Regarding the Role of Midwifery-Led Mobile Health App Intervention in Pregnancy

Abstract

The use of mobile health (mHealth) apps during pregnancy is becoming increasingly prevalent, driven by the need for accessible, real-time health interventions. Midwifery-led mHealth interventions are especially well-positioned to address gaps in prenatal care and ensure continuity of care, particularly for underserved populations (Dai et al. 2024; Edwards et al. 2021). These apps allow for self-monitoring, provide educational resources and foster communication between healthcare professionals and pregnant women, all of which can help promote healthier pregnancies and birth outcomes. We read with great interest the recent article by Dai and colleagues entitled ‘Assessing women's and health professionals' views on developing a midwifery-led mobile health app intervention in pregnancy: A descriptive qualitative study’ (Dai et al. 2024), which explored women's and health professionals' views on the development of a midwifery-led mHealth app intervention in antenatal care and their demands for app functionality. We are writing to express my interest and explore the growing role of midwifery-led mHealth interventions, drawing on insights from recent studies to analyse their potential benefits, limitations and challenges.

Midwives are the primary caregivers for many pregnant women, and they are uniquely positioned to provide holistic care that focuses on both physical and emotional well-being (Dai et al. 2024). However, access to midwifery care can be limited because of geographic, economic or healthcare system barriers, particularly in low-resource settings (Dai et al. 2024; Mohan and Sharmil 2023). mHealth apps offer a practical solution to these challenges by providing continuous support outside of clinical settings (Edwards et al. 2021; Sandborg et al. 2021). The development of midwifery-led mHealth apps can bridge gaps in maternity care by offering personalised assessments, educational content and direct communication with midwives (Dai et al. 2024). These apps can help alleviate the challenges posed by the shortage of midwifery staff, particularly in regions where healthcare resources are limited. Women in underserved areas can access reliable health information, self-monitor their progress and receive timely feedback from healthcare professionals, thus ensuring continuity of care throughout their pregnancy. Traditional antenatal care often involves multiple in-person visits, which can be burdensome for pregnant women, especially those living in remote areas or those with limited mobility. mHealth apps reduce the need for frequent visits by allowing women to monitor their health parameters, such as weight gain, blood pressure and fetal movements, and share these data with their healthcare providers (Mazaheri Habibi et al. 2024; Sandborg et al. 2021). This can lead to more efficient use of healthcare resources while maintaining high standards of care. Midwifery-led mHealth apps can also promote informed decision-making by providing pregnant women with tailored health education on topics such as nutrition, physical activity, and mental health (Grundy 2022; Mazaheri Habibi et al. 2024; Mohan and Sharmil 2023). These apps can empower women to take an active role in their health care, improving outcomes for both the mother and the baby.

Health literacy is a significant factor in pregnancy outcomes. Many women, especially those in underserved populations, may have limited access to reliable health information (Dai et al. 2024). mHealth apps offer an accessible platform for disseminating evidence-based health education, helping women better understand their pregnancy and the steps they can take to maintain a healthy lifestyle (Mazaheri Habibi et al. 2024). By providing easy-to-understand information in a digital format, these apps can improve health literacy, reduce anxiety, and promote healthier behaviours (Mazaheri Habibi et al. 2024). Moreover, mHealth apps can foster a sense of empowerment by encouraging women to take control of their pregnancy journey (Dai et al. 2024). For instance, women can track their progress, set health goals and receive feedback on their achievements, all of which can enhance their motivation and adherence to healthy lifestyle recommendations (Sandborg et al. 2021). Studies have shown that self-monitoring and feedback features in mHealth apps are associated with improved dietary habits, increased physical activity and better overall health during pregnancy. One of the most significant advantages of mHealth interventions is their potential to facilitate behaviour change. Apps that promote healthy dietary habits, physical activity and weight management have been shown to improve pregnancy outcomes (Mohan and Sharmil 2023; Sandborg et al. 2021). For example, the HealthyMoms app, a midwifery-led intervention, was found to support healthier weight gain during pregnancy, particularly among women with overweight or obesity. By providing personalised feedback and goal-setting features, these apps can encourage pregnant women to adopt and maintain healthier behaviours. In addition to promoting physical health, midwifery-led mHealth apps can support mental and emotional well-being. Pregnancy is often a stressful time, and many women experience anxiety and uncertainty about their health and the health of their baby. mHealth apps can provide valuable psychological support by offering resources on stress management, mindfulness and relaxation techniques (Mazaheri Habibi et al. 2024). Moreover, the ability to communicate directly with healthcare professionals through the app can reassure women and address any concerns they may have in real time.

