interviews, and observations. Qualitative themes were aligned with behavioral and information technology communications theoretical constructs to develop a survey instrument used. repeated-measures pre- and post-test design to evaluate changes in participants’ knowledge, attitudes, and beliefs, of mHealth and T4B after a minimum of 4 weeks’ exposure to the text message–based intervention. Triangulation and mixing of both qualitative and quantitative data occurred primarily during the survey development and also during final analysis. Results: A total of 9 women participated in phase 1, and 49 patients signed up for T4B and completed a 31-item survey at baseline and again during follow-up. Three themes were identified: (1) patient-provider engagement, (2) social support, and (3) acculturation. With time as a barrier to quality care, inadequate patient-provider engagement left participants feeling indifferent about the prenatal care and information they received in the clinical setting. Of 49 survey participants, 63% (31/49) strongly agreed that T4B would provide them with extra support during their pregnancy. On a Likert scale of 1 to 5, participants’ perception of the usefulness of T4B ranked at 4.26, and their perception of the compatibility and relative advantage of using T4B ranked at 4.41 and 4.15, respectively. At follow-up, there was a 14% increase in participants reporting their intent to use T4B and a 28% increase from pretest and posttest in pregnant women strongly agreeing to speak more with their doctor about the information learned through T4B. Conclusions: Urban African American and Afro-Caribbean immigrant pregnant women in Brooklyn endure a number of social and ecological determinants like low health literacy, income, and language that serve as barriers to accessing quality prenatal health care and information, which negatively impacts prenatal health behaviors and outcomes. Our study indicates a number of systematic, political, and other microsystem-level factors that perpetuate health inequities in our study population. 
%M 32053117
%R 10.2196/14737
%U http://mhealth.jmir.org/2020/2/e14737/
%U https://doi.org/10.2196/14737
%U http://www.ncbi.nlm.nih.gov/pubmed/32053117

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 21
%N 12
%P e13694
%T Pregnancy-Related Information Seeking and Sharing in the Social Media Era Among Expectant Mothers: Qualitative Study
%A Zhu,Chengyan
%A Zeng,Runxi
%A Zhang,Wei
%A Evans,Richard
%A He,Rongrong
%+ Smart Health Institute, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, #13 Hangkong Road, Qiaokou District, Wuhan, 430030, China, 86 13397110378, weizhanghust@hust.edu.cn
%K pregnant women
%K social media
%K information seeking
%K consumer health information
%K China
%D 2019

%7 4.12.2019
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Social media has become the most popular communication tool used by Chinese citizens, including expectant mothers. An increasing number of women have adopted various forms of social media channels, such as interactive websites, instant messaging, and mobile apps, to solve problems and obtain answers to queries during pregnancy. Although the use of the internet by pregnant women has been studied extensively worldwide, limited research exists that explores the changing social media usage habits in China, where the 1 child policy ended in 2015. Objective: This study aimed to (1) present the status quo of pregnancy-related information seeking and sharing via social media among Chinese expectant mothers, (2) reveal the impact of social media usage, and (3) shed light on pregnancy-related health services delivered via social media channels. Methods: A qualitative approach was employed to examine social media usage and its consequences on pregnant women. A total of 20 women who had conceived and were at various stages of pregnancy were interviewed from July 20 to August 10, 2017. Thematic analysis was conducted on the collected data to identify patterns in usage. Results: Overall, 80% (16/20) of participants were aged in their 20s (mean 28.5 years [SD 4.3]). All had used social media for pregnancy-related purposes. For the seeking behavior, 18 codes were merged into 4 themes, namely, gravida, fetus, delivery, and the postpartum period; whereas for sharing behaviors, 10 codes were merged into 4 themes, namely, gravida, fetus, delivery, and caretaker. Lurking, small group sharing, bad news avoidance, and cross-checking were identified as the preferred patterns for using social media. Overall, 95% (19/20) of participants reported a positive mental impact from using social media during their pregnancy. Conclusions: It is indisputable that social media has played an increasingly important role in supporting expectant mothers in China. The specific seeking and sharing patterns identified in this study indicate that the general quality of pregnancy-related information on social media, as well as Chinese culture toward pregnancy, is improving. The new themes that merge in pregnancy-related social media use represent a shift toward safe pregnancy and the promotion of a more enjoyable pregnancy. Future prenatal care should provide further information on services related to being comfortable during pregnancy and reducing the inequality of social media–based services caused by the digital divide. 
%M 31799939
%R 10.2196/13694
%U https://www.jmir.org/2019/12/e13694
%U https://doi.org/10.2196/13694
%U http://www.ncbi.nlm.nih.gov/pubmed/31799939

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 8
%N 11
%P e15530
%T Delivering a Post-Partum Weight Loss Intervention via Facebook or In-Person Groups: Protocol for a Randomized Feasibility Pilot Trial
%A Waring,Molly E
%A Libby,Brooke A
%A Moore Simas,Tiffany A
%A Bracken,Madison L
%A Bibeau,Jessica L
%A Herrera,Valeria
%A Wang,Justin
%A Pagoto,Sherry L
%+ Department of Allied Health Sciences, UConn Center for mHealth and Social Media, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269, United States, 1 8604861446, molly.waring@uconn.edu
%K postpartum period
%K weight loss
%K social media
%K pilot study
%D 2019

%7 28.11.2019
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Postpartum weight retention contributes to long-term weight gain and obesity for many women. Lifestyle interventions with numerous visits are logistically challenging for many postpartum women. Delivering a lifestyle intervention via social media may overcome logistic challenges to participation in in-person weight loss programs. Objective: The objective of this study is to conduct a randomized feasibility pilot trial of a 6-month postpartum weight loss intervention delivered via Facebook or in-person groups with 72 postpartum women with overweight or obesity. Methods: Women with overweight or obesity who are 8 weeks to 12 months postpartum (N=72) will be recruited from the Hartford, Connecticut community. Eligible participants must also own an iPhone or Android smartphone and be an active Facebook user. Participants will receive a 6-month postpartum weight loss intervention based on the Diabetes Prevention Program lifestyle intervention and adapted for postpartum women. Participants will be randomized to receive the intervention via a private Facebook group or in-person group meetings. Assessments will occur at baseline, weekly during the intervention, at 6 months (at the end of the intervention), and at 12 months. Primary feasibility outcomes are recruitment, sustained participation, contamination, retention, and feasibility of assessment procedures including measurement of costs to deliver and receive the intervention. We will describe 6- and 12-month weight loss as an exploratory outcome. Results: Recruitment began in September 2018. The first wave of the intervention began in February 2019, and the second wave of the intervention is expected to begin in fall 2019. We anticipate completing follow-up assessments in fall 2020, and results will be analyzed at that time. Conclusions: Results will inform the design of a large randomized controlled trial to assess whether delivering a postpartum weight loss intervention via Facebook is noninferior for weight loss and more cost-effective than delivering the intervention via traditional in-person groups. International Registered Report Identifier (IRRID): DERR1-10.2196/15530 
%M 31778116
%R 10.2196/15530
%U http://www.researchprotocols.org/2019/11/e15530/
%U https://doi.org/10.2196/15530
%U http://www.ncbi.nlm.nih.gov/pubmed/31778116

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 3
%N 4
%P e13013
%T A Promising Food-Coaching Intervention Program to Achieve Optimal Gestational Weight Gain in Overweight and Obese Pregnant Women: Pilot Randomized Controlled Trial of a Smartphone App
%A Li,Ling-Jun
%A Aris,Izzuddin M
%A Han,Wee Meng
%A Tan,Kok Hian
%+ Department of Obstetrics & Gynecology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Children's Tower Level 3, Singapore, 229899, Singapore, 65 63941099, queenie.li.l.j@gmail.com
%K overweight, obesity, pregnant women
%K gestational weight gain
%K food diary
%K randomized controlled trial
%K smartphone app
%K food coaching
%K dietary recommendation
%K feasibility
%D 2019

%7 24.10.2019
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Traditional dietary recommendations for achieving optimal gestational weight gain are ineffective for pregnant women due to the lack of real-time communication and tedious consultation processes. Objective: In this pilot study, we aimed to determine the feasibility of a novel food-coaching smartphone app for controlling gestational weight gain and macronutrient intake among overweight and obese pregnant women. Methods: We designed a randomized controlled trial and recruited 30 overweight and obese pregnant women (1:1 ratio) during 18-20 weeks of gestation and followed them up after 4 and 8 weeks, respectively. Both groups received standard pregnancy dietary orientation at recruitment, while the intervention group received 8 weeks of real-time food coaching via a smartphone app. This food-coaching smartphone app (Glycoleap, Holmusk, Singapore) aimed to improve care and outcomes for people with diabetes. Pregnant women using this app were able to upload food images (eg, a picture of a meal, a drink, or a dessert) and received real-time and detailed food-coaching comments and guidance provided by professional dietitians during the day (8 AM to 8 PM). We recorded detailed characteristics during recruitment and examined anthropometry at all visits. We compared the mean differences of the 8-week gestational weight gain and macronutrient intake between the two groups. Results: Upon study completion, three subjects dropped out from the intervention, and one gave birth prematurely in the control group. The acceptance rate of the smartphone app was 90%. More participants achieved optimal gestational weight gain per week in the intervention group (8/12, 67%) than in the control group (5/14, 36%). After the 8-week intervention, women in the intervention group appeared to have lower gestational weight gain (mean difference=–0.08 kg; 95% CI –1.80 to 1.63) and cholesterol intake (mean difference=–31.73 mg; 95% CI –102.91 to 39.45) than those in the control group. Conclusions: Our findings showed that this food-coaching smartphone app is feasible and favorable for weight gain control and cholesterol intake control among overweight and obese pregnant women. Although our results were not significant (perhaps, attributed to the small sample size), it provided proof of concept for the feasibility of applying such technology in future randomized controlled trials with a larger sample size, an earlier intervention onset, and a longer follow-up for overweight and obese pregnant women. 
%M 31651407
%R 10.2196/13013
%U http://formative.jmir.org/2019/4/e13013/
%U https://doi.org/10.2196/13013
%U http://www.ncbi.nlm.nih.gov/pubmed/31651407

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 10
%P e13935
%T Mobile Health Coaching on Nutrition and Lifestyle Behaviors for Subfertile Couples Using the Smarter Pregnancy Program: Model-Based Cost-Effectiveness Analysis
%A Oostingh,Elsje C
%A Ophuis,Robbin H
%A Koster,Maria PH
%A Polinder,Suzanne
%A Lingsma,Hester F
%A Laven,Joop SE
%A Steegers-Theunissen,Régine PM
%+ Erasmus University Medical Center, Postbus 2040, Rotterdam, 3000 CA, Netherlands, 31 107038255, r.steegers@erasmusmc.nl
%K preconception
%K subfertility
%K IVF treatment
%K pregnancy
%K cost-effectiveness
%D 2019

%7 23.10.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The health care costs for reproductive care have substantially increased with the use of in vitro fertilization (IVF) treatment. The mobile health (mHealth) coaching program Smarter Pregnancy is an effective intervention to improve nutrition and lifestyle behaviors and pregnancy rates in (sub)fertile couples, including those who undergo IVF treatment. Therefore, we hypothesize that this mHealth program can also reduce health care costs associated with IVF treatment. Objective: This study aimed to evaluate the cost-effectiveness of the mHealth coaching program Smarter Pregnancy and compare it to usual care in women of subfertile couples who start their first IVF cycle. Methods: This model-based cost-effectiveness analysis was performed on data from couples undergoing IVF treatment at the Erasmus MC, University Medical Center Rotterdam. A decision tree model was used to assess the incremental cost-effectiveness ratio (ICER) of ongoing pregnancies and costs of use of the mHealth program as compared to usual care. A probabilistic sensitivity analysis was performed to consider the uncertainty surrounding the point estimates of the input parameters. Results: Based on our model including 793 subfertile women undergoing IVF treatment, use of the mHealth program resulted in 86 additional pregnancies and saved €270,000 compared to usual care after two IVF cycles, with an ICER of –€3050 (95% CI –3960 to –540) per additional pregnancy. The largest cost saving was caused by the avoided IVF treatment costs. Sensitivity analyses showed that the mHealth program needs to increase the ongoing pregnancy rate by at least 51% after two IVF cycles for cost saving. Conclusions: The mHealth coaching program Smarter Pregnancy is potentially cost saving for subfertile couples preceding their first IVF treatment. Implementation of this mHealth program in routine preconception care for subfertile couples should be seriously considered, given the relatively low costs and promising cost-effectiveness estimates. 
%M 31647476
%R 10.2196/13935
%U http://mhealth.jmir.org/2019/10/e13935/
%U https://doi.org/10.2196/13935
%U http://www.ncbi.nlm.nih.gov/pubmed/31647476

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 8
%N 10
%P e12444
%T Health Research Using Facebook to Identify and Recruit Pregnant Women Who Use Electronic Cigarettes: Internet-Based Nonrandomized Pilot Study
%A Lee,Harold H
%A Hsieh,Yuli Patrick
%A Murphy,Joe
%A Tidey,Jennifer W
%A Savitz,David A
%+ Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 428F, 401 Park Dr, Boston, MA, 02215, United States, 1 617 432 1135, hhlee@hsph.harvard.edu
%K e-cigarette
%K pregnancy
%K social media
%D 2019

%7 18.10.2019
%9 Original Paper
%J JMIR Res Protoc
%G English
                
%X Background: Participant recruitment is often a challenge, particularly enrolling individuals with relatively rare characteristics. The wide reach of social media may provide a mechanism to overcome these challenges. Objective: This paper aimed to provide information to researchers who seek to recruit participants from rare populations using social media for studies with demanding protocols. We aimed to describe a pilot study protocol that identified and enrolled pregnant women (second or third trimester) who were exclusive users of electronic cigarettes (e-cigarettes). We have described the recruitment methods, time, and cost; examined advertisement types that were more or less successful; discussed participant retention and relationship management; and described the process of collecting biological data. Methods: In an open-access, nonrandomized pilot study, we placed Facebook advertisements that were selectively targeting women who were likely to be pregnant and interested in e-cigarettes or vaping. The advertisements invited individuals to complete a fully automated eligibility screener based on Qualtrics. Eligible participants were asked to (1) complete a Web-based survey that collected detailed information on the use of e-cigarettes, including the exact type of device and electronic liquid, (2) report the frequency and intensity of e-cigarette use for 3 months before pregnancy and during each trimester, and (3) provide a saliva specimen for a nicotine biomarker assay. We collected a photograph of each participant’s e-cigarette device, 8 weeks after the mother’s due date, to allow corroboration of the self-report and the baby’s birth weight and gestational age from the participant’s physician. Results: Participants were recruited between August 19 and October 26, 2017. We enrolled 20 participants in 2 months at a cost of US $3421.28. Baseline data were collected for all 20 participants. Of the 20 women enrolled, 16 provided a saliva sample, 4 provided a photo of the e-cigarette device, and 10 provided physician contact information. Of the 10 physicians contacted by mail, 6 responded with information on the participants and their babies. Conclusions: Study findings suggest that Facebook’s targeting criteria should focus on e-cigarette users to maximize advertisement exposure of potentially eligible women. In addition, saliva sample collection was feasible among pregnant women (second or third trimester) who were exclusive e-cigarette users, but obtaining photographs and physician reports was problematic and called for further refinement. These lessons are likely useful to others who are seeking to use social media to recruit participants from rare populations into studies with demanding protocols. 
%M 31628785
%R 10.2196/12444
%U https://www.researchprotocols.org/2019/10/e12444
%U https://doi.org/10.2196/12444
%U http://www.ncbi.nlm.nih.gov/pubmed/31628785

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 10
%P e14699
%T Dropout and Abstinence Outcomes in a National Text Messaging Smoking Cessation Intervention for Pregnant Women, SmokefreeMOM: Observational Study
%A Kamke,Kristyn
%A Grenen,Emily
%A Robinson,Cendrine
%A El-Toukhy,Sherine
%+ Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 7201 Wisconsin Ave, RM 533M, Bethesda, MD, 20814, United States, 1 301 594 4743, sherine.el-toukhy@nih.gov
%K smoking cessation
%K pregnancy
%K women's health
%K mHealth
%K text messaging intervention
%D 2019

%7 7.10.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Population-level text messaging smoking cessation interventions may reduce racial and ethnic differences in smoking among pregnant women. Objective: Our objective was to examine racial and ethnic differences in dropout, response, and abstinence rates among users of a US national, publicly available text messaging cessation intervention targeting pregnant women, SmokefreeMOM. Methods: Participants were online subscribers to SmokefreeMOM who set a prospective quit date within the 9 months before their due date. We examined demographics, smoking frequency, number of cigarettes smoked per day, and prequit time (up to 14 days of preparation time before quit date) as correlates of response rate and abstinence at 8 time points: quit date, day 7, day 14, day 21, day 28, day 35, day 42 (intervention end), and day 72 (1-month follow-up). We conducted survival analysis of time from quit date to dropout by race and ethnicity. Results: The mean age of the analytic sample of 1288 users was 29.46 (SD 7.11) years. Of these, 65.81% (848/1288) were white, 16.04% (207/1288) were black, 8.86% (114/1288) were Latina, and 9.29% (120/1288) were multiracial, American Indian/Alaska Native, Native Hawaiian Pacific Islander, or other; 82.68% (1065/1288) had some college education or less. Point-prevalence abstinence was 14.51% (157/1082) on quit day, 3.51% (38/1082) at intervention end, and 1.99% (21/1053) at 1-month follow-up. Black users (hazard ratio 0.68, 95% CI 0.51-0.91) and those with a high school degree or less (hazard ratio 0.66, 95% CI 0.49-0.89) or some college education (hazard ratio 0.75, 95% CI 0.57-0.99) were less likely to drop out than whites or users with a bachelor’s degree or higher. Response and abstinence rates were similar across race, ethnicity, and education. Conclusions: Enrollment was low among racial and ethnic minority women but high among less-educated women. Abstinence at intervention end and 1-month follow-up was lower than that in controlled trials of text messaging cessation interventions for pregnant women (range 7%-20%). Increasing the reach, engagement, and effectiveness of SmokefreeMOM, especially among women with high rates of smoking during pregnancy, must be prioritized. 
%M 31593542
%R 10.2196/14699
%U https://mhealth.jmir.org/2019/10/e14699
%U https://doi.org/10.2196/14699
%U http://www.ncbi.nlm.nih.gov/pubmed/31593542

%0 Journal Article
        
%@ 1929-073X
%I JMIR Publications
%V 8
%N 3
%P e10355
%T What the Health? Information Sources and Maternal Lifestyle Behaviors
%A Dalhaug,Emilie Mass
%A Haakstad,Lene Annette Hagen
%+ The Norwegian School of Sport Sciences, Department of Sports Medicine, PO Box 4014, Ullevål Stadion, Oslo, 0806, Norway, 47 23 26 20 00, emiliefmass@gmail.com
%K pregnancy
%K physical activity
%K gestational weight gain
%K diet
%K prenatal care
%K behavior
%D 2019

%7 05.07.2019
%9 Original Paper
%J Interact J Med Res
%G English
                
%X Background: Regular physical activity (PA), adequate gestational weight gain (GWG), and healthy eating are important for the long-term health of both mother and baby. Hence, it is important that women receive current and updated advice on these topics and are encouraged to adopt a healthy lifestyle during pregnancy. Objective: The aim of this study was to investigate the main information sources among pregnant women regarding PA, GWG, and nutrition as well as to evaluate how these information sources may affect their health behaviors. Methods: A cross-sectional study design, comprising an electronic questionnaire, was distributed to 2 antenatal clinics, as well as pregnancy-related online chat forums and social media. The inclusion criteria were ≥18 years, ≥20 weeks gestation, and able to read and write Norwegian. In total, 150 pregnant women answered the questionnaire, which was a mix of 11-point Likert scales, close-ended questions, and semi–close-ended questions with the option to elaborate. The relationship between information sources and selected variables, including health behaviors and descriptive variables, were assessed by logistic regression, linear regression, or chi-square as appropriate (P<.05). Results: Mean age (years), gestation week, and prepregnancy body mass index (kg/m2) were 31.1 (SD 4.3), 30.6 (SD 5.9), and 24.2 (SD 4.2), respectively. More than eight out of 10 had received or retrieved information about nutrition (88.7%, 133/150) and PA (80.7%, 121/150), whereas 54.0% (81/150) reported information on GWG. When combining all 3 lifestyle factors, 38.5% had retrieved information from blogs and online forums and 26.6%, from their midwife or family physician. Women who reported
the internet and media as their primary source of information on weight gain had increased odds of gaining weight below the Institute of Medicine (IOM) guidelines compared with gaining within the guidelines (odds ratio [OR] 15.5, 95% CI 1.4-167.4; P=.02). Higher compliance with nutritional guidelines was seen among those who cited the internet and media as their main source of information on nutrition (beta=.7, 95% CI 0.07-1.3; P=.03). On the other side, receiving advice from friends and family on weight gain was significantly associated with gaining weight above the IOM guidelines compared with gaining within the guidelines (OR 12.0, 95% CI 1.3-111.7; P=.03). No other associations were found between information sources and health behaviors. Conclusions: The small number of health professionals giving information and the extensive use of internet- and media-based sources emphasize the need to address the quality of internet advice and guide women toward trustworthy sources of information during pregnancy. The association between information sources and PA, GWG, and nutrition requires further research. 
%M 31278731
%R 10.2196/10355
%U https://www.i-jmr.org/2019/3/e10355/
%U https://doi.org/10.2196/10355
%U http://www.ncbi.nlm.nih.gov/pubmed/31278731

