Decreased fetal movement and mobile application interventions during pregnancy

Abstract

BackgroundPerinatal morbidity and mortality remain significant public health issues globally, with enduring impact on the health and wellbeing of women and their families. Pregnant women who adopt, practice and maintain healthy behaviours can potentially improve the health of themselves and their babies. Stillbirth affects over 2,100 families annually in Australia, often preceded by maternal perception of decreased fetal movement. Mobile applications (apps) have become an integral source of information for women during pregnancy, as evidenced by the hundreds of millions of pregnant women downloading and using them, and information contained within these apps may influence maternal awareness about decreased fetal movement. However, limited evidence exists to support the impact of mobile apps, compared to other communication methods, on maternal behaviour change or perinatal health outcomes. Similarly, few studies have reviewed content of pregnancy apps to assess accuracy of information or appropriateness of recommendations for maternal concerns about fetal movement.AimsThe primary aim of this thesis is to assess the effect of mobile application interventions on health care-seeking behaviour and perinatal health outcomes among pregnant women with concerns about fetal movement.MethodsIn order to achieve this aim, this thesis was designed with four components:- Update and publication of the clinical practice guideline on care of women with decreased fetal movements;- Systematic review of effect of mobile applications on maternal health care-seeking behaviour and perinatal outcomes;- Content analysis and review of information about decreased fetal movement presented by mobile applications intended for use by pregnant women; and- Analysis of mobile application uptake, reporting of decreased fetal movement and perinatal health outcomes for users of the My Baby’s Movements app.Results Studies have demonstrated linkages between provision of information about decreased fetal movement and improved perinatal health outcomes, including reduced stillbirth rates. Such findings have prompted an update to the clinical practice guideline and recommendations for improved guidance and care for pregnant women. Mobile apps have been proposed as an effective mode of sharing information with women during pregnancy. However, our systematic review to understand the effect of mobile app interventions on maternal health care-seeking behaviour and perinatal health outcomes yielded only four studies, and while these studies reported on the primary outcome, “change in maternal behaviours by intervention goals,” the specific outcomes reported varied widely by intervention. None of the studies included in this review reported statistically significant differences between intervention and control groups for neonatal outcomes, delivery or pregnancy complications. To understand the information accessed by women through publicly-available apps, a content review and analysis was performed to specifically address content about decreased fetal movement. Information provided by the 24 apps in the sample was highly variable, and the majority of apps guided women to perform actions to stimulate or track fetal movement that were counter to clinical practice guideline recommendations.Finally, a mobile app intervention to raise awareness about fetal movement was designed and tested as part of a large randomised trial, and data from one hospital were analysed as a prospective cohort study. In this sample, 15.3% of all women birthing at the hospital over one year chose to download and use the app. The tool was popular among younger women and those expecting their first child, but perinatal health outcomes, including reporting of decreased fetal movement, labour induction rates, gestational week at birth and stillbirth rates, were largely similar between cohort groups.ConclusionsMobile applications are a popular means of accessing information during pregnancy. However, it has yet to be proven whether mobile app interventions achieve better results compared to other communication modalities. Factors that may influence uptake, usage and outcomes may include maternal characteristics such as age, or features deemed of interest to users. It is anticipated that the findings of this thesis will help inform future digital health interventions for pregnant women, to improve the health of mothers and babies.