Lessons from digital technology-enabled health interventions implemented during the coronavirus pandemic to improve maternal and birth outcomes: a global scoping review
BMC Pregnancy and Childbirth volume 23, Article number: 195 (2023)
Timely access to essential obstetric and gynecologic healthcare is an effective method for improving maternal and neonatal outcomes; however, the COVID-19 pandemic impacted pregnancy care globally. In this global scoping review, we select and investigate peer-reviewed empirical studies related to mHealth and telehealth implemented during the pandemic to support pregnancy care and to improve birth outcomes.
We searched MEDLINE and PubMed, Scopus, CINAHL and Web of Science for this Review because they include peer-reviewed literature in the disciplines of behavioral sciences, medicine, clinical sciences, health-care systems, and psychology. Because our investigative searches reviewed that there is considerable ‘grey literature’ in this area; we did not restrict our review to any study design, methods, or place of publication. In this Review, peer-reviewed preprints were comparable to published peer-reviewed articles, with relevant articles screened accordingly.
The search identified 1851 peer reviewed articles, and after removal of duplicates, using inclusion and exclusion criteria, only 22 studies were eligible for inclusion in the review published from January 2020 to May 2022. mHealth interventions accounted for 72.7% (16 of 22 studies) and only 27.3% (6 of 22 studies) were telehealth studies. There were only 3 example studies that integrated digital technologies into healthcare systems and only 3 studies that developed and evaluated the feasibility of mobile apps. Experimental studies accounted 68.8% of mHealth studies and only 33.3% studies of telehealth studies. Key functionalities of the pregnancy apps and telehealth platforms focused on mental and physical wellness, health promotion, patient tracking, health education, and parenting support. Implemented interventions ranged from breastfeeding and selfcare to behavioral health. Facilitators of uptake included perceived benefits, user satisfaction and convenience. Mobile apps and short messaging services were the primary technologies employed in the implemented mHealth interventions.
Although our Review emphasizes a lack of studies on mHealth interventions and data from pregnant women during the COVID-19 crisis, the review shows that implementation of digital health interventions during emergencies are inevitable given their potential for supporting pregnancy care. There is also a need for more randomized clinical trials and longitudinal studies to better understand the effectiveness and feasibility of implementing such interventions during disease outbreaks and emergencies.
Contributions to the literature
Modalities and facilitators of uptake of mHealth and telehealth interventions implemented during the coronavirus pandemic is investigated as it impacted on obstetric and gynecologic care and outcomes.
Key functionalities of the pregnancy apps and telehealth platforms are identified, and the focus of the implemented digital-enabled health interventions was on mental and physical wellness, health promotion, patient tracking, health education, and parenting support.
Our findings demonstrate that digital technologies such as mHealth and telehealth have potential for supporting pregnancy care during emergencies and are vital health system strengthening tools globally.
Timely access to key obstetric and gynecologic healthcare has been shown to be an effective method for improving maternal and neonatal outcomes [1,2,3]; however, over the past 3 years, the COVID-19 pandemic has had severe effects on pregnancy care globally [4,5,6,7,8,9,10,11,12,13,14]. Several reports in the US have linked COVID-19 and resultant “Stay-at-Home” orders to changes in health service seeking behaviors among pregnant women [15, 16], a finding supported by a systematic review (n = 56 studies) and meta-analysis (n = 21 studies) conducted by UK researchers of global changes in prenatal care conducted in 2021 . Another study conducted at a tertiary hospital in India noted a decrease in institutional deliveries (by 45%), but an increase in high-risk pregnancies including intensive care unit hospitalizations due to changes in pregnant women’s health seeking behaviors . This finding was also reported by a UK study where the number of women seeking prenatal and postnatal appointments decreased . The pandemic has undoubtedly heightened the risk factors generally linked with poor mental health in pregnancy such as anxiety, depression, and posttraumatic symptoms stemming partly from coronavirus infection fears, poor quality prenatal care, and restrictions on societal behaviors [19,20,21].
A common thread across the studies is in the observed relationship between the augmented need for structural changes to current prenatal care models including timing and frequency of prenatal care to meet the needs of providers, pregnant women, and their babies in different contexts and settings [7, 22,23,24,25,26,27,28,29]. Addressing these needs is key for achieving the United Nations Sustainable Development Goal (SDG) global target of less than 70 maternal deaths per 100,000 live births [30, 31] (from the current level of 152 deaths per 100,000 live births in 2020) . However, while studies have been carried out on the impacts of COVID-19 on pregnancy care, facilitators of uptake of interventions or facilitators by which current prenatal care delivery models have been modified due to the coronavirus impact (e.g., without and /or with a hybrid of in-person and virtual visits) has not been synthesized in the literature.