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 8
%N 6
%P e13569
%T Understanding Pregnancy and Postpartum Health Using Ecological Momentary Assessment and Mobile Technology: Protocol for the Postpartum Mothers Mobile Study
%A Mendez,Dara D
%A Sanders,Sarah A
%A Karimi,Hassan A
%A Gharani,Pedram
%A Rathbun,Stephen L
%A Gary-Webb,Tiffany L
%A Wallace,Meredith L
%A Gianakas,John J
%A Burke,Lora E
%A Davis,Esa M
%+ Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, 5130 Public Health, Pittsburgh, PA, 15261, United States, 1 412 648 5664, ddm11@pitt.edu
%K ecological momentary assessment (EMA)
%K wireless technology
%K remote sensing technology
%K maternal health
%K pregnancy
%K postpartum
%K body weight
%K health status disparities
%K health equity
%D 2019

%7 26.06.2019
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: There are significant racial disparities in pregnancy and postpartum health outcomes, including postpartum weight retention and cardiometabolic risk. These racial disparities are a result of a complex interplay between contextual, environmental, behavioral, and psychosocial factors. Objective: This protocol provides a description of the development and infrastructure for the Postpartum Mothers Mobile Study (PMOMS), designed to better capture women’s daily experiences and exposures from late pregnancy through 1 year postpartum. The primary aims of PMOMS are to understand the contextual, psychosocial, and behavioral factors contributing to racial disparities in postpartum weight and cardiometabolic health, with a focus on the daily experiences of stress and racism, as well as contextual forms of stress (eg, neighborhood stress and structural racism). Methods: PMOMS is a longitudinal observation study that is ancillary to an existing randomized control trial, GDM2 (Comparison of Two Screening Strategies for Gestational Diabetes). PMOMS uses an efficient and cost-effective approach for recruitment by leveraging the infrastructure of GDM2, facilitating enrollment of participants while consolidating staff support from both studies. The primary data collection method is ecological momentary assessment (EMA) and through smart technology (ie, smartphones and scales). The development of the study includes: (1) the pilot phase and development of the smartphone app; (2) feedback and further development of the app including selection of key measures; and (3) implementation, recruitment, and retention. Results: PMOMS aims to recruit 350 participants during pregnancy, to be followed through the first year after delivery. Recruitment and data collection started in December 2017 and are expected to continue through September 2020. Initial results are expected in December 2020. As of early May 2019, PMOMS recruited a total of 305 participants. Key strengths and features of PMOMS have included data collection via smartphone technology to reduce the burden of multiple on-site visits, low attrition rate because of participation in an ongoing trial in which women are already motivated and enrolled, high EMA survey completion and the use of EMA as a unique data collection method to understand daily experiences, and shorter than expected timeframe for enrollment because of the infrastructure of the GDM2 trial. Conclusions: This protocol outlines the development of the PMOMS, one of the first published studies to use an ongoing EMA and mobile technology protocol during pregnancy and throughout 1 year postpartum to understand the health of childbearing populations and enduring racial disparities in postpartum weight and cardiometabolic health. Our findings will contribute to the improvement of data collection methods, particularly the role of EMA in capturing multiple exposures and knowledge in real time. Furthermore, the results of the study will inform future studies investigating weight and cardiometabolic health during pregnancy and the postpartum period, including how social determinants produce population disparities in these outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/13569 
%M 31244478
%R 10.2196/13569
%U http://www.researchprotocols.org/2019/6/e13569/
%U https://doi.org/10.2196/13569
%U http://www.ncbi.nlm.nih.gov/pubmed/31244478

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 6
%P e13828
%T A Community-Based Short Message Service Intervention to Improve Mothers’ Feeding Practices for Obesity Prevention: Quasi-Experimental Study
%A Jiang,Hong
%A Li,Mu
%A Wen,Li Ming
%A Baur,Louise
%A He,Gengsheng
%A Ma,Xiaoying
%A Qian,Xu
%+ School of Public Health, Global Health Institute, Fudan University, 175 Mailbox, 138 Yixueyuan Road, Shanghai, 200032, China, 86 2164179976, h_jiang@fudan.edu.cn
%K short message service
%K child development
%K body mass index
%K BMI
%K childhood obesity
%D 2019

%7 3.6.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The prevalence of childhood obesity is increasing in China, and the effect of mobile phone short message service (SMS) interventions to prevent early childhood obesity needs to be evaluated. Objective: The objective of this study was to assess the effect of an SMS intervention on the prevention of obesity in young children. Methods: A quasi-experimental design SMS intervention was carried out in 4 community health centers (CHCs) in Shanghai, China. A total of 2 CHCs were assigned to the intervention group, and 2 CHCs were assigned to the control group. Mothers in the intervention group received weekly SMS messages on breastfeeding and infant feeding from the third trimester to 12 months postpartum. The primary outcomes were children’s body mass index (BMI), BMI z-score, and weight-for-length z-score at 12 and 24 months. Factors associated with higher BMI and weight-for-length z-score at 24 months were also assessed. Results: A total of 582 expectant mothers were recruited at the beginning of the third gestational trimester. 477 (82.0%) and 467 (80.2%) mothers and their children were followed up to 12 and 24 months postpartum, respectively. There were no significant differences in children’s BMI, BMI z-score, and weight-for-length z-score at 12 and 24 months between the 2 groups. Factors associated with higher BMI, BMI z-score, and weight-for-length z-score at 24 months included higher birth weight, introduction of solid foods before 4 months, and taking a bottle to bed at 12 months. Conclusions: The SMS intervention did not show a significant effect on children’s BMI, BMI z-score, or weight-for-length z-score at 12 and 24 months. Introduction of solid foods before 4 months and taking a bottle to bed at 12 months were significantly and positively correlated with a higher BMI, BMI z-score, and weight-for-length z-score at 24 months. Further studies with more rigorous design are needed to evaluate the effect of SMS interventions on preventing early childhood obesity. 
%R 10.2196/13828
%U http://mhealth.jmir.org/2019/6/e13828/
%U https://doi.org/10.2196/13828

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 21
%N 5
%P e10865
%T Health Information Technologies in the Support Systems of Pregnant Women and Their Caregivers: Mixed-Methods Study
%A Dorst,Marian Taylor
%A Anders,Shilo H
%A Chennupati,Sai
%A Chen,Qingxia
%A Purcell Jackson,Gretchen
%+ Vanderbilt University, 2201 West End Ave, Nashville, TN, 37235, United States, 1 8582005906, DorstM@calmedu.org
%K pregnancy
%K social networks
%K social media
%K health information technology
%K caregivers
%K life stress
%D 2019

%7 09.05.2019
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: The quality and quantity of families’ support systems during pregnancy can affect maternal and fetal outcomes. The support systems of expecting families can include many elements, such as family members, friends, and work or community groups. Emerging health information technologies (eg, social media, internet websites, and mobile apps) provide new resources for pregnant families to augment their support systems and to fill information gaps. Objective: This study sought to determine the number and nature of the components of the support systems of pregnant women and their caregivers (eg, family members) and the role of health information technologies in these support systems. We examined the differences between pregnant women’s support systems and those of their caregivers and the associations between support system composition and stress levels. Methods: We enrolled pregnant women and caregivers from advanced maternal-fetal and group prenatal care clinics. Participants completed surveys assessing sociodemographic characteristics, health literacy, numeracy, and stress levels and were asked to draw a picture of their support system. Support system elements were extracted from drawings, categorized by type (ie, individual persons, groups, technologies, and other) and summarized for pregnant women and caregivers. Participant characteristics and support system elements were compared using the Pearson chi-square test for categorical variables and Wilcoxon ranked sum test for continuous variables. Associations between support system characteristics and stress levels were measured with Spearman correlation coefficient. Results: The study enrolled 100 participants: 71 pregnant women and 29 caregivers. The support systems of pregnant women were significantly larger than those of caregivers—an average of 7.4 components for pregnant women and 5.4 components for caregivers (P=.003). For all participants, the most commonly reported support system elements were individual persons (408/680, 60.0%), followed by people groups (132/680, 19.4%), technologies (112/680, 16.5%), and other resources (28/680, 4.1%). Pregnant women’s and caregivers’ technology preferences within their support systems differed—pregnant women more often identified informational websites, apps, and social media as parts of their support systems, whereas caregivers more frequently reported general internet search engines. The size and components of these support systems were not associated with levels of stress. Conclusions: This study is one of the first demonstrating that technologies comprise a substantial portion of the support systems of pregnant women and their caregivers. Pregnant women more frequently reported specific medical information websites as part of their support system, whereas caregivers more often reported general internet search engines. Although social support is important for maternal and fetal health outcomes, no associations among stress, support system size, and support system components were found in this study. As health information technologies continue to evolve and their adoption increases, their role in patient and caregiver support systems and their effects should be further explored. 
%M 31094327
%R 10.2196/10865
%U https://www.jmir.org/2019/5/e10865/
%U https://doi.org/10.2196/10865
%U http://www.ncbi.nlm.nih.gov/pubmed/31094327

%0 Journal Article
        
%@ 2371-4379
%I JMIR Publications
%V 4
%N 2
%P e10368
%T Achieving Value-Based Care in Chronic Disease Management: Intervention Study
%A Wickramasinghe,Nilmini
%A John,Blooma
%A George,Joey
%A Vogel,Doug
%+ Swinburne University of Technology, PO Box 218, Hawthorn,, Australia, 61 04 5773 7173, nilmini.work@gmail.com
%K diabetes
%K gestational diabetes
%K chronic disease management
%K value-based care
%K mobile health
%K power knowledge
%K Australian health care system
%K 2-period 2-arm crossover
%K clinical trial
%D 2019

%7 03.05.2019
%9 Original Paper
%J JMIR Diabetes
%G English
                
%X Background: The World Health Organization notes that diabetes, a chronic disease, is a silent epidemic, and by 2020 there will be a 54% rise in the total number of individuals diagnosed with this disease. These are alarming figures that have significant repercussions for the quality of life of individuals and their families as well as for the financial stress of health care systems globally. Early detection and proactive management of diabetes is essential. The Diamond solution provides diabetes self-management by enabling patients to send details about their blood sugar readings at specific times to their nominated care coordinator to receive recommendations for diet and exercise and insulin titration. Objective: The aim of the study was to assess the usability, acceptability, and fidelity of the Diamond diabetes monitoring device for patients with gestational diabetes mellitus (GDM). Specifically assessed were (1) patient compliance, (2) patient satisfaction, (3) level of glycemic control achieved, and (4) health professional satisfaction. Methods: Using a design science research perspective, the Diamond diabetes monitoring device solution was adapted to the Australian health care environment. Once the solution was deemed fit for purpose by the director of the OB/GYN clinical institute and on securing all relevant ethics approvals, a 2-period 2-arm nonblinded crossover clinical trial was conducted for 8 weeks total time with crossover at 4 weeks to establish proof of concept, usability, and fidelity. The patient perspective was assessed by using structured questionnaires at 4 specific stages of the project, while the clinician perspective was captured via semistructured interviews and unstructured questionnaires. Results: The 10 patients studied reported preferring standard care with the technology solution to standard care alone. Further, all clinicians involved concurred that the technology solution greatly assisted their ability to provide higher value patient-centered care. They also noted that it was extremely helpful for assisting in systematically monitoring glucose levels and any/all changes and trends. Conclusions: Based on these initial findings, we offer a holistic pervasive approach to enable the achievement of value-based, patient-centered care in chronic disease management. Key lessons include the importance when designing such solutions to focus on the two primary user groups (patients and clinicians). 
%M 31066699
%R 10.2196/10368
%U http://diabetes.jmir.org/2019/2/e10368/
%U https://doi.org/10.2196/10368
%U http://www.ncbi.nlm.nih.gov/pubmed/31066699

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 5
%P e10520
%T A Mobile Prenatal Care App to Reduce In-Person Visits: Prospective Controlled Trial
%A Marko,Kathryn I
%A Ganju,Nihar
%A Krapf,Jill M
%A Gaba,Nancy D
%A Brown,James A
%A Benham,Joshua J
%A Oh,Julia
%A Richards,Lorna M
%A Meltzer,Andrew C
%+ Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, 2120 L Street NW, Suite 450, Washington, DC, 20037, United States, 1 202 741 2952, ameltzer@mfa.gwu.edu
%K prenatal care
%K mobile applications
%K patient monitoring
%K patient safety
%K patient satisfaction
%K technological innovations
%K controlled clinical trial
%K mobile health
%D 2019

%7 01.05.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Risk-appropriate prenatal care has been asserted as a way for the cost-effective delivery of prenatal care. A virtual care model for prenatal care has the potential to provide patient-tailored, risk-appropriate prenatal educational content and may facilitate vital sign and weight monitoring between visits. Previous studies have demonstrated a safe reduction in the frequency of in-person prenatal care visits among low-risk patients but have noted a reduction in patient satisfaction. Objective: The primary objective of this study was to test the effectiveness of a mobile prenatal care app to facilitate a reduced in-person visit schedule for low-risk pregnancies while maintaining patient and provider satisfaction. Methods: This controlled trial compared a control group receiving usual care with an experimental group receiving usual prenatal care and using a mobile prenatal care app. The experimental group had a planned reduction in the frequency of in-person office visits, whereas the control group had the usual number of visits. The trial was conducted at 2 diverse outpatient obstetric (OB) practices that are part of a single academic center in Washington, DC, United States. Women were eligible for enrollment if they presented to care in the first trimester, were aged between 18 and 40 years, had a confirmed desired pregnancy, were not considered high-risk, and had an iOS or Android smartphone that they used regularly. We measured the effectiveness of a virtual care platform for prenatal care via the following measured outcomes: the number of in-person OB visits during pregnancy and patient satisfaction with prenatal care. Results: A total of 88 patients were enrolled in the study, 47 in the experimental group and 41 in the control group. For patients in the experimental group, the average number of in-person OB visits during pregnancy was 7.8 and the average number in the control group was 10.2 (P=.01). There was no statistical difference in patient satisfaction (P>.05) or provider satisfaction (P>.05) in either group. Conclusions: The use of a mobile prenatal care app was associated with reduced in-person visits, and there was no reduction in patient or provider satisfaction. Trial Registration: ClinicalTrials.gov NCT02914301; https://clinicaltrials.gov/ct2/show/NCT02914301 (Archived by WebCite at http://www.webcitation.org/76S55M517) 
%M 31042154
%R 10.2196/10520
%U https://mhealth.jmir.org/2019/5/e10520/
%U https://doi.org/10.2196/10520
%U http://www.ncbi.nlm.nih.gov/pubmed/31042154

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 4
%P e11842
%T Patients’ and Doctors’ Perceptions of a Mobile Phone–Based Consultation Service for Maternal, Neonatal, and Infant Health Care in Bangladesh: A Mixed-Methods Study
%A Alam,Mafruha
%A Banwell,Cathy
%A Olsen,Anna
%A Lokuge,Kamalini
%+ National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, Canberra, 2601, Australia, 61 6125 5602, mafruha.alam@gmail.com
%K mobile-based consultation
%K mHealth
%K remote diagnosis
%K referral
%D 2019

%7 22.04.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: A mobile-based consultation service, or telehealth, can be used for remote consultations with health care professionals for screening, self-care management, and referral. In rural Bangladesh, where there is high demand for scarce male and even scarcer female doctors, remote consultations may help women seeking maternal and child health care. Aponjon is a mHealth service in Bangladesh that provides weekly voice or text messages to pregnant women, new mothers, and family members on various aspects of maternal, neonatal, and infant health. Subscribers can also access a dedicated 24*7 call center to discuss maternal, neonatal, and infant health or emergencies with medically trained doctors. The service provides advice, primary diagnoses, prescriptions, and referrals to subscriber callers. Objective: We investigated the Aponjon service to understand access, acceptability, usability, benefits, and challenges of a mobile phone-based consultation service. Methods: We conducted call log data analysis for September to November 2015 to understand how many unique subscribers accessed the service, who accessed the service, the geographical distribution of callers, and the purpose of the calls. We also conducted a qualitative exploratory substudy of eight married women and eight married men who were subscribers to and accessed the service during this time to understand their experiences. We interviewed 11 doctors from the same service who provided phone consultations to subscribers. Results: Approximately 3894 unique subscribers accessed the service for single or multiple consultations during the study period; 68.36% (2662/3894) of subscribers were from rural households, and 53.00% (2064/3894) of calls were made by pregnant women or new mothers. Approximately 96.08% (5081/5288) calls were nonurgent, 2.69% (142/5288) semiurgent, and 1.23% (65/5288) urgent. Almost 64.7% (134/207) semiurgent or urgent calls came between 8 PM and 8 AM. Callers found the consultation service trustworthy, cost-effective, and convenient. The doctors dispelled misconceptions and promoted good health care practices, regular health check-ups, and responsible use of medicine. They helped families understand the severity of sicknesses and advised them to seek care at health facilities for semiurgent or urgent conditions. The service lacked a pro-poor policy to support talk times of subscribers from poor households and a proper referral system to help patients find the right care at the right facilities. Conclusions: Although a regular messaging service is constrained by a one-way communication system, this service using the same platform, gave subscribers access to an abbreviated “consultation” with medical doctors. The consultations provided subscribers with valued medical advice and support, although they were limited in their population reach and their integration into the wider medical system. Further research is required to understand the impact of advice and referral, cost-effectiveness, and willingness to pay for mHealth consultation services, but this research suggests that these services should be supported or even expanded. 
%M 31008716
%R 10.2196/11842
%U http://mhealth.jmir.org/2019/4/e11842/
%U https://doi.org/10.2196/11842
%U http://www.ncbi.nlm.nih.gov/pubmed/31008716

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 4
%P e12081
%T Effectiveness of Low Glycemic Index Diet Consultations Through a Diet Glycemic Assessment App Tool on Maternal and Neonatal Insulin Resistance: A Randomized Controlled Trial
%A Zhang,Yi
%A Wang,Liping
%A Yang,Wenhong
%A Niu,Dayan
%A Li,Chunying
%A Wang,Liling
%A Gu,Ping
%A Xia,Yingqian
%A Shen,Ying
%A Yan,Juhua
%A Zhao,Qian
%A Mu,Kai
%A Yan,Weili
%+ Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China, 86 21064931215, yanwl@fudan.edu.cn
%K glycemic index
%K overweight
%K pregnancy
%K insulin resistance
%K randomized controlled trial
%D 2019

%7 18.04.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Low glycemic index (LGI) diet has shown to be effective in reducing maternal and neonatal complications in high-risk pregnancies. Objective: This trial aimed to examine the effectiveness of individualized LGI diet consultations based on the accurate diet glycemic load (GL) assessment tool on maternal and neonatal insulin resistance levels and diet behavior changes in overweight and obese pregnant women. Methods: Overweight and obese pregnant women were recruited before 16 weeks of gestation and randomized to the LGI diet arm or the control arm. All participants received standard dietary education according to the Chinese Dietary Guide for Pregnant Women. In the intervention arm, additional individualized dietary GL assessments were performed using an app and instructions of lowering diet glycemic index (GI) to achieve LGI diet were provided by a clinical dietitian at early, middle, and late gestation. Primary outcomes were serum insulin at late gestation, incidence of gestational diabetes mellitus (GDM) for mothers, and cord blood C-peptide level of neonates. Results: In total, 400 subjects were randomized and received different interventions. There were no significant differences in maternal serum insulin levels (13.2 [9.3−13.2] uU/mL vs 12.4 [10.5−12.4] uU/mL), incidence of GDM (45 [22.5%] vs 43 [21.5%]), or cord blood C-peptide levels (mean 0.9ng/mL [SD 0.7] vs mean 0.8ng/mL [SD 0.6]) in the intervention group compared with the controls. The diet GI at late gestation was similar (mean 63.2 [SD 10.4] vs mean 64.3 [SD 10.4]), whereas greater diet fiber intake was observed in the intervention group (mean 11.6 grams [SD 8.0] vs mean 9.0 grams [SD 5.6]; P=.006). Adherence measurements did not significantly differ between 2 groups. Conclusions: Individualized LGI diet consultations for overweight and obese pregnant women failed to make a significant difference in maternal or neonatal insulin resistance compared with the standard gestational diet consultation. Trial Registration: ClinicalTrials.gov NCT01628835; http://clinicaltrials.gov/ct2/show/NCT01628835 (Archived by WebCite at http://www.webcitation.org/77LHgWP0k) 
%M 30998227
%R 10.2196/12081
%U http://mhealth.jmir.org/2019/4/e12081/
%U https://doi.org/10.2196/12081
%U http://www.ncbi.nlm.nih.gov/pubmed/30998227

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 4
%P e11664
%T Neighborhood Deprivation and the Effectiveness of Mobile Health Coaching to Improve Periconceptional Nutrition and Lifestyle in Women: Survey in a Large Urban Municipality in the Netherlands
%A Gootjes,Dionne V
%A van Dijk,Matthijs R
%A Koster,Maria PH
%A Willemsen,Sten P
%A Steegers,Eric AP
%A Steegers-Theunissen,Régine PM
%+ Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, 3015 GD, Netherlands, 31 107043598, r.steegers@erasmusmc.nl
%K pregnancy
%K telemedicine
%K lifestyle
%K nutritional status
%K preconception care
%D 2019