One of the primary challenges associated with mHealth interventions is ensuring data security and privacy. Pregnant women using these apps share sensitive health information, such as their medical history, pregnancy progress and biometric data (Edwards et al. 2021). Ensuring the confidentiality of this data is crucial to maintaining user trust and compliance with privacy regulations. mHealth apps must comply with strict data protection laws, such as the General Data Protection Regulation (GDPR) in Europe, to prevent unauthorised access to personal information. Developers must prioritise secure data storage and transmission to safeguard user privacy and mitigate the risks associated with data breaches (Grundy 2022; Sandborg et al. 2021). Although mHealth apps have the potential to reach a broad audience, not all pregnant women may have access to the necessary technology. In low-resource settings, access to smartphones, reliable internet connections and digital literacy may be limited (Mazaheri Habibi et al. 2024). This digital divide can exacerbate existing health disparities, as women who are unable to use these apps may miss out on the benefits of digital health interventions. To ensure that midwifery-led mHealth apps are accessible to all women, developers must consider strategies to improve digital inclusion. This may involve providing training on how to use the app, offering offline functionality or developing partnerships with community organisations to distribute mobile devices to underserved populations. The integration of mHealth apps into antenatal care also presents medico-legal risks. Healthcare providers must ensure that the information and advice provided through these apps are accurate, evidence-based and compliant with legal and professional standards. Additionally, there are concerns about the liability of healthcare providers if a user experiences adverse outcomes while following the app's recommendations. To mitigate these risks, healthcare professionals must be actively involved in the development and review of mHealth apps. Regular updates to the app's content and functionality are essential to ensure that the information provided remains current and aligned with best practices.

To maximise the effectiveness of midwifery-led mHealth interventions, several key considerations should be taken into account during the app development process. First, developers should adopt a user-centred approach, engaging both pregnant women and healthcare professionals in the design and testing phases. This will ensure that the app meets the needs and preferences of its target users and that the features included are practical and beneficial. Second, future mHealth apps should prioritise integration with existing healthcare systems. By allowing seamless data sharing between pregnant women and their healthcare providers, these apps can facilitate more personalised care and improve clinical decision-making. Moreover, integration with electronic health records can enhance the continuity of care by ensuring that all members of the healthcare team have access to the most up-to-date information about the patient's pregnancy progress (Dai et al. 2024). Lastly, developers should focus on creating scalable and sustainable interventions. mHealth apps have the potential to reach large populations, but their long-term impact will depend on their ability to adapt to different healthcare environments and user needs. Ensuring the sustainability of these interventions will require ongoing investment in app maintenance, user support and data security.

Midwifery-led mHealth app interventions offer a promising solution to many of the challenges associated with traditional maternity care. By providing accessible, real-time support to pregnant women, these apps can improve health outcomes, promote healthier behaviours and enhance the overall pregnancy experience. However, to fully realise the potential of these interventions, developers must address key challenges related to data security, accessibility and medico-legal risks. The future of midwifery-led mHealth apps lies in their ability to integrate seamlessly into existing healthcare systems, provide personalised and evidence-based care and reach underserved populations. As the field of digital health continues to evolve, ongoing research and collaboration between healthcare professionals, app developers and pregnant women will be essential to ensuring the success of these innovative interventions.

Ming-Yan Du, Jing Zhou and Hao Chen: conceptualisation, supervision, validation, writing – review and editing. Ming-Yan Du and Hao Chen: conceptualisation, validation, writing – review and editing. All authors agreed upon the final version of the manuscript.

The authors declare no conflicts of interest.