Digital technologies (e.g., mobile phone and tablet apps and telehealth) have become vital health system strengthening tools globally [33, 34] mostly for overcoming healthcare service delivery challenges [35,36,37,38,39,40], and their use in pregnancy care has been augmented by the coronavirus crisis. Mobile health technology (mHealth) is defined as a component of electronic health used for delivery of health services using information and communication technology [41,42,43,44]. Another digital tool is telemedicine, a component of telehealth, and a practice of medicine utilizing technology to deliver care at a distance (telemedicine signifies clinician-patient interactions and consultations that happen remotely via phone, video calls, text messaging, or other formats) [45, 46]. Systematic reviews and studies conducted in both the ‘global North’ [47, 48] and the ‘global South’ [8, 49,50,51,52,53,54,55,56] have associated patients’ timely access to health services and improvements in obstetric and gynecologic outcomes with digital health interventions [43, 55, 57,58,59,60,61,62] such as test result notification , patient management , and real-time access to patient information and communication at different points of care [65,66,67].
Numerous studies have already demonstrated how digital technologies can address healthcare challenges such as those placed by the coronavirus [68, 69] on pregnancy care and health-seeking behaviors of pregnant women during the pandemic [45, 70, 71]. Additionally, studies evaluating provider and patient experiences with digital-enabled consultations and appointments during the coronavirus crisis report high usage, patient and provider satisfaction [45, 72,73,74,75,76,77], and that both personal and organizational factors motivate implementation [78, 79]. To note, a recent scoping review that used Google searches to evaluate commonly used apps by pregnant women found over 57 unique apps. Of the final evaluated 29 apps, 18 did not have comprehensive information for every stage of pregnancy . This underscores a need to synthesize information regarding the usefulness and benefits of the implemented apps during the coronavirus crisis to support pregnant women, and whether app differences varied by intervention. Furthermore, while some research has been carried out on pregnant women and COVID-19 , no single study exists which assessed a combination of digital-enabled technology (mobile phone and telehealth) implemented during the coronavirus crisis to support pregnancy care. Understanding how and why the digital-enabled technology health interventions were implemented and how they impacted pregnancy care (prenatal, pregnancy and postpartum periods) offer a potential opportunity to improve pregnancy care, reduce costs, resources, and time.
We undertook a global scoping review to identify peer-reviewed articles that used mobile phone and telehealth health interventions to improve pregnancy care and/or outcomes during the COVID-19 pandemic. To our knowledge, this is the first study to uncover context, digital interventions, uptake facilitators, locations, study designs and outcomes in the implemented interventions aimed at supporting pregnancy care during the COVID-19 pandemic.
We conducted a scoping review, a method of knowledge synthesis guided by Arksey and O′Malley’s framework for conducting scoping reviews . To ensure reviewer compliance with best practice guidelines for the conduct of scoping reviews, the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and flow diagram  was followed closely, with minimal disagreements because we established a priori inclusion and exclusion criteria in consultation with a research librarian.
We conducted preliminary searches on COVID-19, pregnant women, postpartum, pregnancy, mobile phone apps, and interventions as well as combining the keywords on Google scholar and Sematic scholar in May 2022. These searches facilitated the delineation of the review scope of this study, research questions, and established eligibility criteria. Subsequently, we selected MEDLINE and PubMed, Scopus, CINAHL and Web of Science for this Review because they include peer-reviewed literature in the disciplines of behavioral sciences, medicine, clinical sciences, health-care systems, and psychology. Appendix A presents the alternative used key search terms used in this study. Because our investigative searches reviewed that there is considerable ‘grey literature’ in this area; study design, and outcome indicators studied varied widely, we did not restrict our review to any study design, methods, or place of publication. Peer-reviewed preprints were comparable to published peer-reviewed articles, with relevant articles screened accordingly.
Inclusion and exclusion criteria
The scoping review included studies that leveraged digital health interventions (e.g., mobile phone, telehealth, or video conferencing) implemented to enhance access to and/or linkage to pregnancy care services such as to support the three stages of pregnancy (perinatal, pregnancy or postpartum) and improve maternal and neonatal outcomes. Two independent reviewers [IKM and NI] searched databases and grey literature for references of identified peer reviewed studies published from January 2019 up to May 2022.