%7 11.04.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: In 2011, we launched the Smarter Pregnancy mobile health (mHealth) coaching program, which has shown to effectively improve inadequate nutrition and lifestyle behaviors in women before and during pregnancy. It is known that in deprived neighborhoods, risk factors for adverse pregnancy outcomes like inadequate nutrition and lifestyle behaviors accumulate. However, it has not yet been investigated whether the Smarter Pregnancy program is equally effective in women living in deprived neighborhoods. Objective: This paper aimed to study the associations between neighborhood deprivation and improvement of inadequate nutrition and lifestyle behaviors of women who were either contemplating pregnancy or already pregnant and subscribed to the Smarter Pregnancy program. Methods: We performed an additional analysis on data from women who used the Smarter Pregnancy program from 2011 to 2016. The program comprised 24 weeks of coaching on 5 nutrition and lifestyle behaviors, of which adequate intakes or lifestyle behaviors were defined as an intake of 200 grams or above of vegetables, 2 pieces of fruit, daily folic acid supplement use of 400 µg per day, and no smoking or alcohol consumption. Neighborhood deprivation was determined according to the status scores of the Netherlands Institute for Social Research. Logistic regression analyses and generalized estimating equation models were used to assess the associations between the neighborhood status score (NSS) and the improvement of inadequate nutrition and lifestyle behaviors, taking into account the behaviors at baseline. We adjusted the analyses for maternal age, body mass index, geographic origin, pregnancy status, and participation as a couple. Results: Of the 2554 women included, 521 participated with their male partner. Overall, daily vegetable intake was most frequently inadequate at the start of the program (77.72, 1985/2554). Women with a higher NSS (ie, nondeprived neighborhood) smoked less often (adjusted odds ratio [OR] 0.85; 95% CI 0.77-0.93), consumed alcohol more often (adjusted OR 1.14, 95% CI 1.04-1.24), and were less likely to complete the 24 weeks of coaching (OR 0.91, 95% CI 0.88-0.95) compared with women who lived in a neighborhood with a low NSS (ie, deprived). In the total group, the relative improvement of inadequate nutrition and lifestyle behaviors after 24 weeks of coaching was between 26% and 64%. NSS was negatively associated with this improvement, indicating that women with a higher NSS were less likely to improve inadequate nutrition and lifestyle behaviors, especially vegetable intake (adjusted OR 0.89, 95% CI 0.82-0.97). Conclusions: The Smarter Pregnancy mHealth coaching program empowers women to improve inadequate nutrition and lifestyle behaviors. Unexpectedly, the program seemed more effective in women living in deprived neighborhoods. It is important to unravel differences in needs and behaviors of specific target groups to further tailor the mHealth program on the basis of demographic characteristics like neighborhood deprivation. 
%M 30973345
%R 10.2196/11664
%U https://mhealth.jmir.org/2019/4/e11664/
%U https://doi.org/10.2196/11664
%U http://www.ncbi.nlm.nih.gov/pubmed/30973345

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 3
%N 2
%P e11397
%T Using Text Messaging, Social Media, and Interviews to Understand What Pregnant Youth Think About Weight Gain During Pregnancy
%A DeJonckheere,Melissa
%A Nichols,Lauren P
%A Vydiswaran,VG Vinod
%A Zhao,Xinyan
%A Collins-Thompson,Kevyn
%A Resnicow,Kenneth
%A Chang,Tammy
%+ Department of Family Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, MI, 48104, United States, 1 (734) 998 7120, mjdejonckheere@gmail.com
%K methods
%K adolescents
%K weight gain
%K pregnancy
%K text messaging
%K social media
%K natural language processing
%D 2019

%7 01.04.2019
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The majority of pregnant youth gain more weight than recommended by the National Academy of Medicine guidelines. Excess weight gain during pregnancy increases the risk of dangerous complications during delivery, including operative delivery and stillbirth, and contributes to the risk of long-term obesity in both mother and child. Little is known regarding youth’s perceptions of and knowledge about weight gain during pregnancy. Objective: The aim of this study was to describe the feasibility and acceptability of 3 novel data collection and analysis strategies for use with youth (social media posts, text message surveys, and semistructured interviews) to explore their experiences during pregnancy. The mixed-methods analysis included natural language processing and thematic analysis. Methods: To demonstrate the feasibility and acceptability of this novel approach, we used descriptive statistics and thematic qualitative analysis to characterize participation and engagement in the study. Results: Recruitment of 54 pregnant women aged between 16 and 24 years occurred from April 2016 to September 2016. All participants completed at least 1 phase of the study. Semistructured interviews had the highest rate of completion, yet all 3 strategies were feasible and acceptable to pregnant youth. Conclusions: This study has described a novel youth-centered strategy of triangulating 3 sources of mixed-methods data to gain a deeper understanding of a health behavior phenomenon among an at-risk population of youth. 
%M 30932869
%R 10.2196/11397
%U https://formative.jmir.org/2019/2/e11397/
%U https://doi.org/10.2196/11397
%U http://www.ncbi.nlm.nih.gov/pubmed/30932869

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 3
%N 1
%P e11374
%T Pregnant Users’ Perceptions of the Birth Plan Interface in the “My Prenatal Care” App: Observational Validation Study
%A Moraes Carrilho,Juliana
%A Oliveira,Isaias José Ramos
%A Santos,Dimitri
%A Osanan,Gabriel Costa
%A Cruz-Correia,Ricardo João
%A Reis,Zilma Silveira Nogueira
%+ Informatics Center in Health, Universidade Federal de Minas Gerais, Faculty of Medicine, Av Professor Alfredo Balena, 190, Funcionários, Belo Horizonte, 30140070, Brazil, 55 31985177473, zilma.medicina@gmail.com
%K birth plan
%K perinatal care
%K usability, mobile health
%K mobile app
%K pregnancy
%K prenatal care
%K mobile phone
%D 2019

%7 28.03.2019
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Birth plans are meant to be a declaration of the expectations and preferences of pregnant woman regarding childbirth. The My Prenatal Care app engages pregnant women in an educational intervention for a healthy pregnancy. We hypothesized that users’ positive perception of an in-app birth plan is a relevant step for establishing direct communication between pregnant women and the health care team, based on an online report available on the app. Objective: This study aimed to evaluate pregnant women’s perception about the communicability of birth-plan preparation using a mobile app. Methods: This was an observational, exploratory, descriptive study. The methodology was user centered, and both qualitative and quantitative approaches were employed. The tools of the communicability evaluation method were applied. Overall, 11 pregnant women evaluated their experience of using a birth-plan prototype interface. The evaluation was performed in a controlled environment, with authorized video recording. There were 8 task-oriented interactions proposed to evaluate interface communicability with users when using the Birth Plan menu. For evaluating perceptions and experiences, a survey with structured and open-ended questions in addition to the free expression of participants was conducted. The primary outcomes assessed were interface communicability and user’s perception of the Birth Plan prototype interface in the My Prenatal Care mobile app. Secondarily, we involved users in the prototyping phase of the interface to identify bottlenecks for making improvements in the app. Results: Regarding users’ performance in accomplishing previously prepared tasks, we found that 10 of 11 (91%) women were capable of completing at least 6 of 8 (75%) tasks. A positive relationship was found between the number of communicability problems and the success of completing the tasks. An analysis of the records revealed three communicability breakdowns related to the data entry, save, and scrollbar functions. The participants freely expressed suggestions for improvements such as for the save function and the process of sharing the birth-plan form upon completion. Conclusions: Users had a positive perception of the Birth Plan menu of the My Prenatal Care app. This user-centered validation enabled the identification of solutions for problems, resulting in improvements in the app. 
%M 30920372
%R 10.2196/11374
%U http://formative.jmir.org/2019/1/e11374/
%U https://doi.org/10.2196/11374
%U http://www.ncbi.nlm.nih.gov/pubmed/30920372

%0 Journal Article
        
%@ 2291-9279
%I JMIR Publications
%V 7
%N 1
%P e12835
%T Exploring Efficacy of a Serious Game (Tobbstop) for Smoking Cessation During Pregnancy: Randomized Controlled Trial
%A Marin-Gomez,Francesc X
%A Garcia-Moreno Marchán,Rocio
%A Mayos-Fernandez,Anabel
%A Flores-Mateo,Gemma
%A Granado-Font,Esther
%A Barrera Uriarte,Maria Luisa
%A Duch,Jordi
%A Rey-Reñones,Cristina
%+ Servei d'Atenció Primària d'Osona, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Pl Divina Pastora N7, Vic, 08500, Spain, 34 938890222, xavy.marin@gmail.com
%K pregnancy
%K video games
%K smoking cessation
%D 2019

%7 27.03.2019
%9 Original Paper
%J JMIR Serious Games
%G English
                
%X Background: Tobacco use during pregnancy entails a serious risk to the mother and harmful effects on the development of the child. Europe has the highest tobacco smoking prevalence (19.3%) compared with the 6.8% global mean. Between 20% to 30% of pregnant women used tobacco during pregnancy worldwide. These data emphasize the urgent need for community education and implementation of prevention strategies focused on the risks associated with tobacco use during pregnancy. Objective: The aim of this study was to investigate the efficacy of an intervention that incorporates a serious game (Tobbstop) to help pregnant smokers quit smoking. Methods: A two-arm randomized controlled trial enrolled 42 women who visited 2 primary care centers in Catalonia, Spain, between March 2015 and November 2016. All participants were pregnant smokers, above 18 years old, attending consultation with a midwife during the first trimester of pregnancy, and had expressed their desire to stop smoking. Participants were randomized to the intervention (n=21) or control group (n=21). The intervention group was instructed to install the game on their mobile phone or tablet and use it for 3 months. Until delivery, all the participants were assessed on their stage of smoking cessation during their follow-up midwife consultations. The primary outcome was continuous tobacco abstinence until delivery confirmed by the amount of carbon monoxide at each visit, measured with a carboxymeter. Results: Continuous abstinence until delivery outcome was 57% (12/21) in the intervention group versus 14% (3/21) in the control group (hazard ratio=4.31; 95% CI 1.87-9.97; P=.001). The mean of total days without smoking until delivery was higher in the intervention group (mean 139.75, SD 21.76) compared with the control group (mean 33.28, SD 13.27; P<.001). In addition, a Kapplan-Meier survival analysis showed that intervention group has a higher abstinence rate compared with the control group (log-rank test, χ21=13.91; P<.001). Conclusions: Serious game use is associated with an increased likelihood to maintain abstinence during the intervention period if compared with those not using the game. Pregnancy is an ideal opportunity to intervene and control tobacco use among future mothers. On the other hand, serious games are an emerging technology, growing in importance, which are shown to be a good tool to help quitting smoking during pregnancy and also to maintain this abstinent behavior. However, because of the study design limitations, these outcomes should be interpreted with caution. More research, using larger samples and longer follow-up periods, is needed to replicate the findings of this study. Trial Registration: ClinicalTrials.gov NCT01734421; https://clinicaltrials.gov/ct2/show/NCT01734421 (Archived by WebCite at http://www.webcitation.org/75ISc59pB) 
%M 30916655
%R 10.2196/12835
%U http://games.jmir.org/2019/1/e12835/
%U https://doi.org/10.2196/12835
%U http://www.ncbi.nlm.nih.gov/pubmed/30916655

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 2
%N 1
%P e12355
%T What Women With Disabilities Write in Personal Blogs About Pregnancy and Early Motherhood: Qualitative Analysis of Blogs
%A Litchman,Michelle L
%A Tran,MJ
%A Dearden,Susan E
%A Guo,Jia-Wen
%A Simonsen,Sara E
%A Clark,Lauren
%+ College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, United States, 1 801 585 9612, Michelle.Litchman@nurs.utah.edu
%K disabled persons
%K pregnancy
%K blog
%K women’s health
%K parenting
%K mothers
%K spinal cord injury
%K autism
%K traumatic brain injury
%D 2019

%7 14.03.2019
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: More than 1 in 10 women of reproductive age identify as having some type of disability. Most of these women are able to become pregnant and have similar desires for motherhood as women without disability. Women with disability, however, face greater stigma and stereotyping, additional risk factors, and may be less likely to receive adequate reproductive health care compared with their peers without disability. More and more individuals, including those with disability, are utilizing the internet to seek information and peer support. Blogs are one source of peer-to-peer social media engagement that may provide a forum for women with disability to both share and obtain peer-to-peer information and support. Nevertheless, it is not clear what content about reproductive health and pregnancy and/or motherhood is featured in personal blogs authored by women with spinal cord injury (SCI), traumatic brain injury (TBI), spina bifida, and autism. Objective: The objective of this study was twofold: (1) to examine the information being shared in blogs by women with 4 types of disabilities, namely, SCI, TBI, spina bifida, and autism, about reproductive health, disability, health care, pregnancy, and motherhood; and (2) to classify the content of reproductive health experiences addressed by bloggers to better understand what they viewed as important. Methods: Personal blogs were identified by searching Google with keywords related to disabilities, SCI, TBI, spina bifida, and autism, and a variety of keywords related to reproductive health. The first 10 pages of each database search in Google, based on the relevance of the search terms, were reviewed and all blogs in these pages were included. Blog inclusion criteria were as follows: (1) written by a woman or care partner (ie, parent or spouse) of a woman with a self-identified diagnosis of SCI, TBI, spina bifida, or autism; (2) focused on the personal experience of health and health care during the prepregnancy, prenatal, antepartum, intrapartum, and/or postpartum periods; (3) written in English; and (4) published between 2013 and 2017. A descriptive and thematic qualitative analysis of blogs and corresponding comments was facilitated with NVivo software and matrix analysis. Results: Our search strategy identified 125 blogs that met all the inclusion criteria; no blogs written by women with spina bifida were identified. We identified 4 reproductive health themes featured in the blog of women with disabilities: (1) (in)accessible motherhood, (2) (un)supportive others, (3) different, but not different, and (4) society questioning motherhood. Conclusions: This analysis of personal blogs about pregnancy and health care written by women with SCI, TBI, and autism provides a glimpse into their experiences. The challenges faced by these women and the adaptations they made to successfully navigate pregnancy and early motherhood provide insights that can be used to shape future research. 
%M 31518332
%R 10.2196/12355
%U http://pediatrics.jmir.org/2019/1/e12355/
%U https://doi.org/10.2196/12355
%U http://www.ncbi.nlm.nih.gov/pubmed/31518332

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 8
%N 3
%P e13011
%T A Smartphone App to Promote Healthy Weight Gain, Diet, and Physical Activity During Pregnancy (HealthyMoms): Protocol for a Randomized Controlled Trial
%A Henriksson,Pontus
%A Sandborg,Johanna
%A Blomberg,Marie
%A Alexandrou,Christina
%A Maddison,Ralph
%A Silfvernagel,Kristin
%A Henriksson,Hanna
%A Leppänen,Marja H
%A Migueles,Jairo H
%A Widman,Linnea
%A Thomas,Kristin
%A Trolle Lagerros,Ylva
%A Löf,Marie
%+ Department of Biosciences and Nutrition, Karolinska Institutet, Group/MLÖ, SE-141 83 Huddinge, Sweden, Huddinge,, Sweden, 46 701749556, pontus.henriksson@ki.se
%K telemedicine
%K pregnancy
%K gestational weight gain
%K diet
%K exercise
%K smartphone
%K mobile phone
%D 2019

%7 01.03.2019
%9 Original Paper
%J JMIR Res Protoc
%G English
                
%X Background: Excessive gestational weight gain is common and associated with adverse outcomes both in the short and long term. Although traditional lifestyle-based interventions have shown to mitigate excess gestational weight gain, little is known about whether mobile Health (mHealth) apps can promote healthy weight gain, diet, and physical activity during pregnancy. Objective: The primary aim of the HealthyMoms trial is to determine the effectiveness of a smartphone app (HealthyMoms) for mitigating excess gestational weight gain during pregnancy. Secondary aims are to determine the effectiveness of the app on dietary habits, physical activity, body fatness, and glycemia during pregnancy. Methods: HealthyMoms is a two-arm randomized controlled trial. Women are being recruited at routine visits at the maternity clinics in Linköping, Norrköping and Motala, Sweden. Women are randomized to the control or intervention group (n=150 per group). All women will receive standard care, and women in the intervention group will also receive the HealthyMoms smartphone app. Results: Recruitment of participants to the trial was initiated in October 2017, and 190 women have so far completed the baseline measurement. The baseline measures are estimated to be finalized in December 2019, and the follow-up measures are estimated to be completed in June 2020. Conclusions: This project will evaluate a novel smartphone app intervention integrated with existing maternity health care. If successful, it has great potential to be implemented nationally in order to promote healthy weight gain and health behaviors during pregnancy. International Registered Report Identifier (IRRID): DERR1-10.2196/13011 
%M 30821695
%R 10.2196/13011
%U http://www.researchprotocols.org/2019/3/e13011/
%U https://doi.org/10.2196/13011
%U http://www.ncbi.nlm.nih.gov/pubmed/30821695

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 21
%N 2
%P e11534
%T Digital Marketing to Promote Healthy Weight Gain Among Pregnant Women in Alberta: An Implementation Study
%A Graham,Jocelyn E
%A Moore,Jana L
%A Bell,Rhonda C
%A Miller,Terri
%+ Reproductive Health, Population, Public and Indigenous Health, Alberta Health Services, 10101 Southport Road SW, Calgary, AB, T2W 3N2, Canada, 1 403 943 1878, Jocelyn.Graham@ahs.ca
%K internet
%K maternal health
%K mobile phone
%K pregnant women
%K search engine
%K social media
%D 2019

%7 01.02.2019
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: As the use of digital media for health promotion has become increasingly common, descriptive studies exploring current and innovative marketing strategies can enhance the understanding of effective strategies and best practices. Objective: This study aims to describe the implementation of a provincial digital media campaign using complementary advertising platforms to promote healthy pregnancy weight gain messages and direct a Web audience to a credible website. Methods: The digital media campaign occurred in 3 phases, each for 8 weeks, and consisted of search engine marketing using Google AdWords and social media advertising through Facebook. All advertising materials directed users to evidence-based pregnancy-related weight gain content on the Healthy Parents, Healthy Children website. Results: Google Ads received a total of 43,449 impressions, 2522 clicks, and an average click-through rate (CTR) of 5.80%. Of people who clicked on a Google ad, 78.9% (1989/2522) completed an action on the website. Across all Facebook advertisements, there were 772,263 impressions, 14,482 clicks, and an average CTR of 1.88%. The highest-performing advertisement was an image of a group of diverse pregnant women with the headline “Pregnancy weight is not the same for every woman.” Conclusions: This study supports the use of digital marketing as an important avenue for delivering health messages and directing Web users to credible sources of information. The opportunity to reach large, yet targeted audiences, along with the ability to monitor and evaluate metrics to optimize activities throughout a campaign is a powerful advantage over traditional marketing tactics. Health organizations can use the results and insights of this study to help inform the design and implementation of similar Web-based activities. 
%M 30707100
%R 10.2196/11534
%U https://www.jmir.org/2019/2/e11534/
%U https://doi.org/10.2196/11534
%U http://www.ncbi.nlm.nih.gov/pubmed/30707100

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 1
%P e11836
%T Effects of Social Media and Mobile Health Apps on Pregnancy Care: Meta-Analysis
%A Chan,Ko Ling
%A Chen,Mengtong
%+ Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong,, China (Hong Kong), 852 5425 9462, jenna.mt.chen@polyu.edu.hk
%K mHealth
%K social media
%K pregnancy
%K postpartum
%K maternal health
%D 2019

%7 30.01.2019
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The use of social media and mobile health (mHealth) apps has been increasing in pregnancy care. However, the effectiveness of these interventions is still unclear. Objectives: We conducted a meta-analysis to examine the effectiveness of these interventions with regard to different health outcomes in pregnant and postpartum women and investigate the characteristics and components of interventions that may affect program effectiveness. Method: We performed a comprehensive literature search of major electronic databases and reference sections of related reviews and eligible studies. A random effects model was used to calculate the effect size. Results: Fifteen randomized controlled trial studies published in and before June 2018 that met the inclusion criteria were included in the meta-analysis. The interventions were effective in promoting maternal physical health including weight management, gestational diabetes mellitus control, and asthma control with a moderate to large effect size (d=0.72). Large effect sizes were also found for improving maternal mental health (d=0.84) and knowledge about pregnancy (d=0.80). Weight control interventions using wearable devices were more effective. Conclusion: Social media and mHealth apps have the potential to be widely used in improving maternal well-being. More large-scale clinical trials focusing on different health outcomes are suggested for future studies. 
%M 30698533
%R 10.2196/11836
%U https://mhealth.jmir.org/2019/1/e11836/
%U https://doi.org/10.2196/11836
%U http://www.ncbi.nlm.nih.gov/pubmed/30698533

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 1
%P e11458
%T Women’s Attitudes Toward Self-Monitoring of Their Pregnancy Using Noninvasive Electronic Devices: Cross-Sectional Multicenter Study
%A Schramm,Katharina
%A Grassl,Niklas
%A Nees,Juliane
%A Hoffmann,Janine
%A Stepan,Holger
%A Bruckner,Thomas
%A Haun,Markus W
%A Maatouk,Imad
%A Haist,Markus
%A Schott,Timm C
%A Sohn,Christof
%A Schott,Sarah
%+ Department of Gynecology and Obstetrics, University Women's Clinic Heidelberg, Im Neuenheimer Feld 440, Heidelberg, 69120, Germany, 49 6221567906, sarah.schott@med.uni-heidelberg.de
%K eHealth
%K fetal monitoring
%K pregnancy
%K telemedicine
%D 2019