We excluded studies published before the COVID-19 pandemic, study protocols [83, 84], commentary [9, 40, 46, 85,86,87] or viewpoint , thesis , or if they were qualitative studies focused on perception of users, mHealth conceptual models [26, 89] not published in English language or did not report on COVID-19. We excluded review papers or studies focused on only mobile phone apps and/or pregnant women without a link to COVID-19 [55, 90, 91]. Also excluded were studies that did not focus on an intervention (e.g., mental health, education, test, vaccines, lifestyle, or mental health).
Screening and data extraction
Studies retrieved from each database were imported into Endnote X8 reference management software . These studies were then imported into Covidence, a systematic online review management program  which allowed for screening of eligible studies. The screening process was completed in two phases after duplicates were removed. After the two of five reviewers [including IMK, NI] screened all articles independently at each stage, the authors screened all articles based on relevance of information contained in the title and abstract, and then determined their inclusion for full text review. We then compared the individual screening results and resolved discrepancies by consensus via discussion among the five researchers. Only studies that met the inclusion criteria underwent a full text review.
Two reviewers abstracted data which was then validated by a third reviewer, with sections assigned based on reviewers’ expertise.
To evaluate the methodological quality of all primary research studies, we utilized the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies . We used the checklist to assess the extent to which the selected studies report on the likelihood of bias in nine topics of study design, conduct, and analysis as used in previous studies , ranging from phase 0 (poor quality) to 2 (high quality), with studies receiving a total quality score (ranged from 0-poor quality to 18- higher quality). We excluded studies with a total score of < 13. Five researchers [IMK, NI, CW, SW, and SV] independently evaluated each included study, and through discussion, we decided on any doubt about the quality of included studies.
We reviewed attributes of the included studies. Narratively synthesized were key implemented health interventions that supported the three stages of pregnancy. To categorize the selected studies, we adopted a conceptual model developed a priori based on existing literature on mHealth and maternal and child health . Digital interventions were identified based on their purpose, modalities, facilitators for uptake (e.g., choices, perceptions), relevant actors (pregnant women, providers, mothers), study design, context or conditions required for program facilitators to activate or not, and mobile phone or telehealth intervention outcomes .
Figure 1 presents the PRISMA flow diagram used for the scoping review. The search yielded 1851 peer reviewed articles from select databases: PubMed MEDLINE (1481), CINAHL (220), Web of Science (28), Scopus (12) and grey searches (110). Of these, we excluded 30 duplicates. Of the remaining 1821 studies, 1713 studies were non-empirical, such as study protocols, thesis, commentary, viewpoints, or reviews. Based on title and abstract review, 108 studies were left for a full-text review, and of these, 85 studies were excluded (with 18 studies excluded after assessment for quality) leaving 22 studies (n = 16 mHealth studies and 6 telehealth studies).
Table 1 shows the 22 studies that were selected on COVID-19, mHealth and telehealth from the three stages of pregnancy. The included studies were published in English, and between 2020 and 2022. Of the 16 mHealth studies, 7 studies were conducted in the USA (n = 4) and Iran (n = 3). The remaining 9 studies were conducted in Australia, Canada, Guatemala, Indonesia, Mozambique, Singapore, Sri Lanka and the UK (one study in each country). One study’s location was unclear. Of the 6 telehealth studies, one was conducted in the USA and the rest in Australia, Germany, Indonesia, Iran and Spain (one study in each country). Figure 2 shows the country locations of the peer-reviewed studies included in this scoping review.
The 16 mHealth included studies were classified into four types of study designs: experimental studies (11 studies, including 5 randomized control trials (RCTs), and 2 quasi-experimental studies), one was a mixed methods study, and two were observational studies. Two of 16 mHealth studies used a multistage iterative development process and a user centered design. We then grouped the identified 6 telehealth interventions into three types of study designs: experinmental studies (2 studies), evalaution studies (3 studies), and one study was a retrospective chart review of all pre- and post-natal care visits. All included studies reported the use of mHealth or telehealth to support the three stages of pregancy during the COVID-19 pandemic.
Although included studies (telehealth and mHealth) reported varying degrees of eligiblity criteria for selecting study participants, women had to be pregnant or should have given birth within a stipulated study period. Study particpants in most studies were selected based on the pregnant woman’s age (e.g., at least 18 years), their gestational age in weeks or months (e.g., 16–20 weeks of gestation), or if the pregnant woman was a parent with a child born within 6 months postpartum. Two articles included women of reproductive age. A few studies selected pregnant women based on their area of residence and/or service clinic or if women were active users of the study digital technolgy.