%7 07.01.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Pregnancy can be distressing, particularly if expectant mothers are worried about the well-being of their fetus. Consequently, the desire for reassurance and frequent fetal monitoring is often pronounced. Smart wearable devices and telemedicine are promising tools that could assist women in self-monitoring their pregnancy at home, hence disburdening emergency departments (EDs). They present the possibility to clarify the need for urgent care remotely and offer tighter pregnancy monitoring. However, patients’ acceptance of such new technologies for fetal monitoring has not yet been explored extensively. Objective: This survey aimed to elucidate the attitudes of women toward self-monitoring of their pregnancy using noninvasive electronic devices. The technical details of the proposed devices were not specified. Methods: A cross-sectional multicenter study was conducted at the departments of obstetrics of the University Hospitals of Heidelberg and Leipzig, Germany. All patients seen in the obstetrics clinic who were above 18 years were offered participation. We designed a survey questionnaire including validated instruments covering population characteristics, issues in current and past pregnancies, as well as attitudes toward self-monitoring of pregnancy with smart devices. Results: A total of 509 pregnant women with no previous experience in telemedicine participated. Only a small minority of 5.9% (29/493) regarded self-monitoring with wearable devices as an alternative to consulting their physicians. Along these lines, only 7.7% (38/496) strongly believed they would visit the ED less often if such devices were readily available. However, if the procedure were combined with a Web-based telemetric physician consult, 13.5% (66/487) would be highly motivated to use the devices. Furthermore, significantly more women regarded it as an alternative prior to seeing a doctor when they perceived a decline in fetal movements (P<.001). Interestingly, women with university degrees had a higher propensity to engage in pregnancy self-monitoring compared with women without one (37% vs 23%; P=.001). Of the participants, 77.9% (381/489) would like smart wearable devices to measure fetal heart sounds, and 62.6% (306/489) wished to use the devices on their own. Feedback from a doctor or midwife was also very important in their choice of such devices (61.8%, 301/487 wished feedback). The intended frequency of use differed vastly among women, ranging from 13.8% (65/471) who would like to use such a device several times per day to 31.6% (149/471) who favored once per week at most. Conclusions: Our results point to a skeptical attitude toward pregnancy self-monitoring among pregnant women. Nevertheless, many women are open to using devices for pregnancy monitoring in parallel to consulting their physician. The intention to use such devices several times daily or weekly, expressed by more than half of the participants, highlights the potential of such technologies. 
%M 30617040
%R 10.2196/11458
%U https://mhealth.jmir.org/2019/1/e11458/
%U https://doi.org/10.2196/11458
%U http://www.ncbi.nlm.nih.gov/pubmed/30617040

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 12
%P e11213
%T The Impact of a Maternal Education Program Through Text Messaging in Rural China: Cluster Randomized Controlled Trial
%A Xie,Ri-Hua
%A Tan,Hongzhuan
%A Taljaard,Monica
%A Liao,Yan
%A Krewski,Daniel
%A Du,Qingfeng
%A Wen,Shi Wu
%+ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Ottawa, ON, ON K1H 8L6, Canada, 1 6137378899 ext 73912, swwen@ohri.ca
%K maternal education
%K text messaging
%K maternal health
%K infant health
%K cluster trial
%D 2018

%7 19.12.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: In recent years, attempts have been made to use mobile phone text messaging (short message service, SMS) to achieve positive results for a range of health issues. Reports on the impact of maternal education programs based on this widely available, inexpensive, and instant communication tool are sparse. Objective: This study aimed to explore the impact of a maternal education program through text messaging. Methods: We conducted a cluster randomized trial in a remote region in the Chinese province of Hunan between October 1, 2011, and December 31, 2012. We used county as the unit of randomization (a total of 10 counties), with half of the counties randomly allocated to the intervention arm (with maternal education material adapted from the World Health Organization being delivered by text messaging to village health workers and pregnant women alike) and the other half to the control arm (normal care without text messaging). Data on maternal and infant health outcomes and health behaviors were collected and compared between the 2 arms, with maternal and perinatal mortality as the primary outcomes. Results: A total of 13,937 pregnant women completed the follow-up and were included in the final analysis. Among them, 6771 were allocated to the intervention arm and 6966 were allocated to the control arm. At the county level, the mean (SD) of maternal mortality and perinatal mortality rate were 0.0% (0.1) and 1.3% (0.6), respectively, in the intervention arm and 0.1% (0.2) and 1.5% (0.4), respectively, in the control arm. However, these differences were not statistically significant. At the individual level, there were 3 maternal deaths (0.04%) and 84 perinatal deaths (1.24%) in the intervention arm and 6 maternal deaths (0.09%) and 101 perinatal deaths (1.45%) in the control arm. However, the differences were again not statistically significant. Conclusions: Adequate resources should be secured to launch large-scale cluster randomized trials with smaller cluster units and more intensive implementation to confirm the benefits of the text messaging–based maternal education program suggested by this trial. Trial Registration: ClinicalTrials.gov NCT01775150; https://clinicaltrials.gov/ct2/show/NCT01775150 (Archived by WebCite at http://www.webcitation.org/74cHmUexo) 
%M 30567693
%R 10.2196/11213
%U http://mhealth.jmir.org/2018/12/e11213/
%U https://doi.org/10.2196/11213
%U http://www.ncbi.nlm.nih.gov/pubmed/30567693

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 11
%P e11508
%T The Association Between the Use of Antenatal Care Smartphone Apps in Pregnant Women and Antenatal Depression: Cross-Sectional Study
%A Mo,Yushi
%A Gong,Wenjie
%A Wang,Joyce
%A Sheng,Xiaoqi
%A Xu,Dong R
%+ XiangYa School of Public Health, Central South University, 238 Shangmayuanling Lane, Xiangya Road, KaiFu District, Changsha,, China, 86 13607445252, gongwenjie@csu.edu.cn
%K antenatal care
%K antenatal depression
%K app
%K mobile phone
%D 2018

%7 29.11.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Antenatal care smartphone apps are increasingly used by pregnant women, but studies on their use and impact are scarce. Objective: This study investigates the use of antenatal care apps in pregnant women and explores the association between the use of these apps and antenatal depression. Methods: This study used a convenient sample of pregnant women recruited from Hunan Provincial Maternal and Child Health Hospital in November 2015. The participants were surveyed for their demographic characteristics, use of antenatal care apps, and antenatal depression. Factors that influenced antenatal pregnancy were analyzed using logistic regression. Results: Of the 1304 pregnant women, 71.31% (930/1304) used antenatal care apps. Higher usage of apps was associated with urban residency, nonmigrant status, first pregnancy, planned pregnancy, having no previous children, and opportunity to communicate with peer pregnant women. The cutoff score of the Edinburgh Postnatal Depression Scale was 10, and 46.11% (601/1304) of the pregnant women had depression. Logistic regression showed that depression was associated with the availability of disease-screening functions in the apps (odds ratio (OR) 1.78, 95% CI 1.03-3.06) and spending 30 minutes or more using the app (OR 2.05, 95% CI 1.19-3.52). Using apps with social media features was a protective factor for antenatal depression (OR 0.33, 95% CI 0.12-0.89). Conclusions: The prevalence of the use of prenatal care apps in pregnant women is high. The functions and time spent on these apps are associated with the incidence of antenatal depression. 
%M 30497996
%R 10.2196/11508
%U http://mhealth.jmir.org/2018/11/e11508/
%U https://doi.org/10.2196/11508
%U http://www.ncbi.nlm.nih.gov/pubmed/30497996

%0 Journal Article
        
%@ 2368-7959
%I JMIR Publications
%V 5
%N 4
%P e10007
%T A Mobile App for the Self-Report of Psychological Well-Being During Pregnancy (BrightSelf): Qualitative Design Study
%A Doherty,Kevin
%A Barry,Marguerite
%A Marcano-Belisario,José
%A Arnaud,Bérenger
%A Morrison,Cecily
%A Car,Josip
%A Doherty,Gavin
%+ School of Computer Science and Statistics, Trinity College Dublin, College Green, Dublin,, Ireland, 353 1 8963858, Gavin.Doherty@tcd.ie
%K engagement
%K mental health
%K mHealth
%K midwifery
%K perinatal depression
%K pregnancy
%K self-report
%K well-being
%K mobile phone
%D 2018

%7 27.11.2018
%9 Original Paper
%J JMIR Ment Health
%G English
                
%X Background: Maternal mental health impacts both parental well-being and childhood development. In the United Kingdom, 15% of women are affected by depression during pregnancy or within 1 year of giving birth. Suicide is a leading cause of perinatal maternal mortality, and it is estimated that >50% of perinatal depression cases go undiagnosed. Mobile technologies are potentially valuable tools for the early recognition of depressive symptoms, but complex design challenges must be addressed to enable their use in public health screening. Objective: The aim of this study was to explore the issues and challenges surrounding the use of mobile phones for the self-report of psychological well-being during pregnancy. Methods: This paper presents design research carried out as part of the development of BrightSelf, a mobile app for the self-report of psychological well-being during pregnancy. Design sessions were carried out with 38 participants, including pregnant women, mothers, midwives, and other health professionals. Overall, 19 hours of audio were fully transcribed and used as the basis of thematic analysis. Results: The study highlighted anxieties concerning the pregnancy journey, challenges surrounding current approaches to the appraisal of well-being in perinatal care, and the midwife-patient relationship. Designers should consider the framing of perinatal mental health technologies, the experience of self-report, supporting self-awareness and disclosure, providing value to users through both self-report and supplementary features, and designing for longitudinal engagement. Conclusions: This study highlights the needs, motivations, and anxieties of women with respect to technology use in pregnancy and implications for the design of mobile health technologies. 
%M 30482742
%R 10.2196/10007
%U http://mental.jmir.org/2018/4/e10007/
%U https://doi.org/10.2196/10007
%U http://www.ncbi.nlm.nih.gov/pubmed/30482742

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 11
%P e189
%T The Rise of Pregnancy Apps and the Implications for Culturally and Linguistically Diverse Women: Narrative Review
%A Hughson,Jo-anne Patricia
%A Daly,J Oliver
%A Woodward-Kron,Robyn
%A Hajek,John
%A Story,David
%+ Research Unit for Multilingualism and Cross-Cultural Communication, University of Melbourne, Babel Building, Parkville, 3010, Australia, 61 425710396, hughson@unimelb.edu.au
%K culture
%K emigrants and immigrants
%K health communication
%K information-seeking behavior
%K literacy
%K maternal health
%K mHealth
%K mobile phone
%K pregnancy
%K self-care
%K vulnerable populations
%D 2018

%7 16.11.2018
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Pregnancy apps are a booming global industry, with most pregnant women in high-income countries now using them. From the perspective of health care and health information provision, this is both encouraging and unsettling; the demand indicates a clear direction for the development of future resources, but it also underscores the importance of processes ensuring access, reliability, and quality control. Objective: This review provides an overview of current literature on pregnancy apps and aims at describing (1) the ways in which apps are used by women, in general, and by those of a culturally and linguistically diverse (CALD) background; (2) the utility and quality of information provided; and (3) areas where more research, development, and oversight are needed. Methods: We chose a narrative review methodology for the study and performed a structured literature search including studies published between 2012 and 2017. Searches were performed using MEDLINE, EMBASE, and CINAHL databases. Studies were identified for inclusion using two separate search criteria and strategies: (1) studies on pregnancy apps and pregnant women’s use of these apps and (2) studies on CALD pregnant women and their use of technology for accessing information on and services for pregnancy. Overall, we selected 38 studies. Results: We found that pregnancy apps were principally used to access pregnancy health and fetal development information. Data storage capability, Web-based features or personalized tools, and social media features were also popular app features sought by women. Lower rates of the pregnancy app uptake were indicated among lower-income and non-English-speaking women. Preliminary evidence indicates that a combination of technological, health literacy, and language issues may result in lower uptake of pregnancy apps by these groups; however, further investigation is required. A marked limitation of the health app industry is lack of regulation in a commercially dominated field, making it difficult for users to assess the reliability of the information being presented. Health professionals and users alike indicate that given the choice, they would prefer using pregnancy apps that are relevant to their local health care context and come from a trusted source. Evidence indicates a need for greater health professional and institutional engagement in the app development, as well as awareness of and guidance for women’s use of these resources. Conclusions: This is the first review of pregnancy app use, types of information provided, and features preferred by pregnant women in general and by those of a CALD background in particular. It indicates the demand for access to accurate information that is relevant to users, their community, and their associated health services. Given the popularity of pregnancy apps, such apps have enormous potential to be used for the provision of accurate, evidence-based health information. 
%M 30446483
%R 10.2196/mhealth.9119
%U https://mhealth.jmir.org/2018/11/e189/
%U https://doi.org/10.2196/mhealth.9119
%U http://www.ncbi.nlm.nih.gov/pubmed/30446483

%0 Journal Article
        
%@ 2369-3762
%I JMIR Publications
%V 4
%N 2
%P e10347
%T Use of Grading of Recommendations, Assessment, Development, and Evaluation to Combat Fake News: A Case Study of Influenza Vaccination in Pregnancy
%A Zafar,Sidra
%A Habboush,Yacob
%A Beidas,Sary
%+ Department of Internal Medicine, Orange Park Medical Center, 2001 Kingsley Avenue, Orange Park, Jacksonville, FL, 32073, United States, 1 904 639 8500, sary.beidas@hcahealthcare.com
%K GRADE
%K influenza
%K vaccination
%K spontaneous abortion
%K miscarriage
%D 2018

%7 07.11.2018
%9 Review
%J JMIR Med Educ
%G English
                
%X Background: The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework is a validated evaluation tool used to assess the quality of scientific publications. It helps in enhancing clinicians’ decision-making process and supports production of informed healthy policy. Objective: The purpose of this report was two-fold. First, we reviewed the interpretation of observational studies. The second purpose was to share or provide an example using the GRADE criteria. Methods: To illustrate the use of the GRADE framework to assess publications, we selected a study evaluating the risk of spontaneous abortion (SAB) after influenza vaccine administration. Results: Since 2004, the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practice have recommended influenza vaccination of pregnant women. Previous studies have not found an association between influenza vaccination and SAB. However, in a recent case-control study by Donahue et al, a correlation with SAB in women who received the H1N1 influenza vaccine was identified. For women who received H1N1–containing vaccine in the previous and current influenza season, the adjusted odds ratio (aOR) for SAB was 7.7 (95% CI, 2.2-27.3), while the aOR for women not vaccinated in the previous season but vaccinated in the current season was 1.3 (95% CI, 0.7-2.7). Conclusions: Our goal is to enable the readers to critique published literature using appropriate evaluation tools such as GRADE. 
%M 30404772
%R 10.2196/10347
%U http://mededu.jmir.org/2018/2/e10347/
%U https://doi.org/10.2196/10347
%U http://www.ncbi.nlm.nih.gov/pubmed/30404772

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 5
%N 4
%P e29
%T Developing Culturally Sensitive mHealth Apps for Caribbean Immigrant Women to Use During Pregnancy: Focus Group Study
%A AlJaberi,Hana
%+ Department of Computer Graphics Technology, Purdue Polytechnic Institute, Purdue University, Knoy Hall, 401 N Grant St, West Lafayette, IN, 47907, United States, 1 765 494 7505, aljaberi.hana@gmail.com
%K mHealth
%K human computer interaction
%K prenatal health
%K Caribbean
%K immigrant women
%K mobile phone
%D 2018

%7 10.10.2018
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: A valuable addition to the mobile health (mHealth) space is an exploration of the context of minorities in developed countries. The transition period postmigration, culture, and socioeconomic uniqueness of migratory groups can shed light on the problems with existing prenatal mHealth apps. Objective: The objectives of this study were to (1) use the theoretical concept of pregnancy ecology to understand the emotional, physical, information, and social challenges affecting low-income Caribbean immigrant women’s prenatal well-being practices and (2) develop a deep understanding of challenges worthy of consideration in mHealth design for these women. Methods: This qualitative interpretive approach using analytical induction presents the findings of 3 focus group sessions with 12 Caribbean immigrant women living in South Florida in the United States. The study took place from April to September 2015. Results: The participants revealed problematic tiers and support needs within the pregnancy ecology including emotional stressors caused by family separation, physical challenges, information gaps, and longing for social support. Conclusions: mHealth interventions for low-income Caribbean immigrant women must be designed beyond the conventional way of focusing on the events surrounding the unborn child. It can be tailored to the needs of the expecting mother. Pregnancy information should be customized on the basis of the variability of lifestyle, cultural practices, socioeconomic status, and social ties while still being able to deliver appropriate guidelines and clear cultural misconceptions. 
%M 30305256
%R 10.2196/humanfactors.9787
%U http://humanfactors.jmir.org/2018/4/e29/
%U https://doi.org/10.2196/humanfactors.9787
%U http://www.ncbi.nlm.nih.gov/pubmed/30305256

%0 Journal Article
        
%@ 2368-7959
%I JMIR Publications
%V 5
%N 3
%P e10420
%T Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial
%A Rondung,Elisabet
%A Ternström,Elin
%A Hildingsson,Ingegerd
%A Haines,Helen M
%A Sundin,Örjan
%A Ekdahl,Johanna
%A Karlström,Annika
%A Larsson,Birgitta
%A Segeblad,Birgitta
%A Baylis,Rebecca
%A Rubertsson,Christine
%+ Department of Psycholgy, Mid Sweden University, Campus Östersund, Östersund, 831 25, Sweden, 46 706430721, elisabet.rondung@miun.se
%K fear of birth
%K anxiety
%K pregnancy
%K cognitive behavioral therapy
%K internet-based
%D 2018

%7 10.08.2018
%9 Original Paper
%J JMIR Ment Health
%G English
                
%X Background: Although many pregnant women report fear related to the approaching birth, no consensus exists on how fear of birth should be handled in clinical care. Objective: This randomized controlled trial aimed to compare the efficacy of a guided internet-based self-help program based on cognitive behavioral therapy (guided ICBT) with standard care on the levels of fear of birth in a sample of pregnant women reporting fear of birth. Methods: This nonblinded, multicenter randomized controlled trial with a parallel design was conducted at three study centers (hospitals) in Sweden. Recruitment commenced at the ultrasound screening examination during gestational weeks 17-20. The therapist-guided ICBT intervention was inspired by the Unified protocol for transdiagnostic treatment of emotional disorders and consisted of 8 treatment modules and 1 module for postpartum follow-up. The aim was to help participants observe and understand their fear of birth and find new ways of coping with difficult thoughts and emotions. Standard care was offered in the three different study regions. The primary outcome was self-assessed levels of fear of birth, measured using the Fear of Birth Scale. Results: We included 258 pregnant women reporting clinically significant levels of fear of birth (guided ICBT group, 127; standard care group, 131). Of the 127 women randomized to the guided ICBT group, 103 (81%) commenced treatment, 60 (47%) moved on to the second module, and only 13 (10%) finished ≥4 modules. The levels of fear of birth did not differ between the intervention groups postintervention. At 1-year postpartum follow-up, participants in the guided ICBT group exhibited significantly lower levels of fear of birth (U=3674.00, z=−1.97, P=.049, Cohen d=0.28, 95% CI –0.01 to 0.57). Using the linear mixed models analysis, an overall decrease in the levels of fear of birth over time was found (P≤
.001), along with a significant interaction between time and intervention, showing a larger reduction in fear of birth in the guided ICBT group over time (F1,192.538=4.96, P=.03). Conclusions: Fear of birth decreased over time in both intervention groups; while the decrease was slightly larger in the guided ICBT group, the main effect of time alone, regardless of treatment allocation, was most evident. Poor treatment adherence to guided ICBT implies low feasibility and acceptance of this treatment. Trial Registration: ClinicalTrials.gov NCT02306434; https://clinicaltrials.gov/ct2/show/NCT02306434 (Archived by WebCite at http://www.webcitation.org/70sj83qat) 
%M 30097422
%R 10.2196/10420
%U http://mental.jmir.org/2018/3/e10420/
%U https://doi.org/10.2196/10420
%U http://www.ncbi.nlm.nih.gov/pubmed/30097422

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 8
%P e10012
%T The Effect of Mobile App Interventions on Influencing Healthy Maternal Behavior and Improving Perinatal Health Outcomes: Systematic Review
%A Daly,Lisa M
%A Horey,Dell
%A Middleton,Philippa F
%A Boyle,Frances M
%A Flenady,Vicki
%+ Mater Research Institute, The University of Queensland, Level 3, Aubigny Place, South Brisbane, 4101, Australia, 61 7 3163 5330, lisa.daly@uq.edu.au
%K apps
%K pregnancy
%K perinatal
%K maternal
%K infant
%K mobile
%K systematic review
%K behavior change
%K intervention
%D 2018

%7 09.08.2018
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Perinatal morbidity and mortality are significant public health issues with an enduring impact on the health and well-being of women and their families. Millions of pregnant women now download and use mobile applications to access, store, and share health information. However, little is known about the consequences. An investigation of their impact on perinatal health outcomes is particularly topical. Objective: To determine the effects of mobile app interventions during pregnancy on influencing healthy maternal behavior and improving perinatal health outcomes. Methods: Searches of PubMed, Embase, the Cochrane Library, CINAHL, WHO Global Health Library, POPLINE, and CABI Global Health were conducted with no date or language restrictions. Randomized and non-randomized studies were included if they reported perinatal health outcomes of interventions targeting pregnant women, using mobile apps compared with other communication modalities or with standard care. The primary outcome measure was the change in maternal behaviors (as defined by trial authors), by intervention goals. Two reviewers independently extracted data using standardized forms. Results: Four randomized controlled trials (RCTs) involving 456 participants were included. All studies targeted participants in early pregnancy; however, wide variation was evident in participant characteristics, intervention, and study outcomes measures. Three trials were based in hospital settings, comparing women using mobile apps with routine antenatal care. One community-based trial gave all participants a device to promote physical activity; the intervention arm was also given a mobile app. All studies reported data for the primary outcome measure, describing some benefit from the intervention compared with controls. However, few statistically significant primary or secondary outcomes were reported. Due to insufficient data, the planned meta-analysis and subgroup analyses were not performed. Conclusions: Due to limited numbers, heterogeneity of interventions, comparators, and outcome measures, no firm conclusions can be drawn on the effects of mobile application interventions during pregnancy on maternal knowledge, behavior change, and perinatal health outcomes. As millions of women utilize mobile apps during pregnancy, rigorous studies are essential for health care and maternity care providers to optimally design, implement, and evaluate interventions. 
%M 30093368
%R 10.2196/10012
%U http://mhealth.jmir.org/2018/8/e10012/
%U https://doi.org/10.2196/10012
%U http://www.ncbi.nlm.nih.gov/pubmed/30093368

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 1
%N 2
%P e7
%T Engaging Men in Prenatal Health via eHealth: Findings From a National Survey
%A Mackert,Michael
%A Guadagno,Marie
%A Lazard,Allison
%A Donovan,Erin
%A Rochlen,Aaron
%A Garcia,Alexandra
%A Damásio,Manuel José
%A Crook,Brittani
%+ Center for Health Communication, The University of Texas at Austin, 1 University Station A1200, Austin, TX, 78712, United States, 1 5172143200, mariea@utexas.edu
%K health communication
%K fathering
%K expectant fathers
%K prenatal health
%D 2018

%7 09.08.2018
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Pregnancy outcomes in the United States rank among the worst of countries with a developed health care system. Although traditional prenatal health primarily focuses on women, promising findings have emerged in international research that suggest the potential of including men in prenatal health interventions in the United States. eHealth apps present a promising avenue to reach new and expectant fathers with crucial parenting knowledge and healthy, supportive behaviors. Objective: The aim was to explore the perceived role of men in prenatal health, acceptability of eHealth to positively engage men during pregnancy, and participant-suggested ways of improving a prenatal health app designed for new and expectant fathers. Methods: A nationally representative sample of adult males (N=962) was recruited through an online survey panel. A third-party market research and digital data collection agency managed the recruitment. The sample had a mean age of 30.2 (SD 6.3) years and included both fathers (413/962, 42.9%) and non-fathers (549/962, 57.1%). Nearly 12.0% (115/962) of participants had a partner who was pregnant at the time of the survey. Results: Despite perceived barriers, such as time constraints, financial burdens, and an unclear role, men believe it is important to be involved in pregnancy health. The majority of participants (770/944, 81.6%) found the site to contain useful and interesting information. Most substantially, more than three-quarters (738/962, 76.7%) of the sample said they would share the site with others who would benefit from the information. Participants recommended the addition of interactive modules, such as a financial planning tool and videos, to make the site stronger. Conclusions: We explored the use of targeted eHealth to introduce men to prenatal education. Results indicate men are favorable to this intervention. Additional refinement should include interactive tools to further engage men in this important issue. Reaching men at the prenatal phase is an early “teachable moment”—where new/expectant fathers are open to information on how to help their partners have a healthy pregnancy and promote the health of their unborn children. Findings will further inform best practices for engaging men in pregnancy, which is crucial for improving maternal and child health outcomes in the United States. 
%M 31518311
%R 10.2196/pediatrics.9513
%U http://pediatrics.jmir.org/2018/2/e7/
%U https://doi.org/10.2196/pediatrics.9513
%U http://www.ncbi.nlm.nih.gov/pubmed/31518311

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 8
%P e10063
%T A Web-Based Survey Assessing the Attitudes of Health Care Professionals in Germany Toward the Use of Telemedicine in Pregnancy Monitoring: Cross-Sectional Study
%A Grassl,Niklas
%A Nees,Juliane
%A Schramm,Katharina
%A Spratte,Julia
%A Sohn,Christof
%A Schott,Timm C
%A Schott,Sarah
%+ Department of Gynecology and Obstetrics, University Women's Clinic Heidelberg, Im Neuenheimer Feld 440, Heidelberg, 69120, Germany, 49 6221 56 7901, sarah.schott@med.uni-heidelberg.de
%K telemedicine
%K obstetrics
%K eHealth
%K pregnancy monitoring
%K job satisfaction
%K sleeping problems
%K night shift
%K emergency consultation
%D 2018

%7 08.08.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The demand for fetal monitoring and constant reassurance is high in pregnant women. Consequently, pregnant women use various health apps and are more likely to visit emergency departments due to subjective but nonurgent complaints. However, electronic health (eHealth) and mobile health (mHealth) solutions are rarely used to prevent nonurgent emergency consultations. To implement modern care solutions, a better understanding of the attitudes, fears, and hopes of health care professionals toward eHealth and mHealth is needed. Objective: The aim of this study was to investigate the attitudes of health care professionals in obstetrics toward telemedicine. Methods: A quantitative Web-based survey on health care professionals in obstetrics in Germany was conducted. The participants included nurses, midwives, and physicians of all age groups and job positions working in hospitals that provide various levels of health care. The questionnaire comprised 24 questions about the characteristics of the study population, views about emergency consultations in obstetrics, attitude toward telemedicine, job satisfaction, and sleeping behavior. Results: In total, 244 health care professionals participated in the Web-based survey. In general, health care professionals were skeptical (170/233, 72.9%) about the use of telemedicine in obstetrics; however, 55.8% (130/233) recognized its potential. Moreover, 72% (62/86) of physicians were optimistic in using apps for pregnancy monitoring, whereas 36.1% (47/130) of nonphysicians (P<.001) were not. Significantly, more nonphysicians rejected such developments (75/130, 57.7% rejected) compared with physicians (24/86, 28%; P<.001). We also found that obstetricians with more than 10 years of work-experience are more skeptical; however, approximately 49% (18/37) of them believed that telemedicine could reduce nonurgent emergency consultations, whereas 73.2% (106/145) of obstetricians with less than 5 years of experience (P=.01) thought otherwise. Our survey revealed a high job satisfaction and a prevalence of regular sleeping problems of 45.9% (91/198) among health care professionals in obstetrics. Surprisingly, both job satisfaction and sleeping problems were independent from the number of night shifts per month (P=.77 and P=.99, respectively). Yet, 56.6% (112/198) of the survey participants thought they would be happier with their job if they had to work fewer night shifts per month. Conclusions: Our study reveals an ambivalent attitude toward the use of telemedicine among health care professionals in obstetrics in Germany at the moment. Efforts to promote the use of telemedicine should focus on nurses and midwives because these groups are the most skeptical. By contrast, particularly young physicians recognize the potential of apps in patient care and would like to use such technology in pregnancy monitoring. 
%M 30089606
%R 10.2196/10063
%U http://mhealth.jmir.org/2018/8/e10063/
%U https://doi.org/10.2196/10063
%U http://www.ncbi.nlm.nih.gov/pubmed/30089606

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 7
%P e153
%T Forecasting the Value for Money of Mobile Maternal Health Information Messages on Improving Utilization of Maternal and Child Health Services in Gauteng, South Africa: Cost-Effectiveness Analysis
%A LeFevre,Amnesty
%A Cabrera-Escobar,Maria A
%A Mohan,Diwakar
%A Eriksen,Jaran
%A Rogers,Debbie
%A Neo Parsons,Annie
%A Barre,Iman
%A Jo,Youngji
%A Labrique,Alain
%A Coleman,Jesse
%+ Department of Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm,, Sweden, 46 852480000, denots@gmail.com
%K mHealth
%K cost effectiveness
%K cost utility analysis
%K digital health
%D 2018

%7 27.07.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Limited evidence exists on the value for money of mHealth information programs in low resource settings. Objective: This study sought to model the incremental cost-effectiveness of gradually scaling up text messaging services to pregnant women throughout Gauteng province, South Africa from 2012 to 2017. Methods: Data collection occurred as part of a retrospective study in 6 health centers in Gauteng province. Stage-based short message service (SMS) text messages on maternal health were sent to pregnant women twice per week during pregnancy and continued until the infant’s first birthday. Program costs, incremental costs to users, and the health system costs for these women were measured along with changes in the utilization of antenatal care visits and childhood immunizations and compared with those from a control group of pregnant women who received no SMS text messages. Incremental changes in utilization were entered into the Lives Saved Tool and used to forecast lives saved and disability adjusted life years (DALYs) averted by scaling up program activities over 5 years to reach 60% of pregnant women across Gauteng province. Uncertainty was characterized using one-way and probabilistic uncertainty analyses. Results: Five-year program costs were estimated to be US $1.2 million, 17% of which were incurred by costs on program development and 31% on SMS text message delivery costs. Costs to users were US $1.66 to attend clinic-based services, nearly 90% of which was attributed to wages lost. Costs to the health system included provider time costs to register users (US $0.08) and to provide antenatal care (US $4.36) and postnatal care (US $3.08) services. Incremental costs per DALY averted from a societal perspective ranged from US $1985 in the first year of implementation to US $200 in the 5th year. At a willingness-to-pay threshold of US $2000, the project had a 40% probability of being cost-effective in year 1 versus 100% in all years thereafter. Conclusions: Study findings suggest that delivering SMS text messages on maternal health information to pregnant and postpartum women may be a cost-effective strategy for bolstering antenatal care and childhood immunizations, even at very small margins of coverage increases. Primary data obtained prospectively as part of more rigorous study designs are needed to validate modeled results. 
%M 30054263
%R 10.2196/mhealth.8185
%U http://mhealth.jmir.org/2018/7/e153/
%U https://doi.org/10.2196/mhealth.8185
%U http://www.ncbi.nlm.nih.gov/pubmed/30054263

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 6
%P e140
%T The Rise and Need for Mobile Apps for Maternal and Child Health Care in China: Survey Based on App Markets
%A Zhang,Puhong
%A Dong,Le
%A Chen,Huan
%A Chai,Yanling
%A Liu,Jianbo
%+ Department of Women and Child Health, The George Institute for Global Health at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, No. 6 Zhichun Rd, Beijing, 100088, China, 86 1082800577 ext 512, zpuhong@georgeinstitute.org.cn
%K mHealth
%K health services, maternal-child
%K mobile apps
%K market research
%D 2018

%7 08.06.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile health services are thriving in the field of maternal and child health in China due to expansions in the field of electronic health and the introduction of the two-child policy. There are numerous maternal and child health apps in computer stores, but the exact number of apps, number of downloads, and features of these apps is not known. Objective: This study aimed to explore the use of maternal and child health apps in Android and iOS app stores and to describe the key functional features of the most popular apps, with the purpose of providing insight into further research and development of maternal and child health mobile health products. Methods: The researchers conducted a search in the 3 most popular Android app stores (Tencent MyApp, Baidu Mobile Assistant, and 360 Mobile Assistant) and the iTunes App Store in China. All apps regarding family planning (contraception and preparing for pregnancy), pregnancy and perinatal care, neonatal care and health, and development for children under 6 years were included in the initial analysis. Maternal and child health mobile apps with predominant features of product marketing, children’s songs, animation, or games were excluded from the study. The 50 most frequently used apps in each of the Android stores as well as the iTunes store (a total of 78 deduplicated apps) were selected and downloaded for an in-depth analysis. Results: A total of 5276 Android apps and 877 iOS apps developed for maternal and child health care were identified. Of the 78 most frequently used apps, 43 (55%) apps focused on one stage of MCH care, mainly targeting child care (25 apps) and before pregnancy care (11 apps), whereas 35 (45%) of the apps covered 2 or more stages, most of which (32 apps) included both pregnancy and child care services. The app features that were commonly adopted by the popular apps were health education, communication, health status self-monitoring, a diary, reminders, and counseling. Within the app feature of “health status self-monitoring,” the researchers found 47 specific tools supporting activities such as pregnancy preparation, fetal heart monitoring, blood glucose and blood pressure monitoring, and doctor visits. A few apps were equipped with external devices (n=3) or sensors. No app with intelligent decision-support features to support disease management for conditions such as gestational diabetes and pregnancy-induced hypertension was found. A small number of apps (n=5) had a Web connection with hospital information systems to support appointment making, payments, hospital service guidance, or checking of laboratory results. Conclusions: There are thousands of maternal and child health apps in the Chinese market. Child care, pregnancy, and before pregnancy were the mostly covered maternal and child health stages, in that order. Various app features and tools were adopted by maternal and child health apps, but the use of internal or external sensors, intelligent decision support, and tethering with existing hospital information systems was rare and these features need more research and development. 
%M 29884601
%R 10.2196/mhealth.9302
%U http://mhealth.jmir.org/2018/6/e140/
%U https://doi.org/10.2196/mhealth.9302
%U http://www.ncbi.nlm.nih.gov/pubmed/29884601

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 20
%N 6
%P e202
%T eHealth as the Next-Generation Perinatal Care: An Overview of the Literature
%A van den Heuvel,Josephus FM
%A Groenhof,T Katrien
%A Veerbeek,Jan HW
%A van Solinge,Wouter W
%A Lely,A Titia
%A Franx,Arie
%A Bekker,Mireille N
%+ Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Lundlaan 6, Utrecht, 3584 AB, Netherlands, 31 887554913, jheuve10@umcutrecht.nl
%K pregnancy
%K eHealth
%K telemedicine
%K pregnancy complications
%K fetal monitoring
%K patient-centered care
%K pregnancy, high risk
%K diabetes, gestational
%K remote consultation
%K ambulatory monitoring
%K obstetrics
%K perinatal care
%K antenatal care
%D 2018

%7 05.06.2018
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Unrestricted by time and place, electronic health (eHealth) provides solutions for patient empowerment and value-based health care. Women in the reproductive age are particularly frequent users of internet, social media, and smartphone apps. Therefore, the pregnant patient seems to be a prime candidate for eHealth-supported health care with telemedicine for fetal and maternal conditions. Objective: This study aims to review the current literature on eHealth developments in pregnancy to assess this new generation of perinatal care. Methods: We conducted a systematic literature search of studies on eHealth technology in perinatal care in PubMed and EMBASE in June 2017. Studies reporting the use of eHealth during prenatal, perinatal, and postnatal care were included. Given the heterogeneity in study methods, used technologies, and outcome measurements, results were analyzed and presented in a narrative overview of the literature. Results: The literature search provided 71 studies of interest. These studies were categorized in 6 domains: information and eHealth use, lifestyle (gestational weight gain, exercise, and smoking cessation), gestational diabetes, mental health, low- and middle-income countries, and telemonitoring and teleconsulting. Most studies in gestational diabetes and mental health show that eHealth applications are good alternatives to standard practice. Examples are interactive blood glucose management with remote care using smartphones, telephone screening for postnatal depression, and Web-based cognitive behavioral therapy. Apps and exercise programs show a direction toward less gestational weight gain, increase in step count, and increase in smoking abstinence. Multiple studies describe novel systems to enable home fetal monitoring with cardiotocography and uterine activity. However, only few studies assess outcomes in terms of fetal monitoring safety and efficacy in high-risk pregnancy. Patients and clinicians report good overall satisfaction with new strategies that enable the shift from hospital-centered to patient-centered care. Conclusions: This review showed that eHealth interventions have a very broad, multilevel field of application focused on perinatal care in all its aspects. Most of the reviewed 71 articles were published after 2013, suggesting this novel type of care is an important topic of clinical and scientific relevance. Despite the promising preliminary results as presented, we accentuate the need for evidence for health outcomes, patient satisfaction, and the impact on costs of the possibilities of eHealth interventions in perinatal care. In general, the combination of increased patient empowerment and home pregnancy care could lead to more satisfaction and efficiency. Despite the challenges of privacy, liability, and costs, eHealth is very likely to disperse globally in the next decade, and it has the potential to deliver a revolution in perinatal care. 
%R 10.2196/jmir.9262
%U http://www.jmir.org/2018/6/e202/
%U https://doi.org/10.2196/jmir.9262

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 5
%P e130
%T Mobile Health Solutions for Hypertensive Disorders in Pregnancy: Scoping Literature Review
%A Rivera-Romero,Octavio
%A Olmo,Alberto
%A Muñoz,Rocío
%A Stiefel,Pablo
%A Miranda,María Luisa
%A Beltrán,Luis M
%+ Department of Electronic Technology, Universidad de Sevilla, avda. Reina Mercedes s/n, ETSI Informática, Sevilla, 41012, Spain, 34 954554325, orivera@us.es
%K pregnancy
%K hypertension
%K pre-eclampsia
%K blood pressure
%K telemedicine
%D 2018

%7 30.05.2018
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Hypertensive disorders are the most common complications during pregnancy, occurring in 5% to 11% of pregnancies; gestational hypertension and preeclampsia are the leading causes of perinatal and maternal morbidity and mortality, especially in low- and middle-income countries (LMIC) where maternal and perinatal mortality ratios are still high. Pregnant women with hypertensive disorders could greatly benefit from mobile health (mHealth) solutions as a novel way to identify and control early symptoms, as shown in an increasing number of publications in the field. Such digital health solutions may overcome access limiting factors and the lack of skilled medical professionals and finances commonly presented in resource-poor environments. Objective: The aim of this study was to conduct a literature review of mHealth solutions used as support in hypertensive disorders during pregnancy, with the objective to identify the most relevant protocols and prototypes that could influence and improve current clinical practice. Methods: A methodological review following a scoping methodology was conducted. Manuscripts published in research journals reporting technical information of mHealth solutions for hypertensive disorders in pregnancy were included, categorizing articles in different groups: Diagnosis and Monitoring, mHealth Decision Support System, Education, and Health Promotion, and seven research questions were posed to study the manuscripts. Results: The search in electronic research databases yielded 327 articles. After removing duplicates, 230 articles were selected for screening. Finally, 11 articles met the inclusion criteria, and data were extracted from them. Very positive results in the improvement of maternal health and acceptability of solutions were found, although most of the studies involved a small number of participants, and none were complete clinical studies. Accordingly, none of the reported prototypes were integrated in the different health care systems. Only 4 studies used sensors for physiological measurements, and only 2 used blood pressure sensors despite the importance of this physiological parameter in the control of hypertension. The reported mHealth solutions have great potential to improve clinical practice in areas lacking skilled medical professionals or with a low health care budget, of special relevance in LMIC, although again, no extensive clinical validation has been carried out in these environments. Conclusions: mHealth solutions hold enormous potential to support hypertensive disorders during pregnancy and improve current clinical practice. Although very positive results have been reported in terms of usability and the improvement of maternal health, rigorous complete clinical trials are still necessary to support integration in health care systems. There is a clear need for simple mHealth solutions specifically developed for resource-poor environments that meet the United Nations Sustainable Development Goal (SDG); of enormous interest in LMIC. 
%R 10.2196/mhealth.9671
%U http://mhealth.jmir.org/2018/5/e130/
%U https://doi.org/10.2196/mhealth.9671

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 7
%N 5
%P e146
%T Optimizing Gestational Weight Gain With the Eating4Two Smartphone App: Protocol for a Randomized Controlled Trial
%A Davis,Deborah
%A Davey,Rachel
%A Williams,Lauren T
%A Foureur,Maralyn
%A Nohr,Ellen
%A Knight-Agarwal,Catherine
%A Lawlis,Tanya
%A Oats,Jeremy
%A Skouteris,Helen
%A Fuller-Tyszkiewicz,Matthew
%+ University of Canberra, University Drive, Belconnen Australian Capital Territory, Canberra, 2617, Australia, 61 2606 3869, deborah.davis@canberra.edu.au
%K smartphone
%K technology
%K prenatal care
%K pregnancy
%K weight gain
%D 2018

%7 30.05.2018
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Approximately 50% of women gain excessive weight in pregnancy. Optimizing gestational weight gain is important for the short- and long-term health of the childbearing woman and her baby. Despite this, there is no recommendation for routine weighing in pregnancy, and weight is a topic that many maternity care providers avoid. Resource-intensive interventions have mainly targeted overweight and obese women with variable results. Few studies have examined the way that socioeconomic status might influence the effectiveness or acceptability of an intervention to participants. Given the scale of the problem of maternal weight gain, maternity services will be unlikely to sustain resource intensive interventions; therefore, innovative strategies are required to assist women to manage weight gain in pregnancy. Objective: The primary aim of the trial was to examine the effectiveness of the Eating4Two smartphone app in assisting women of all body mass index categories to optimize gestational weight gain. Secondary aims include comparing childbirth outcomes and satisfaction with antenatal care and examining the way that relative advantage and disadvantage might influence engagement with and acceptability of the intervention. Methods: This randomized controlled trial will randomize 1330 women to control or intervention groups in 3 regions of different socioeconomic status. Women will be recruited from clinical and social media sites. The intervention group will be provided with access to the Eating4Two mobile phone app which provides nutrition and dietary information specifically tailored for pregnancy, advice on food serving sizes, and a graph that illustrates women’s weight change in relation to the range recommended by the Institute of Medicine. Women will be encouraged to use the app to prompt conversations with their maternity care providers about weight gain in pregnancy. The control group will receive routine antenatal care. Results: Recruitment has commenced though the recruitment rate is slower than expected. Additional funds are required to employ research assistants and promote the study in an advertising campaign. Conclusion: Feasibility testing highlighted the inadequacy of the original recruitment strategy and the need to provide the app in both major platforms (Android and iOS). Smartphone technologies may offer an effective alternative to resource intensive strategies for assisting women to optimize weight gain in pregnancy. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000169347; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371470 (Archived by WebCite at http://www.webcitation.org /6zDvgw5bo) Registered Report Identifier: RR1-10.2196/9920 
%R 10.2196/resprot.9920
%U http://www.researchprotocols.org/2018/5/e146/
%U https://doi.org/10.2196/resprot.9920

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 7
%N 5
%P e143
%T A Healthy Eating Education Program for Midwives to Investigate and Explore Their Knowledge, Understanding, and Confidence to Support Pregnant Women to Eat Healthily: Protocol for a Mixed-Methods Study
%A Othman,Shwikar Mahmoud Etman
%A Steen,Mary P
%A Jayasekara,Rasika
%A Fleet,Julie-Anne
%+ School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, GPO Box 2471, Adelaide SA 5001, Adelaide,, Australia, 61 0470626813, othsm001@mymail.unisa.edu.au
%K healthy eating
%K midwives
%K education program
%K mixed-methods research
%K pregnancy
%K study protocol
%D 2018