Overview of interventions examined
To classify the chosen studies, we applied the program theory of mHealth programs and maternal and child health  and developed a modified model of the major outcomes (Fig. 2). The included 22 studies reported on three outcomes: 1) mental and physical wellness, 2) health promotion, patient tracking and education, and 3) parenting support (Fig. 3). The mHealth interventions were delivered using various technology platforms, including mobile app (iOS and Android) or smartphone (15 studies) with some sending intervention content via WhatsApp Messenger and/or email (1 study). A few studies used a combination of mobile phone or smart phone and/or websites.
Mental and physical wellness
A recent review of the psychological impact of COVID-19 pandemic on the mental health of pregnant women, conducted by researchers at the University of Cagliari in Italy in 2021, linked an increase in mental health of pregnant women to the coronavirus pandemic  and underscored the need for psychological support during pregnancy to mitigate mental health and the risk of long-term impacts on child development. Three of six mHealth mental and physical wellness studies supported pregnant women (3 studies) while three studies supported postpartum care. Mental and physical wellness interventions included: 1) self-paced guided mediation, 2) meditation training, 3) psychological support, 4) psychosocial coaching, and 5) physical activity.
mHealth mental and physical wellness interventions for pregnancy support
To determine the effect of a mobile application (app)-based health interventions, with motivational multimedia with photos and videos on physical activity, Kiani and Pirzadeh  conducted a quasi-experimental study of 93 pregnant women (16–20 weeks of gestation) participating in childbirth preparation classes during the coronavirus crisis. Researchers encouraged women to use the mobile app designed not to require internet connection for a specified period. Findings (pre- and 3 months-post intervention) showed that the perceived benefits and enjoyment of physical activity increased post intervention in the intervention group (compared to the control group), so did the mean score of physical activity in this group. Smith and colleagues evaluated the effect of a consumer-based mobile app-based meditation on wellness by randomizing 101 women (50 women in the treatment group, and 51 women in the control group and standard care). Pregnant women in the treatment group used the mindfulness meditation app Calm for 30 days. Results showed a significant reduction in the intervention group (compared to the control group) in perceived stress, depression, anxiety, and sleep disturbance .
mHealth mental and physical wellness interventions for postpartum support
To evaluate the effect of a six-week postpartum mobile phone text message program (“Essential Coaching for Every Mother”) on maternal self-efficacy, social support, postpartum anxiety, and depression, Dol and colleagues  conducted a prospective study with 88 first-time mothers enrolled after giving birth and 6 weeks postpartum between July 15 and September 19, 2020. The study noted an increase in self-efficacy (at follow-up compared to baseline), and a reduction in anxiety, and women’s satisfaction with the program . However, further work is required to establish the viability of this program. Using a large-scale, population-based pregnancy cohort, Jayasinghe and colleagues  recruited 3374 first-trimester pregnant women registered with midwives at the field prenatal clinics to assess the feasibility and the coverage and feasibility of app-based interventions and generalizability of telephone interviews for psychological support during the pandemic. The study revealed that mHealth led to selection bias and that mHealth may not be the best strategy for interventions in this remote area.
Two studies in the US tested the feasibility and acceptability of offering a self-paced, commercially available mobile-app (Headspace™)-based mindfulness intervention in women with depressive symptoms by using single arm trials [48, 98]. Notably, although one of these studies focused on pregnant women (< 28 weeks of gestation who were not practicing a regular, < 3 times per week) mindfulness/meditation ; the other study focused on postpartum women . Both studies noted significant improvements in pre-post-intervention scores for depression symptoms, perceived stress, sleep disturbance, mindfulness, feasibility, and acceptability of the mHealth mindfulness intervention for pregnant and postpartum women. In both studies, women had to follow a self-paced, 6-week mindfulness meditation program using the app 10–20 minutes each day over the 6-week period .