%7 25.05.2018
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Nutrition and healthy eating behaviors during pregnancy are vitally important for the health of a mother and her developing baby. However, some midwives have reported a lack of evidence-based nutrition knowledge for providing information about healthy eating to women during pregnancy. Objective: In this study, the aim is to design and evaluate a healthy eating education program to enhance midwives’ knowledge, understanding, and confidence to support pregnant women in South Australia to make healthy eating choices. Methods: This mixed-methods study consists of two phases. The first phase, Phase 1, consists of an education program for midwives, “Healthy Eating in Pregnancy,” to be delivered through a workshop or webinar. Each midwife will attend one workshop or webinar, which will be approximately two hours in length. This program will be evaluated through pre-, immediate-, and post-educational questionnaires utilizing a website specifically designed for this study. The participants will be midwives who are members of the Australian College of Midwives and the Australian Nursing and Midwives Federation, and users of social media (eg, Facebook and Twitter) residing and employed in South Australia. Phase 2 will consist of semistructured interviews with a purposive sample of midwives. These interviews will be undertaken to gain an in-depth understanding of midwives’ views and how confident they feel educating pregnant women after receiving the healthy eating education. Interviews will be face-to-face or conducted by telephone with midwives who have participated in the healthy eating educational program. Results: A systematic review has previously been undertaken to inform this study protocol. This paper describes and discusses the protocol for this mixed-methods study, which will be completed in April 2019. Conclusions: The results from the systematic review suggest that there is clear justification to undertake this mixed-methods study to investigate and explore midwives’ knowledge, understanding and confidence to support healthy eating in pregnant women. The results and conclusions from the systematic review provided some guidance for the design and development of this study protocol. This mixed-methods study will address a gap in the literature. The results from quantitative and qualitative data sources in this proposed study will help to draw conclusions to address the research topic. Registered Report Identifier: RR1-10.2196/9861 
%M 29802092
%R 10.2196/resprot.9861
%U http://www.researchprotocols.org/2018/5/e143/
%U https://doi.org/10.2196/resprot.9861
%U http://www.ncbi.nlm.nih.gov/pubmed/29802092

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 5
%P e123
%T Health Care Professionals’ Attitudes Toward, and Experiences of Using, a Culture-Sensitive Smartphone App for Women with Gestational Diabetes Mellitus: Qualitative Study
%A Garnweidner-Holme,Lisa
%A Hoel Andersen,Therese
%A Sando,Mari Wastvedt
%A Noll,Josef
%A Lukasse,Mirjam
%+ Institute for Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, PB 4 St. Olavs plass, Oslo, 0130, Norway, 47 48091956, lisa.garnweidner-holme@oslomet.no
%K mHealth
%K gestational diabetes mellitus
%K antenatal care
%K culture sensitivity
%D 2018

%7 14.05.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The increasing prevalence of gestational diabetes mellitus (GDM) among women of different ethnic backgrounds provides new challenges for health care professionals, who often find it difficult to provide information about the management of this disease to such individuals. Mobile health (mHealth) may act as a useful tool for blood sugar control and care process enhancement. However, little is known about health care professionals’ experiences and attitudes toward the use of mHealth for women with GDM. Objective: The aim of this study was to explore how health care professionals perceived the provision of care to pregnant women who managed their GDM using the culture-sensitive Pregnant+ app in a randomized controlled trial. Methods: Individual interviews with 9 health care professionals providing care for women with GDM were conducted. Braun and Clark’s method of thematic content analysis inspired the analysis. This study included health care professionals who were primarily responsible for providing care to participants with GDM in the Pregnant+ randomized controlled trial at 5 diabetes outpatient clinics in Oslo, Norway. Results: Health care professionals perceived mHealth, particularly the Pregnant+ app, as an appropriate tool for the care of women with GDM, who were described as individuals comprising a heterogeneous, motivated group that could be easily approached with health-related information. Some participants reported challenges with respect to provision of advice to women with different food cultures. The advantages of the Pregnant+ app included provision of information that women could access at home, the information provided being perceived as trustworthy by health care professionals, the culture sensitivity of the app, and the convenience for women to register blood sugar levels. Technical problems, particularly those associated with the automatic transfer of blood glucose measurements, were identified as the main barrier to the use of the Pregnant+ app. Strict inclusion criteria and the inclusion of participants who could not speak Norwegian were the main challenges in the recruitment process for the randomized controlled trial. Conclusions: The findings of this study suggest that mHealth is a useful tool to enhance the care provided by health care professionals to women with GDM. Future mobile apps for the management of GDM should be developed by a trustworthy source and in cooperation with health care professionals. They should also be culture sensitive and should not exhibit technical problems. 
%M 29759959
%R 10.2196/mhealth.9686
%U http://mhealth.jmir.org/2018/5/e123/
%U https://doi.org/10.2196/mhealth.9686
%U http://www.ncbi.nlm.nih.gov/pubmed/29759959

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 5
%P e119
%T Multistakeholder Perspectives on Maternal Text Messaging Intervention in Uganda: Qualitative Study
%A Ilozumba,Onaedo
%A Dieleman,Marjolein
%A Van Belle,Sara
%A Mukuru,Moses
%A Bardají,Azucena
%A Broerse,Jacqueline EW
%+ Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, Netherlands, 31 205983143, ona.ilozumba@vu.nl
%K maternal health
%K telemedicine
%K community health workers
%K Uganda
%K evaluation studies
%D 2018

%7 10.05.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Despite continued interest in the use of mobile health for improving maternal health outcomes, there have been limited attempts to identify relevant program theories. Objectives: This study had two aims: first, to explicate the assumptions of program designers, which we call the program theory and second, to contrast this program theory with empirical data to gain a better understanding of mechanisms, facilitators, and barriers related to the program outcomes. Methods: To achieve the aforementioned objectives, we conducted a retrospective qualitative study of a text messaging (short message service) platform geared at improving individual maternal health outcomes in Uganda. Through interviews with program designers (n=3), we elicited 3 main designers’ assumptions and explored these against data from qualitative interviews with primary beneficiaries (n=26; 15 women and 11 men) and health service providers (n=6), as well as 6 focus group discussions with village health team members (n=50) who were all involved in the program. Results: Our study results highlighted that while the program designers’ assumptions were appropriate, additional mechanisms and contextual factors, such as the importance of incentives for village health team members, mobile phone ownership, and health system factors should have been considered. Conclusions: Our results indicate that text messages could be an effective part of a more comprehensive maternal health program when context and system barriers are identified and addressed in the program theories. 
%M 29748159
%R 10.2196/mhealth.9565
%U http://mhealth.jmir.org/2018/5/e119/
%U https://doi.org/10.2196/mhealth.9565
%U http://www.ncbi.nlm.nih.gov/pubmed/29748159

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 20
%N 5
%P e160
%T Web-Based Intervention for Women With Type 1 Diabetes in Pregnancy and Early Motherhood: Critical Analysis of Adherence to Technological Elements and Study Design
%A Berg,Marie
%A Linden,Karolina
%A Adolfsson,Annsofie
%A Sparud Lundin,Carina
%A Ranerup,Agneta
%+ Centre for Person-Centred Care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, Gothenburg, 405 30, Sweden, 46 31 7866084, marie.berg@fhs.gu.se
%K randomized controlled trial
%K eHealth
%K mHealth
%K case study
%D 2018

%7 02.05.2018
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Numerous Web-based interventions have been implemented to promote health and health-related behaviors in persons with chronic conditions. Using randomized controlled trials to evaluate such interventions creates a range of challenges, which in turn can influence the study outcome. Applying a critical perspective when evaluating Web-based health interventions is important. Objective: The objective of this study was to critically analyze and discuss the challenges of conducting a Web-based health intervention as a randomized controlled trial. Method: The MODIAB-Web study was critically examined using an exploratory case study methodology and the framework for analysis offered through the Persuasive Systems Design model. Focus was on technology, study design, and Web-based support usage, with special focus on the forum for peer support. Descriptive statistics and qualitative content analysis were used. Results: The persuasive content and technological elements in the design of the randomized controlled trial included all four categories of the Persuasive Systems Design model, but not all design principles were implemented. The study duration was extended to a period of four and a half years. Of 81 active participants in the intervention group, a maximum of 36 women were simultaneously active. User adherence varied greatly with a median of 91 individual log-ins. The forum for peer support was used by 63 participants. Although only about one-third of the participants interacted in the forum, there was a fairly rich exchange of experiences and advice between them. Thus, adherence in terms of social interactions was negatively affected by limited active participation due to prolonged recruitment process and randomization effects. Lessons learned from this critical analysis are that technology and study design matter and might mutually influence each other. In Web-based interventions, the use of design theories enables utilization of the full potential of technology and promotes adherence. The randomization element in a randomized controlled trial design can become a barrier to achieving a critical mass of user interactions in Web-based interventions, especially when social support is included. For extended study periods, the technology used may need to be adapted in line with newly available technical options to avoid the risk of becoming outdated in the user realm, which in turn might jeopardize study validity in terms of randomized controlled trial designs. Conclusions: On the basis of lessons learned in this randomized controlled trial, we give recommendations to consider when designing and evaluating Web-based health interventions. 
%M 29720365
%R 10.2196/jmir.9665
%U http://www.jmir.org/2018/5/e160/
%U https://doi.org/10.2196/jmir.9665
%U http://www.ncbi.nlm.nih.gov/pubmed/29720365

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 4
%P e77
%T Impact of the Growing Healthy mHealth Program on Maternal Feeding Practices, Infant Food Preferences, and Satiety Responsiveness: Quasi-Experimental Study
%A Russell,Catherine Georgina
%A Denney-Wilson,Elizabeth
%A Laws,Rachel A
%A Abbott,Gavin
%A Zheng,Miaobing
%A Lymer,Sharyn J
%A Taki,Sarah
%A Litterbach,Eloise-Kate V
%A Ong,Kok-Leong
%A Campbell,Karen J
%+ Centre for Advanced Sensory Science, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 03924 ext 68503, georgie.russell@deakin.edu.au
%K mHealth
%K obesity
%K infant
%K parents
%K food preferences
%K appetite
%K pediatric obesity
%K feeding behavior
%K overweight
%K eating
%K health promotion
%D 2018

%7 25.04.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Infancy is an important life stage for obesity prevention efforts. Parents’ infant feeding practices influence the development of infants’ food preferences and eating behaviors and subsequently diet and weight. Mobile health (mHealth) may provide a feasible medium through which to deliver programs to promote healthy infant feeding as it allows low cost and easy access to tailored content. Objective: The objective of this study was to describe the effects of an mHealth intervention on parental feeding practices, infant food preferences, and infant satiety responsiveness. Methods: A quasi-experimental study was conducted with an mHealth intervention group (Growing Healthy) and a nonrandomized comparison group (“Baby's First Food"). The intervention group received access to a free app with age-appropriate push notifications, a website, and an online forum that provided them with evidence-based advice on infant feeding for healthy growth from birth until 9 months of age. Behavior change techniques were selected using the Behaviour Change Wheel framework. Participants in both groups completed three Web-based surveys, first when their infants were less than 3 months old (baseline, T1), then at 6 months (time 2, T2), and 9 months of age (time 3, T3). Surveys included questions on infant feeding practices and beliefs (Infant Feeding Questionnaire, IFQ), satiety responsiveness (Baby Eating Behaviour Questionnaire), and infant’s food exposure and liking. Multivariate linear regression models, estimated using maximum likelihood with bootstrapped standard errors, were fitted to compare continuous outcomes between the intervention groups, with adjustment for relevant covariates. Multivariate logistic regression adjusting for the same covariates was performed for categorical outcomes. Results: A total of 645 parents (Growing Healthy: n=301, Baby's First Food: n=344) met the eligibility criteria and were included in the study, reducing to a sample size of 546 (Growing Healthy: n=234, Baby's First Food: n=312) at T2 and a sample size of 518 (Growing Healthy: n=225, Baby's First Food: n=293) at T3. There were approximately equal numbers of boy and girl infants, and infants were aged less than 3 months at baseline (Growing Healthy: mean 7.0, SD 3.7 weeks; Baby's First Food: mean 7.9, SD 3.8 weeks), with Growing Healthy infants being slightly younger than Baby's First Food infants (P=.001). All but one (IFQ subscale “concerns about infant overeating or becoming overweight” at T2) of the measured outcomes did not differ between Growing Healthy and Baby's First Food. Conclusions: Although mHealth can be effective in promoting some health behaviors and offers many advantages in health promotion, the results of this study suggest that design and delivery characteristics needed to maximize the impact of mHealth interventions on infant feeding are uncertain. The sensitivity of available measurement tools and differences in baseline characteristics of participants may have also affected the results. 
%M 29695373
%R 10.2196/mhealth.9303
%U http://mhealth.jmir.org/2018/4/e77/
%U https://doi.org/10.2196/mhealth.9303
%U http://www.ncbi.nlm.nih.gov/pubmed/29695373

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 4
%P e109
%T The Usability and Effectiveness of Mobile Health Technology–Based Lifestyle and Medical Intervention Apps Supporting Health Care During Pregnancy: Systematic Review
%A Overdijkink,Sanne B
%A Velu,Adeline V
%A Rosman,Ageeth N
%A van Beukering,Monique DM
%A Kok,Marjolein
%A Steegers-Theunissen,Regine PM
%+ Department of Obstetrics and Gynecology, Erasmus Medical Center, PO Box 2040, Rotterdam, 3000CA, Netherlands, 31 107043598, r.steegers@erasmusmc.nl
%K mHealth
%K pregnancy
%K lifestyle
%K health care
%K maternal health
%D 2018

%7 24.04.2018
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: A growing number of mobile health (mHealth) technology–based apps are being developed for personal lifestyle and medical health care support, of which several apps are related to pregnancy. Evidence on usability and effectiveness is limited but crucial for successful implementation. Objective: This study aimed to evaluate the usability, that is, feasibility and acceptability, as well as effectiveness of mHealth lifestyle and medical apps to support health care during pregnancy in high-income countries. Feasibility was defined as the actual use, interest, intention, and continued use; perceived suitability; and ability of users to carry out the activities of the app. Acceptability was assessed by user satisfaction, appreciation, and the recommendation of the app to others. Methods: We performed a systematic review searching the following electronic databases for studies on mHealth technology–based apps in maternal health care in developed countries: EMBASE, MEDLINE Epub (Ovid), Cochrane Library, Web of Science, and Google Scholar. All included studies were scored on quality, using the ErasmusAGE Quality Score or the consolidated criteria for reporting qualitative research. Main outcome measures were usability and effectiveness of mHealth lifestyle and medical health care support apps related to pregnancy. All studies were screened by 2 reviewers individually, and the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were followed. Results: Our search identified 4204 titles and abstracts, of which 2487 original studies remained after removing duplicates. We performed full-text screening of 217 studies, of which 29 were included in our study. In total, 19 out of 29 studies reported on mHealth apps to adopt healthy lifestyles and 10 out of 29 studies to support medical care. The lifestyle apps evaluated in 19 studies reported on usability and effectiveness: 10 studies reported positive on acceptability, and 14 studies reported on feasibility with positive results except one study. In total, 4 out of 19 studies evaluating effectiveness showed significant results on weight gain restriction during pregnancy, intake of vegetables and fruits, and smoking cessation. The 10 studies on medical mHealth apps involved asthma care, diabetic treatment, and encouraging vaccination. Only one study on diabetic treatment reported on acceptability with a positive user satisfaction. In total, 9 out of 10 studies reported on effectiveness. Moreover, the power of most studies was inadequate to show significant effects. Conclusions: Most studies on mHealth apps to support lifestyle and medical care for high-income countries reveal the usability of these apps to reduce gestational weight gain, increase intakes of vegetables and fruit, to quit smoking cessation, and to support health care for prevention of asthma and infections during pregnancy. In general, the evidence on effectiveness of these apps is limited and needs further investigation before implementation in medical health care. 
%M 29691216
%R 10.2196/mhealth.8834
%U http://mhealth.jmir.org/2018/4/e109/
%U https://doi.org/10.2196/mhealth.8834
%U http://www.ncbi.nlm.nih.gov/pubmed/29691216

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 4
%P e91
%T Development of a Healthy Lifestyle Mobile App for Overweight Pregnant Women: Qualitative Study
%A Lau,Ying
%A Cheng,Ling Jie
%A Chi,Claudia
%A Tsai,Cammy
%A Ong,Kai Wen
%A Ho-Lim,Sarah Su Tin
%A Wang,Wei
%A Tan,Kian-Lee
%+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66011603, nurly@nus.edu.sg
%K mobile apps
%K overweight
%K obesity
%D 2018

%7 23.04.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile apps are becoming an increasingly ubiquitous platform for delivery of health behavior interventions among overweight and obese perinatal women. However, only a few methodological guidelines on integrating theory, evidence, and qualitative research for their designs are available. Objective: The aim of this study was to develop a theory-based, evidence-driven, and user-centered healthy lifestyle app targeting overweight and obese multiethnic pregnant women. Methods: This paper illustrates how intervention development may be enriched with theoretical basis, systematic review, and qualitative study. An individual face-to-face interview was performed to incorporate the user’s involvement in the design. These interviews were audiotaped and transcribed. Thematic analysis technique was used for emerging themes. Results: Integrated concepts of social cognitive theory of self-regulation, self-regulation model, and strength model of self-control were selected as bases of the intervention. Evidence from our systematic review and meta-analysis provided the strongest evidence for the development of intervention. We invited 16 obese or overweight pregnant women to participate in a semistructured interview . The following key themes emerged: content, platform, interactivity, format, and functionality. Apps are a favorable technology platform for healthy diet advice, appropriate physical exercise, and weight management because they are user-friendly and convenient. The app used in this study contains culture-specific, pregnancy-related, and credible contents, including educational, professional and peer support, and self-monitoring domains. The design should include aesthetic appeal, visualized features, and interactive multimedia. Conclusions: A 3-step process integrating theoretical basis, evidence from systematic review, and research findings from target users can be considered a guide for future app development. 
%M 29685868
%R 10.2196/mhealth.9718
%U http://mhealth.jmir.org/2018/4/e91/
%U https://doi.org/10.2196/mhealth.9718
%U http://www.ncbi.nlm.nih.gov/pubmed/29685868

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 20
%N 4
%P e146
%T Uptake of Tailored Text Message Smoking Cessation Support in Pregnancy When Advertised on the Internet (MiQuit): Observational Study
%A Emery,Joanne L
%A Coleman,Tim
%A Sutton,Stephen
%A Cooper,Sue
%A Leonardi-Bee,Jo
%A Jones,Matthew
%A Naughton,Felix
%+ Behavioral Science Group, Institute of Public Health, University of Cambridge, Forvie Site, Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom, 44 0 1223 330355, jle40@medschl.cam.ac.uk
%K smoking cessation
%K pregnancy
%K internet
%K telemedicine
%K public health
%K social media
%D 2018

%7 19.04.2018
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Smoking in pregnancy is a major public health concern. Pregnant smokers are particularly difficult to reach, with low uptake of support options and few effective interventions. Text message–based self-help is a promising, low-cost intervention for this population, but its real-world uptake is largely unknown. Objective: The objective of this study was to explore the uptake and cost-effectiveness of a tailored, theory-guided, text message intervention for pregnant smokers (“MiQuit”) when advertised on the internet. Methods: Links to a website providing MiQuit initiation information (texting a short code) were advertised on a cost-per-click basis on 2 websites (Google Search and Facebook; £1000 budget each) and free of charge within smoking-in-pregnancy webpages on 2 noncommercial websites (National Childbirth Trust and NHS Choices). Daily budgets were capped to allow the Google and Facebook adverts to run for 1 and 3 months, respectively. We recorded the number of times adverts were shown and clicked on, the number of MiQuit initiations, the characteristics of those initiating MiQuit, and whether support was discontinued prematurely. For the commercial adverts, we calculated the cost per initiation and, using quit rates obtained from an earlier clinical trial, estimated the cost per additional quitter. Results: With equal capped budgets, there were 812 and 1889 advert clicks to the MiQuit website from Google (search-based) and Facebook (banner) adverts, respectively. MiQuit was initiated by 5.2% (42/812) of those clicking via Google (95% CI 3.9%-6.9%) and 2.22% (42/1889) of those clicking via Facebook (95% CI 1.65%-2.99%). Adverts on noncommercial webpages generated 53 clicks over 6 months, with 9 initiations (9/53, 17%; 95% CI 9%-30%). For the commercial websites combined, mean cost per initiation was £24.73; estimated cost per additional quitter, including text delivery costs, was £735.86 (95% CI £227.66-£5223.93). Those initiating MiQuit via Google were typically very early in pregnancy (median gestation 5 weeks, interquartile range 10 weeks); those initiating via Facebook were distributed more evenly across pregnancy (median gestation 16 weeks, interquartile range 14 weeks). Conclusions: Commercial online adverts are a feasible, likely cost-effective method for engaging pregnant smokers in digital cessation support and may generate uptake at a faster rate than noncommercial websites. As a strategy for implementing MiQuit, online advertising has large reach potential and can offer support to a hard-to-reach population of smokers. 
%M 29674308
%R 10.2196/jmir.8525
%U http://www.jmir.org/2018/4/e146/
%U https://doi.org/10.2196/jmir.8525
%U http://www.ncbi.nlm.nih.gov/pubmed/29674308

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 20
%N 3
%P e115
%T Pregnant Women Sharing Pregnancy-Related Information on Facebook: Web-Based Survey Study
%A Harpel,Tammy
%+ Department of Family & Consumer Sciences, Illinois State University, Campus Box 5060, Turner Hall, Normal, IL, 61790-5060, United States, 1 3094382680, tsharpe@ilstu.edu
%K pregnancy
%K social media
%K Facebook
%D 2018

%7 22.03.2018
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Research indicates expectant and new mothers use the Internet, specifically social media, to gain information and support during the transition to parenthood. Although parents regularly share information about and photos of their child or children on Facebook, researchers have neither explored the use of Facebook to share pregnancy-related information nor investigated factors that influence such sharing. Objective: The aim of this study was to address a gap in the literature by exploring the use of Facebook by pregnant women. Specifically, the study examined the use of Facebook to share pregnancy-related information, as well as any association between prenatal attachment and the aforementioned aspects of sharing pregnancy-related information on Facebook. Methods: Pregnant women who were at least 18 years of age were recruited for participation in the study through posts and paid advertisements on Facebook and posts to professional organization listservs. Individuals interested in participating were directed to a secure Web-based survey system where they completed the consent form and the survey that focused on their current pregnancy. Participants completed the Maternal Antenatal Attachment Scale and answered questions that assessed how often they shared pregnancy-related information on Facebook, who they shared it with, why they shared it, and what they shared. Results: A total of 117 pregnant women completed the survey. Descriptive statistics indicated that the pregnancy announcement was most commonly shared (75/108, 69.4%), with most women sharing pregnancy-related information on Facebook less than monthly (52/117, 44.4%) with only family and friends (90/116, 77.6% and 91/116, 78.4%, respectively) and for the purpose of involving others or sharing the experience (62/107, 57.9%). Correlation and regression analyses showed that prenatal attachment, in general, was positively and significantly related to all aspects of sharing pregnancy-related information at the P<.05 level, with the exception of sharing because of expectations. Quality of attachment, which involves the positive feelings the woman has about her unborn child, was significantly associated with sharing to involve others or share the pregnancy (t8,93=2.654 , P=.009). In contrast, after controlling for other variables, the strength or preoccupation component of prenatal attachment was significantly associated with frequency of sharing (t8,100=2.554 , P=.01), number to types of information shared (t8,97=2.605 , P=.01), number of groups with whom shared (t8,99=3.467, P=.001), and sharing to get advice (χ28=5.339 , P=.02). Conclusions: Pregnant women in this study used Facebook for a variety of reasons, demonstrating the use of the social media platform during pregnancy for supportive and informational purposes. Overall, the results of this study are likely to be useful to professionals who are seeking alternative methods for providing intervention, information, and support to pregnant women via social media in our technology-driven society. 
%M 29567636
%R 10.2196/jmir.7753
%U http://www.jmir.org/2018/3/e115/
%U https://doi.org/10.2196/jmir.7753
%U http://www.ncbi.nlm.nih.gov/pubmed/29567636

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 5
%N 12
%P e176
%T Texting Condolences: Adapting mHealth Programs After Unexpected Pregnancy and Infant Outcomes
%A Unger,Jennifer A
%A Kinuthia,John
%A John-Stewart,Grace
%+ Global Center for Integrated Health of Women, Adolescents and Children, Department of Global Health, University of Washington, Harborview Medical Center, Seattle, WA,, United States, 1 206 388 8141, junger@uw.edu
%K mHealth
%K infant loss
%K miscarriage
%D 2017

%7 08.12.2017
%9 Viewpoint
%J JMIR Mhealth Uhealth
%G English
                
%X Mobile health (mHealth) short message system (SMS) interventions for maternal and child health (MCH) are being implemented globally. In many low- and middle-income settings in which these mHealth interventions are being rolled out, stillbirths and neonatal and infant deaths are common. It is important that mHealth solutions do not exacerbate emotional stress and pain by continuing with routine messaging for pregnancy or infant care when someone has experienced loss. In this brief viewpoint paper, we argue that SMS programs for maternal and child health need to adapt and make available messaging for miscarriage, stillbirth, and infant loss.
%M 29222078
%R 10.2196/mhealth.8303
%U http://mhealth.jmir.org/2017/12/e176/
%U https://doi.org/10.2196/mhealth.8303
%U http://www.ncbi.nlm.nih.gov/pubmed/29222078

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 5
%N 11
%P e172
%T Electronic Brief Intervention and Text Messaging for Marijuana Use During Pregnancy: Initial Acceptability of Patients and Providers
%A Gray,Justin
%A Beatty,Jessica R
%A Svikis,Dace S
%A Puder,Karoline S
%A Resnicow,Ken
%A Konkel,Janine
%A Rice,Shetoya
%A McGoron,Lucy
%A Ondersma,Steven J
%+ Merrill Palmer Skillman Institute, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, 71 East Ferry, Detroit, MI, 48202, United States, 1 3136642518, jbeatty@wayne.edu
%K pregnancy
%K marijuana
%K intervention study
%K text messaging
%D 2017

%7 08.11.2017
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Marijuana is the most widely used illicit substance during pregnancy. Technology-delivered brief interventions and text messaging have shown promise in general and pregnant samples but have not yet been applied to marijuana use in pregnancy. Objective: The objective of the study was to evaluate, among pregnant women and prenatal care providers, the acceptability of an electronic brief intervention and text messaging plan for marijuana use in pregnancy. Methods: Participants included patients (n=10) and medical staff (n=12) from an urban prenatal clinic. Patient-participants were recruited directly during a prenatal care visit. Those who were eligible reviewed the interventions individually and provided quantitative and qualitative feedback regarding software acceptability and helpfulness during a one-on-one interview with research staff. Provider-participants took part in focus groups in which the intervention materials were reviewed and discussed. Qualitative and focus group feedback was transcribed, coded manually, and classified by category and theme. Results: Patient-participants provided high ratings for satisfaction, with mean ratings for respectfulness, interest, ease of use, and helpfulness ranging between 4.4 and 4.7 on a 5-point Likert scale. Of the 10 participants, 5 reported that they preferred working with the program versus their doctor, and 9 of 10 said the intervention made them more likely to reduce their marijuana use. Provider-participants received the program favorably, stating the information presented was both relevant and important for their patient population. Conclusions: The findings support the acceptability of electronic brief intervention and text messaging for marijuana use during pregnancy. This, combined with their ease of use and low barrier to initiation, suggests that further evaluation in a randomized trial is appropriate. 
%M 29117931
%R 10.2196/mhealth.7927
%U http://mhealth.jmir.org/2017/11/e172/
%U https://doi.org/10.2196/mhealth.7927
%U http://www.ncbi.nlm.nih.gov/pubmed/29117931

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 3
%N 3
%P e49
%T The Use of Facebook Advertising for Communicating Public Health Messages: A Campaign Against Drinking During Pregnancy in New Zealand
%A Parackal,Mathew
%A Parackal,Sherly
%A Eusebius,Shobhit
%A Mather,Damien
%+ Department of Marketing, University of Otago, Suite 6.35, Commerce Building, 60 Clyde Street, Dunedin, 9035, New Zealand, 64 34797696, mathew.parackal@otago.ac.nz
%K social media
%K health promotion
%K alcohol
%K pregnancy
%K New Zealand
%D 2017

%7 10.08.2017
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Social media is gaining recognition as a platform for delivering public health messages. One area attracting attention from public health researchers and professionals is Facebook’s advertising channel. This channel is reported to have a broad reach and generate high user engagement with the disseminated campaign materials. However, to date, no study has examined the communication process via this channel which this study aimed to address. Objective: The specific objectives of the study were to (1) examine user engagement for a public health campaign based on the metadata provided by Facebook, (2) analyze comments generated by the campaign materials using text mining, and (3) investigate the relationship between the themes identified in the comments and the message and the sentiments prevalent in the themes that exhibited significant relationships. Methods: This study examined a New Zealand public health pilot campaign called “Don’t Know? Don’t Drink,” which warned against drinking alcohol during pregnancy. The campaign conveyed the warning through a video and three banner ads that were delivered as news feeds to women aged 18-30 years. Thematic analysis using text mining performed on the comments (n=819) identified four themes. Logistic regression was used to identify meaning-making themes that exhibited association with the message. Results: The users’ engagement was impressive with the video receiving 203,754 views. The combined likes and shares for the promotional materials (video and banner ads) amounted to 6125 and 300, respectively. The logistic regression analysis showed two meaning-making themes, namely, risk of pregnancy (P=.003) and alcohol and culture (P<.001) exhibited association with the message. The sentiment analysis carried out on the two themes revealed there were more negative than positive comments (47% vs 28%). Conclusions: The user engagement observed in this study was consistent with previous research. The numbers reported for views, likes, and shares may be seen as unique interactions over the fixed period of the campaign; however, survey research would be required to find out the true evaluative worth of these metadata. A close examination of the comments, employing text mining, revealed that the message was not accepted by a majority of the target segment. Self-identity and conformity theories may help to explain these observed reactions, albeit warrant further investigations. Although the comments were predominantly negative, they provide opportunities to engage back with the women. The one-way communication format followed in this campaign did not support any two-way engagement. Further investigation is warranted to establish whether using a two-way communication format would have improved the acceptability of such public health messages delivered via social media. The findings of this study caution using a one-way communication format to convey public health messages via Facebook’s advertising channel. 
%M 28798011
%R 10.2196/publichealth.7032
%U http://publichealth.jmir.org/2017/3/e49/
%U https://doi.org/10.2196/publichealth.7032
%U http://www.ncbi.nlm.nih.gov/pubmed/28798011

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 19
%N 6
%P e194
%T “You Sort of Go Down a Rabbit Hole...You’re Just Going to Keep on Searching”: A Qualitative Study of Searching Online for Pregnancy-Related Information During Pregnancy
%A Prescott,Julie
%A Mackie,Lynn
%+ Education and Psychology, University of Bolton, Deane Road, Bolton, BL3 5AB, United Kingdom, 44 0120490 ext 3676, j.prescott@bolton.ac.uk
%K pregnancy
%K information seeking behavior
%K qualitative research
%D 2017

%7 2.6.2017
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: The Web is becoming increasingly popular for gaining information on medical or health issues; with women in particular likely to search online for this type of information and support. Despite the increased use of the Web for health-related information, we need to question whether the Web and the ease of seeking health information that it provides leads to more (patient) empowerment. As well as being a time of joy and expectations, pregnancy can be a worrying time for women, especially first time mums-to-be, with unfamiliar experiences and symptoms and concerns for the baby as well as the self. Objective: Our aim was to explore how and why pregnant women use the Web to gain information and support during pregnancy and what they consider a reliable source. Methods: To meet the objectives of the study, a qualitative approach was required to gather information on the experiences of currently pregnant women who use the Web to gain information and support during their pregnancy. Sixteen pregnant women took part in a semistructured interview, either face-to-face or via telephone. The interviews took place from January to March 2016, all participants were from England, and the health professionals are all employed by the National Health Service (NHS). Qualitative analytical procedures were employed using inductive thematic analysis supported by NVivo software (QSR International). Results: Pregnant women found reassurance from the experiences of others. This reassurance resulted in them feeling less alone, as well as enabling them to normalize any symptoms or experiences they were undergoing. The women understood that caution was needed at times while reading the stories of others, acknowledging the potential for extreme cases or worst case scenarios. This is particularly pertinent to the Web, as this wide range of stories may not be as easily accessible if stories where confined to those in a woman’s offline social circle. The interviews provide insights into how and why pregnant women search online for information and perhaps more so, support while pregnant. Conclusions: Searching for health information and advice online during pregnancy is viewed as quick, easy, and accessible. The affordances of the Web have provided women the opportunity to go online as a first port of call. Knowing they were not alone and reading the experiences or symptoms of other pregnant women enabled women to normalize their experience and was ultimately reassuring for pregnant women. 
%M 28583906
%R 10.2196/jmir.6302
%U http://www.jmir.org/2017/19/e194/
%U https://doi.org/10.2196/jmir.6302
%U http://www.ncbi.nlm.nih.gov/pubmed/28583906

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 5
%N 5
%P e73
%T Perceptions of Patient Engagement Applications During Pregnancy: A Qualitative Assessment of the Patient’s Perspective
%A Goetz,Maren
%A Müller,Mitho
%A Matthies,Lina Maria
%A Hansen,Jenny
%A Doster,Anne
%A Szabo,Akos
%A Pauluschke-Fröhlich,Jan
%A Abele,Harald
%A Sohn,Christof
%A Wallwiener,Markus
%A Wallwiener,Stephanie
%+ Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, Heidelberg, 69121, Germany, 49 6221 5637551, Stephanie.wallwiener@googlemail.com
%K pregnancy
%K telemedicine
%K mobile applications
%K information procurement
%K patient participation
%K qualitative research
%D 2017

%7 26.05.2017
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: With growing demand for medical information and health applications in pregnancy, the potential of electronic health (eHealth) and mobile health (mHealth) solutions in clinical care is increasingly unfolding. However, we still do not know how pregnant women engage with mobile apps, how such apps impact routine medical care, and whether benefit expectations are met. Whereas recent research has raised the subject of user distribution and analyzed the content of pregnancy applications, there is still a significant knowledge gap regarding what pregnant women like and dislike about pregnancy tools, along with how such interventions could be improved. Objective: The aim of the study was to examine the perceptions and expectations of mobile and Web-based patient-engagement pregnancy applications. We assessed usability requirements, general acceptance of eHealth, and the impact of eHealth and mHealth pregnancy applications on the doctor-patient interaction and daily clinical routine. Methods: A qualitative study was conducted at the maternity department of a major German university hospital. The sample included 30 women with low- to medium-risk pregnancies. Half of the patients were seen during outpatient care and half were hospitalized for several days. The extent and frequency of Web- and mobile phone app usage were assessed. Semistructured interviews were conducted and analyzed using systematic thematic analysis. Results: Patients had a high demand for Web-based pregnancy applications. Study findings suggested a strong request for personalization, monitoring, and accessibility for frequent use as main themes derived from the interviews. Fostering patient empowerment in the doctor-patient relationship was also highly valued for a pregnancy app. Participants favored further integration of medical apps in their daily routine and pregnancy care. However, concerns were raised about content quality, trustworthiness of Web sources, and individual data security. Conclusions: eHealth and mHealth applications are a highly frequented source of information. Expectations and usability requirements for those applications are also high, thus posing a challenge to interdisciplinary service providers. Patients’ attitude toward integrating apps in routine care settings was positive with a favorable influence on patient empowerment. Health care professionals should guide pregnant women toward a successful integration of these educational tools in pregnancy care. 
%M 28550005
%R 10.2196/mhealth.7040
%U http://mhealth.jmir.org/2017/5/e73/
%U https://doi.org/10.2196/mhealth.7040
%U http://www.ncbi.nlm.nih.gov/pubmed/28550005

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 5
%N 4
%P e42
%T Development and Testing of the MyHealthyPregnancy App: A Behavioral Decision Research-Based Tool for Assessing and Communicating Pregnancy Risk
%A Krishnamurti,Tamar
%A Davis,Alexander L
%A Wong-Parodi,Gabrielle
%A Fischhoff,Baruch
%A Sadovsky,Yoel
%A Simhan,Hyagriv N
%+ Department of Engineering and Public Policy, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, United States, 1 (412) 268 2670, tamar@cmu.edu
%K mhealth
%K pregnancy
%K premature birth
%K decision making
%D 2017

%7 10.04.2017
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Despite significant advances in medical interventions and health care delivery, preterm births in the United States are on the rise. Existing research has identified important, seemingly simple precautions that could significantly reduce preterm birth risk. However, it has proven difficult to communicate even these simple recommendations to women in need of them. Our objective was to draw on methods from behavioral decision research to develop a personalized smartphone app-based medical communication tool to assess and communicate pregnancy risks related to preterm birth. Objective: A longitudinal, prospective pilot study was designed to develop an engaging, usable smartphone app that communicates personalized pregnancy risk and gathers risk data, with the goal of decreasing preterm birth rates in a typically hard-to-engage patient population. Methods: We used semistructured interviews and user testing to develop a smartphone app based on an approach founded in behavioral decision research. For usability evaluation, 16 participants were recruited from the outpatient clinic at a major academic hospital specializing in high-risk pregnancies and provided a smartphone with the preloaded app and a digital weight scale. Through the app, participants were queried daily to assess behavioral risks, mood, and symptomology associated with preterm birth risk. Participants also completed monthly phone interviews to report technical problems and their views on the app’s usefulness. Results: App use was higher among participants at higher risk, as reflected in reporting poorer daily moods (Odds ratio, OR 1.20, 95% CI 0.99-1.47, P=.08), being more likely to smoke (OR 4.00, 95% CI 0.93-16.9, P=.06), being earlier in their pregnancy (OR 1.07, 95% CI 1.02-1.12, P=.005), and having a lower body mass index (OR 1.07, 95% CI 1.00-1.15, P=.05). Participant-reported intention to breastfeed increased from baseline to the end of the trial, t15=−2.76, P=.01. Participants’ attendance at prenatal appointments was 84% compared with the clinic norm of 50%, indicating a conservatively estimated cost savings of ~US $450/patient over 3 months. Conclusions: Our app is an engaging method for assessing and communicating risk during pregnancy in a typically hard-to-reach population, providing accessible and personalized distant obstetrical care, designed to target preterm birth risk, specifically. 
%M 28396302
%R 10.2196/mhealth.7036
%U http://mhealth.jmir.org/2017/4/e42/
%U https://doi.org/10.2196/mhealth.7036
%U http://www.ncbi.nlm.nih.gov/pubmed/28396302

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 4
%N 4
%P e122
%T A Systematic Review of Apps using Mobile Criteria for Adolescent Pregnancy Prevention (mCAPP)
%A Chen,Elizabeth
%A Mangone,Emily Rose
%+ International Health Division, Abt Associates, 4550 Montgomery Avenue, Suite 800 North, Bethesda, MD, 20814, United States, 1 650 919 3414, emilyrose.mangone@gmail.com
%K mHealth
%K eHealth
%K smartphone
%K mobile phone
%K app
%K teen
%K adolescent
%K young adult
%K systematic review
%K unintended pregnancy
%K family planning
%K pregnancy prevention
%K contraception
%D 2016

%7 10.11.2016
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Adolescents in the United States and globally represent a high-risk population for unintended pregnancy, which leads to high social, economic, and health costs. Access to smartphone apps is rapidly increasing among youth, but little is known about the strategies that apps employ to prevent pregnancy among adolescents and young adults. Further, there are no guidelines on best practices for adolescent and young adult pregnancy prevention through mobile apps. Objective: This review developed a preliminary evaluation framework for the assessment of mobile apps for adolescent and young adult pregnancy prevention and used this framework to assess available apps in the Apple App Store and Google Play that targeted adolescents and young adults with family planning and pregnancy prevention support. Methods: We developed an assessment rubric called Mobile Criteria for Adolescent Pregnancy Prevention (mCAPP) for data extraction using evidence-based and promising best practices from the literature. mCAPP comprises 4 domains: (1) app characteristics, (2) user interface features, (3) adolescent pregnancy prevention best practices, and (4) general sexual and reproductive health (SRH) features. For inclusion in the review, apps that advertised pregnancy prevention services and explicitly mentioned youth, were in English, and were free were systematically identified in the Apple App Store and Google Play in 2015. Screening, data extraction, and 4 interrater reliability checks were conducted by 2 reviewers. Each app was assessed for 92 facets of the mCAPP checklist. Results: Our search returned 4043 app descriptions in the Apple App Store (462) and Google Play (3581). After screening for inclusion criteria, 22 unique apps were included in our analysis. Included apps targeted teens in primarily developed countries, and the most common user interface features were clinic and health service locators. While app strengths included provision of SRH education, description of modern contraceptives, and some use of evidence-based adolescent best practices, gaps remain in the implementation of the majority of adolescent best practices and user interface features. Of the 8 best practices for teen pregnancy prevention operationalized through mCAPP, the most commonly implemented best practice was the provision of information on how to use contraceptives to prevent pregnancy (15/22), followed by provision of accurate information on pregnancy risk of sexual behaviors (13/22); information on SRH communication, negotiation, or refusal skills (10/22); and the use of persuasive language around contraceptive use (9/22). Conclusions: The quality and scope of apps for adolescent pregnancy prevention varies, indicating that developers and researchers may need a supportive framework. mCAPP can help researchers and developers consider mobile-relevant evidence-based best practices for adolescent SRH as they develop teen pregnancy prevention apps. Given the novelty of the mobile approach, further research is needed on the impact of mCAPP criteria via mobile channels on adolescent health knowledge, behaviors, and outcomes. 
%M 27833070
%R 10.2196/mhealth.6611
%U http://mhealth.jmir.org/2016/4/e122/
%U https://doi.org/10.2196/mhealth.6611
%U http://www.ncbi.nlm.nih.gov/pubmed/27833070

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 4
%N 2
%P e53
%T Impact of an mHealth Platform for Pregnancy on Nutrition and Lifestyle of the Reproductive Population: A Survey
%A Van Dijk,Matthijs R
%A Huijgen,Nicole A
%A Willemsen,Sten P
%A Laven,Joop SE
%A Steegers,Eric AP
%A Steegers-Theunissen,Régine PM
%+ Erasmus Medical Center (MC), Department of Obstetrics and Gynecology, University Medical Center, PO Box 2040, Rotterdam, 3000 CA, Netherlands, 31 107043598, r.steegers@erasmusmc.nl
%K preconception care
%K nutrition
%K lifestyle
%K mHealth
%K pregnancy
%D 2016

%7 27.05.2016
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: Poor nutrition and lifestyle behaviors exert detrimental effects on reproduction and health during the life course. Therefore, lifestyle interventions during the periconceptional period can improve fertility, pregnancy outcome, and health of subsequent generations. Objective: This survey investigates the compliance, usability, and initial effectiveness of the Web-based mHealth platform, Smarter Pregnancy. Methods: A free subscription to the mHealth platform, Smarter Pregnancy, was provided to couples contemplating pregnancy (n=1275) or already pregnant (n=603). After baseline identification of inadequate nutrition and lifestyle behaviors, a personal online coaching program of 6 months was generated. Using multiple imputation and the generalized estimating equation model with independent correlations, we estimated the changes from inadequate to adequate nutrition and lifestyle behaviors over time. Subgroup analyses were performed for (1) overweight and obese women (body mass index [BMI] ≥25 kg/m2), (2) pregnant women at the start of the program, and (3) couples. Results: A 64.86% (1218/1878) compliance rate was observed and 54.7% (range 39.2-73.4%) of participants rated the program usability as positive or very positive. Adequate nutrition and lifestyle behaviors at baseline were 21.57% (405/1878) for vegetable intake, 52.61% (988/1878) for fruit intake, 85.44% (1303/1525) for folic acid use, 86.79% (1630/1878) for no tobacco use, and 64.43% (1210/1878) for no alcohol consumption. After 6 months of coaching, these lifestyle behaviors improved by 26.3% (95% CI 23.0-29.9) for vegetable intake, 38.4% (95% CI 34.5-42.5) for fruit intake, 56.3% (95% CI 48.8-63.6) for folic acid use, 35.1% (95% CI 29.1-41.6) for no tobacco use, and 41.9% (95% CI 35.2-48.9) for no alcohol consumption. The program showed the strongest effectiveness for participating couples. Conclusions: This novel Web-based mHealth platform shows high compliance and usability, and users demonstrate improvements in nutrition and lifestyle behaviors. The next step will be further validation in randomized controlled trials and implementation. 
%M 27234926
%R 10.2196/mhealth.5197
%U http://mhealth.jmir.org/2016/2/e53/
%U https://doi.org/10.2196/mhealth.5197
%U http://www.ncbi.nlm.nih.gov/pubmed/27234926

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications Inc.
%V 18
%N 5
%P e113
%T Web-based Discussion Forums on Pregnancy Complaints and Maternal Health Literacy in Norway: A Qualitative Study
%A Fredriksen,Eva Haukeland
%A Harris,Janet
%A Moland,Karen Marie
%+ Department of Occupational Therapy, Physiotherapy and Radiography, Faculty of Health and Social Sciences, Bergen University College, Inndalsveien 28, Bergen, Postbox 7030, 5020 Bergen, Norway, 47 55585607, eva.haukeland.fredriksen@hib.no
%K qualitative research
%K Internet
%K pregnancy
%K health literacy
%K web-based discussion forums
%K pelvic girdle pain
%D 2016

%7 26.05.2016
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: The Internet is one of the fastest growing information sources for pregnant women and seems to be used across social and economic strata. However, we still lack knowledge on how interaction in Web-based discussion forums influence maternal health literacy, in terms of how pregnant women access, appraise, and apply information to promote and maintain good health. Objective: The aim of this study was to understand how Web-based discussion forums influence maternal health literacy; hence, we explored the role of interactions in Web-based discussion forums among women who experienced health problems during pregnancy. More specifically, we explored why media-literate women experiencing the medically unexplained condition, pelvic girdle pain (PGP), during pregnancy participated in Web-based discussion forums and how they appraised and applied the information and advice that they gained from the Web-based interaction with other women. Methods: Women were invited to participate in the study via postings on 3 different open websites for pregnant women and mothers. The sample included 11 Norwegian women who participated in open Web-based discussion forums when experiencing PGP in pregnancy. The data were collected using synchronous qualitative email interviews and were analyzed using thematic analysis. Results: In our study sample, interaction in Web-based discussion forums influenced maternal health literacy in terms of increased health-related knowledge and competencies, increased awareness of health promotion and health protection, and increased system navigation. The women appraised and selectively applied information and advice that resonated with their own experiences. For many, the information provided online by other women in the same situation was valued more highly than advice from health professionals. Women reported that they used their knowledge and competency in encounters with health professionals but hesitated to disclose the origin of their knowledge. Those with a high level of education in medicine-related fields raised a concern about the Internet as a source of horror stories and erroneous information and were actively engaged in trying to minimize potential negative effects, by providing biomedical information. Conclusions: The popularity of Web-based discussion forums among pregnant women suggests that this group needs additional sources of information and support to complement traditional consultations with the health professionals. The professionals need to recognize that pregnant women access Web-based discussion forums for support and information to increase their ability to take better health decisions for themselves. This is a potential resource that health professionals may find useful in consultations with pregnant women. 
%M 27230094
%R 10.2196/jmir.5270
%U http://www.jmir.org/2016/5/e113/
%U https://doi.org/10.2196/jmir.5270
%U http://www.ncbi.nlm.nih.gov/pubmed/27230094

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications Inc.
%V 18
%N 4
%P e81
%T Crowdsourcing and the Accuracy of Online Information Regarding Weight Gain in Pregnancy: A Descriptive Study
%A Chang,Tammy
%A Verma,Bianca A
%A Shull,Trevor
%A Moniz,Michelle H
%A Kohatsu,Lauren
%A Plegue,Melissa A
%A Collins-Thompson,Kevyn
%+ Department of Family Medicine, University of Michigan, 2800 Plymouth Rd, Building 14- Room G107, Ann Arbor, MI, , United States, 1 734 647 3305, tachang@med.umich.edu
%K Internet
%K crowdsourcing
%K weight gain
%K pregnancy
%D 2016

%7 07.04.2016
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Excess weight gain affects nearly half of all pregnancies in the United States and is a strong risk factor for adverse maternal and fetal outcomes, including long-term obesity. The Internet is a prominent source of information during pregnancy; however, the accuracy of this online information is unknown. Objective: To identify, characterize, and assess the accuracy of frequently accessed webpages containing information about weight gain during pregnancy. Methods: A descriptive study was used to identify and search frequently used phrases related to weight gain during pregnancy on the Google search engine. The first 10 webpages of each query were characterized by type and then assessed for accuracy and completeness, as compared to Institute of Medicine guidelines, using crowdsourcing. Results: A total of 114 queries were searched, yielding 305 unique webpages.  Of these webpages, 181 (59.3%) included information regarding weight gain during pregnancy. Out of 181 webpages, 62 (34.3%) contained no specific recommendations, 48 (26.5%) contained accurate but incomplete recommendations, 41 (22.7%) contained complete and accurate recommendations, and 22 (12.2%) were inaccurate. Webpages were most commonly from for-profit websites (112/181, 61.9%), followed by government (19/181, 10.5%), medical organizations or associations (13/181, 7.2%), and news sites (12/181, 6.6%). The largest proportion of for-profit sites contained no specific recommendations (44/112, 39.3%). Among pages that provided inaccurate information (22/181, 12.2%), 68% (15/22) were from for-profit sites. Conclusions: For-profit websites dominate the online space with regard to weight gain during pregnancy and largely contain incomplete, inaccurate, or no specific recommendations. This represents a significant information gap regarding an important risk factor for obesity among mothers and infants. Our findings suggest that greater clinical and public health efforts to disseminate accurate information regarding healthy weight gain during pregnancy may help prevent significant morbidity and may support healthier pregnancies among at-risk women and children. 
%M 27056465
%R 10.2196/jmir.5138
%U http://www.jmir.org/2016/4/e81/
%U https://doi.org/10.2196/jmir.5138
%U http://www.ncbi.nlm.nih.gov/pubmed/27056465

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 4
%N 1
%P e6
%T Mobile Phone Apps for the Prevention of Unintended Pregnancy: A Systematic Review and Content Analysis
%A Mangone,Emily Rose
%A Lebrun,Victoria
%A Muessig,Kathryn E
%+ Gillings School of Global Public Health, Department of Health Policy and Management, UNC Chapel Hill, 135 Dauer Drive, 1101 McGavran-Greenberg Hall, CB Number 7411, Chapel Hill, NC, 27599-7411, United States, 1 650 919 3414, emilyrose.mangone@gmail.com
%K mHealth
%K eHealth
%K mobile phone
%K app
%K systematic review
%K unintended pregnancy
%K family planning
%K pregnancy prevention
%K contraception
%D 2016

%7 19.01.2016
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: Over 50% of pregnancies in the United States are unintended, meaning that the pregnancy is mistimed, unplanned, or unwanted. Unintended pregnancy increases health risks for mother and child, leads to high economic costs for society, and increases social disparities. Mobile phone ownership is rapidly increasing, providing opportunities to reach at-risk populations with reproductive health information and tailored unintended pregnancy prevention interventions through mobile phone apps. However, apps that offer support for unintended pregnancy prevention remain unevaluated. Objective: To identify, describe, and evaluate mobile phone apps that purport to help users prevent unintended pregnancy. Methods: We conducted an extensive search of the Apple iTunes and Android Google Play stores for apps that explicitly included or advertised pregnancy prevention or decision-making support in the context of fertility information/tracking, birth control reminders, contraceptive information, pregnancy decision-making, abortion information or counseling, sexual communication/negotiation, and pregnancy tests. We excluded apps that targeted medical professionals or that cost more than US $1.99. Eligible apps were downloaded and categorized by primary purpose. Data extraction was performed on a minimum of 143 attributes in 3 domains: (1) pregnancy prevention best practices, (2) contraceptive methods and clinical services, and (3) user interface. Apps were assigned points for their inclusion of features overall and for pregnancy prevention best practices and contraceptive information. Results: Our search identified 6805 app descriptions in iTunes and Google Play. Of these, 218 unique apps met inclusion criteria and were included in the review. Apps were grouped into 9 categories: fertility trackers (n=72), centers and resources (n=38), birth control reminders (n=35), general sexual and reproductive health (SRH) information (n=17), SRH information targeted specifically to young adults (YA) (n=16), contraceptive information (n=15), service or condom locators (n=12), pregnancy tests (n=10), and games (n=3). Twelve apps scored at least 50 points (out of 94) for overall number of features and at least 15 points (out of 21) for contraceptive information and pregnancy prevention best practices. Overall, 41% of apps did not mention any modern contraceptive methods and 23% mentioned only 1 method. Of apps that did mention a modern contraceptive method, fewer than 50% of these apps provided information on how to use it. YA SRH apps had the highest percentage of pregnancy prevention best practices in each app. Demographic and interface evaluation found that most apps (72%) did not target any race and only 10% explicitly targeted youth. Communication interface features were present in fewer than 50% of apps. Conclusions: This review identified several useful, evidence-based apps that support the prevention of unintended pregnancy. However, most apps miss opportunities to provide users with valuable information, interactive decision aids, and evidence-based interventions for unintended pregnancy prevention. Further, some apps in this space may increase the likelihood of unintended pregnancy due to the low effectiveness of the contraceptive methods promoted. 
%M 26787311
%R 10.2196/mhealth.4846
%U http://mhealth.jmir.org/2016/1/e6/
%U https://doi.org/10.2196/mhealth.4846
%U http://www.ncbi.nlm.nih.gov/pubmed/26787311

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 3
%N 4
%P e99
%T Views of Women and Health Professionals on mHealth Lifestyle Interventions in Pregnancy: A Qualitative Investigation
%A Willcox,Jane C
%A van der Pligt,Paige
%A Ball,Kylie
%A Wilkinson,Shelley A
%A Lappas,Martha
%A McCarthy,Elizabeth A
%A Campbell,Karen J
%+ Centre for Nutrition and Physical Activity Research, School of Nutrition and Exercise Sciences, Deakin University, 221 Burwood Highway, Burwood, , Australia, 61 92468733, jwillcox@deakin.edu.au
%K pregnancy
%K attitude
%K qualitative research
%K mHealth
%D 2015

%7 28.10.2015
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: Evidence suggests that women are failing to meet guidelines for nutrition, physical activity, and weight gain during pregnancy. Interventions to promote a healthy lifestyle in pregnancy demonstrate mixed results and many are time and resource intensive. mHealth-delivered interventions offer an opportunity to provide trusted source information in a timely and cost-effective manner. Studies regarding women’s and health professionals’ views of mHealth in antenatal care are limited. Objective: This study aimed to explore women’s and health professionals’ views regarding mHealth information sources and interventions to assist women to eat well, be physically active, and gain healthy amounts of weight in pregnancy. Methods: A descriptive qualitative research approach employed focus groups and in-depth interviews with 15 pregnant or postpartum women and 12 in-depth interviews with health professionals including two from each category: obstetricians, general practitioners, midwives, dietitians, physiotherapists, and community pharmacists. All interviews were transcribed verbatim and thematically analyzed. Results: Women uniformly embraced the concept of mHealth information sources and interventions in antenatal care and saw them as central to information acquisition and ideally incorporated into future antenatal care processes. Health professionals exhibited varied views perceiving mHealth as an inevitable, often parallel, service rather than one integrated into the care model.

Four key themes emerged: engagement, risk perception, responsibility, and functionality. Women saw their ability to access mHealth elements as a way to self-manage or control information acquisition that was unavailable in traditional care models and information sources. The emergence of technology was perceived by some health professionals to have shifted control of information from trusted sources, such as health professionals and health organizations, to nontrusted sources. Some health professionals were concerned about the medicolegal risks of mHealth (incorrect or harmful information and privacy concerns), while others acknowledged that mHealth was feasible if inherent risks were addressed.

Across both groups, there was uncertainty as to who should be responsible for ensuring high-quality mHealth. The absence of a key pregnancy or women’s advocacy group, lack of health funds for technologies, and the perceived inability of maternity hospitals to embrace technology were seen to be key barriers to provision.

Women consistently identified the functionality of mHealth as adding value to antenatal care models. For some health professionals, lack of familiarity with and fear of mHealth limited their engagement with and comprehension of the capacity of new technologies to support antenatal care. Conclusions: Women exhibited positive views regarding mHealth for the promotion of a healthy lifestyle in antenatal care. Conversely, health professionals expressed a much wider variation in attitudes and were more able to identify potential risks and barriers to development and implementation. This study contributes to the understanding of the opportunities and challenges in developing mHealth lifestyle interventions in antenatal care. 
%M 26510886
%R 10.2196/mhealth.4869
%U http://mhealth.jmir.org/2015/4/e99/
%U https://doi.org/10.2196/mhealth.4869
%U http://www.ncbi.nlm.nih.gov/pubmed/26510886

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications Inc.
%V 16
%N 12
%P e274
%T Reducing Alcohol Use During Pregnancy Via Health Counseling by Midwives and Internet-Based Computer-Tailored Feedback: A Cluster Randomized Trial
%A van der Wulp,Nickie Y
%A Hoving,Ciska
%A Eijmael,Kim
%A Candel,Math JJM
%A van Dalen,Wim
%A De Vries,Hein
%+ Dutch Institute for Alcohol Policy STAP, P.O. Box 9769, Utrecht, 3506 GT, Netherlands, 31 306565041, nvanderwulp@stap.nl
%K alcohol drinking
%K pregnancy
%K counseling
%K telemedicine
%K midwifery
%D 2014

%7 05.12.2014
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Effective interventions are needed to reduce neurobehavioral impairments in children due to maternal alcohol use during pregnancy. Currently, health-counseling interventions have shown inconsistent results to reduce prenatal alcohol use. Thus, more research using health counseling is needed to gain more knowledge about the effectiveness of this type of intervention on reducing alcohol use during pregnancy. An alternative and promising strategy is computer tailoring. However, to date, no study has shown the effectiveness of this intervention mode. Objective: The aim was to test the effectiveness of health counseling and computer tailoring on stopping and reducing maternal alcohol use during pregnancy in a Dutch sample of pregnant women using alcohol. Methods: A total of 60 Dutch midwifery practices, randomly assigned to 1 of 3 conditions, recruited 135 health counseling, 116 computer tailoring, and 142 usual care respondents from February to September 2011. Health-counseling respondents received counseling from their midwife according to a health-counseling protocol, which consisted of 7 steps addressed in 3 feedback sessions. Computer-tailoring respondents received usual care from their midwife and 3 computer-tailored feedback letters via the Internet. Usual care respondents received routine alcohol care from their midwife. After 3 and 6 months, we assessed the effect of the interventions on alcohol use. Results: Multilevel multiple logistic regression analyses showed that computer-tailoring respondents stopped using alcohol more often compared to usual care respondents 6 months after baseline (53/68, 78% vs 51/93, 55%; P=.04). Multilevel multiple linear regression analyses showed that computer-tailoring respondents (mean 0.35, SD 0.31 units per week) with average (P=.007) or lower (P<.001) alcohol use before pregnancy or with average (P=.03) or lower (P=.002) social support more strongly reduced their alcohol use 6 months after baseline compared to usual care respondents (mean 0.48, SD 0.54 units per week). Six months after baseline, 72% (62/86) of the health-counseling respondents had stopped using alcohol. This 17% difference with the usual care group was not significant. Conclusions: This is the first study showing that computer tailoring can be effective to reduce alcohol use during pregnancy; health counseling did not effectively reduce alcohol use. Future researchers developing a health-counseling intervention to reduce alcohol use during pregnancy are recommended to invest more in recruitment of pregnant women and implementation by health care providers. Because pregnant women are reluctant to disclose their alcohol use to health professionals and computer tailoring preserves a person’s anonymity, this effective computer-tailoring intervention is recommended as an attractive intervention for pregnant women using alcohol. Trial Registration: Dutch Trial Register NTR 2058; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2058 (Archived by WebCite at http://www.webcitation.org/6NpT1oHol) 
%M 25486675
%R 10.2196/jmir.3493
%U http://www.jmir.org/2014/12/e274/
%U https://doi.org/10.2196/jmir.3493
%U http://www.ncbi.nlm.nih.gov/pubmed/25486675

%0 Journal Article
        
%@ 14388871
%I JMIR Publications Inc.
%V 16
%N 2
%P e60
%T Multiple Information Sources and Consequences of Conflicting Information About Medicine Use During Pregnancy: A Multinational Internet-Based Survey
%A Hämeen-Anttila,Katri
%A Nordeng,Hedvig
%A Kokki,Esa
%A Jyrkkä,Johanna
%A Lupattelli,Angela
%A Vainio,Kirsti
%A Enlund,Hannes
%+ Assessment of Pharmacotherapies, Finnish Medicines Agency, PO Box, Fimea, 00034, Finland, 358 295223514, johanna.jyrkka@fimea.fi
%K pharmaceutical preparations
%K pregnancy
%K access to information
%K information seeking behavior
%K information dissemination
%K questionnaires
%K Internet
%K international
%D 2014

%7 20.02.2014
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: A wide variety of information sources on medicines is available for pregnant women. When using multiple information sources, there is the risk that information will vary or even conflict. Objective: The objective of this multinational study was to analyze the extent to which pregnant women use multiple information sources and the consequences of conflicting information, and to investigate which maternal sociodemographic, lifestyle, and medical factors were associated with these objectives. Methods: An anonymous Internet-based questionnaire was made accessible during a period of 2 months, on 1 to 4 Internet websites used by pregnant women in 5 regions (Eastern Europe, Western Europe, Northern Europe, Americas, Australia). A total of 7092 responses were obtained (n=5090 pregnant women; n=2002 women with a child younger than 25 weeks). Descriptive statistics and logistic regression analysis were used. Results: Of the respondents who stated that they needed information, 16.16% (655/4054) used one information source and 83.69% (3393/4054) used multiple information sources. Of respondents who used more than one information source, 22.62% (759/3355) stated that the information was conflicted. According to multivariate logistic regression analysis, factors significantly associated with experiencing conflict in medicine information included being a mother (OR 1.32, 95% CI 1.11-1.58), having university (OR 1.33, 95% CI 1.09-1.63) or other education (OR 1.49, 95% CI 1.09-2.03), residing in Eastern Europe (OR 1.52, 95% CI 1.22-1.89) or Australia (OR 2.28, 95% CI 1.42-3.67), use of 3 (OR 1.29, 95% CI 1.04-1.60) or >4 information sources (OR 1.82, 95% CI 1.49-2.23), and having ≥2 chronic diseases (OR 1.49, 95% CI 1.18-1.89). Because of conflicting information, 43.61% (331/759) decided not to use medication during pregnancy, 30.30% (230/759) sought a new information source, 32.67% (248/759) chose to rely on one source and ignore the conflicting one, 25.03% (190/759) became anxious, and 2.64% (20/759) did nothing. Factors significantly associated with not using medication as a consequence of conflicting information were being pregnant (OR 1.75, 95% CI 1.28-2.41) or experiencing 3-4 health disorders (OR 1.99, 95% CI 1.10-3.58). Women with no chronic diseases were more likely not to take medicines than women with ≥2 chronic diseases (OR 2.22, 95% CI 1.47-3.45). Factors significantly associated with becoming anxious were >4 information sources (OR 2.67, 95% CI 1.70-4.18) and residing in Eastern Europe (OR 0.57, 95% CI 0.36-0.90). Conclusions: Almost all the pregnant women used multiple information sources when seeking information on taking medicines during pregnancy and one-fifth obtained conflicting information, leading to anxiety and the decision not to use the medication. Regional, educational, and chronic disease characteristics were associated with experiencing conflicting information and influenced the decision not to use medication or increased anxiety. Accurate and uniform teratology information should be made more available to the public. 
%M 24565696
%R 10.2196/jmir.2939
%U http://www.jmir.org/2014/2/e60/
%U https://doi.org/10.2196/jmir.2939
%U http://www.ncbi.nlm.nih.gov/pubmed/24565696