Health promotion, tracking and patient education
Health education during pregnancy plays a critical role in improving maternal and neonatal outcomes (e.g., birth weight, initiation and continuation of breastfeeding, and postpartum strategies) [116,117,118,119]. Five of the 16 mHealth studies focused on health promotion, tracking and patient education to support the three stages of pregnancy . These interventions focused on educating women regarding the coronavirus, management of gestational diabetes, preeclampsia, perinatal education, visits, and maintenance including uptake.
mHealth for health promotion, tracking for pre- pregnancy support
To estimate the effects of mobile text messages in encouraging the use of family planning services in Mozambique, Leight and colleagues  conducted a randomized controlled trial with 5623 women receiving services from the Integrated Family Planning Program implemented by Population Services International between 20 January and 18 December 2020. Women in the treatment group received a series of text message reminders encouraging uptake of health facility visits for family planning counselling. They observed that women in the treatment group were more likely to receive a contraceptive method at a clinic.
mHealth for health promotion, tracking and pregnancy support
A quality improvement study that screened 552 patients for intimate partner violence (IPV) during the COVID-19 pandemic using a prenatal care app which showed that the use of the IPV screening tool increased during the lock-down period . Another evaluation study focused on the adoption and multidisciplinary care coordination of an mHealth platform in a cohort of women with first-time diagnosis of GDM showed that high blood glucose reviews and antenatal contact among app users (compared to non-app users) .
Two studies conducted in Iran designed and developed two mobile apps to facilitate self-care for pregnant women with preeclampsia during COVID-19, and examined the effect of a self-care smartphone-based application on self-care practices for pregnant women against COVID-19. Both studies noted positive reviews, and the apps were rated highly by users [103, 104].
Parenting can be tough, and parenting apps can lessen the burden for first-time parents through providing access to information and tracking child development  especially during the COVID-19 pandemic, when pregnant parents and parents of young children lost usual support networks. Five studies focused on parenting support during pregnancy (3 studies) and the postpartum period (2 studies), and four interventions enabled by mHealth technology: 1) breastfeeding, 2) nutrition support, 3) self-care tools, 4) postpartum care, perinatal education and/or uptake.
mHealth for parenting support
Ceballos and colleagues  applied a clustered randomized controlled trial (cRCT) to evaluate the feasibility of using simple calendarized mobile text messages (SMS) and phone calls to improve the timely reception of health services of key health and nutrition interventions linked to a critical period of growth and development (the first 1000 days of life), but did not find any effects. However, mobile phone calls were an effective low-cost tool. Rhodes and colleagues  conducted a service evaluation using mixed methods to determine whether the “Baby Buddy”, a pregnancy and parenting app aimed at supporting pregnant women and new parents through the first 24 weeks of parenthood, was meeting users’ needs (436 women). Women reported increased anxiety due to decreased health care delivery and loss of social support from friends and family. In Indonesia, a quasi-experimental study assessed the effectiveness of an interactive mHealth message intervention (text, images), videos, and assistance (consultation, discussion, sharing, and question and answer) using WhatsApp groups to improve postpartum care behavior of 88 mothers and husbands (43 pairs- treatment group and 45 pairs - control group) . The duration of the intervention was 14 days (5 hours per day, followed by random flyers delivered at birth up to 42 days post birth). The researchers report improved postpartum care behavior for mothers and their husbands.
mHealth for parenting support during the postpartum period
One study developed a Supportive Parenting App (SPA) to improve parent and infant outcomes in the perinatal period, and highlight the challenges and lessons learned, which centered around user and technological problems . Likewise, a study in an unspecified location evaluated whether the coronavirus crisis affected breastfeeding consultations by using data from LactApp (a mobile application [app], an mHealth solution designed for breastfeeding support, and revealed an increase in breastfeeding support .
Telehealth for mental and physical wellness
Previous studies conducted prior to the pandemic as well as during the pandemic has demonstrated the significance of telemedicine prenatal care [121, 122]. However, others have raised concerns regarding equity in access to care, particularly in resource-limited settings . The 6-telehealth technology-enable interventions identified in this scoping review focused on exercise, selfcare, prenatal counseling and behavioral health.
Telehealth for mental and physical wellness support during pregnancy
To explore the experiences of pregnant women (8–39 weeks of pregnancy) participating in an online group exercise program, and the role of a virtual group fitness on maternal mental outcomes, Silva-Jose and colleagues  applied a phenomenological approach in study conducted between March to October 2020. The researchers found that pregnant women were receptive to the online group exercise classes and liked the accessibility of the physical activity, and the social connection they provided. Three of the telehealth studies focused on antenatal care. One study quasi-experimental study with 100 pregnant women aged 18–49 years and 20–28 weeks gestation age determined the effect of COVID-19 self-care training via telemedicine on perceived stress and corona disease anxiety, and noted a reduction in perceived stress in the treatment group (compared to the control group) . Findings confirm the effectiveness of the selfcare training implemented via telemedicine and during the coronavirus crisis in reducing the perceived stress and anxiety of pregnant women.
Telehealth for health promotion, tracking and education support during pregnancy
Regarding the telehealth technology-enable interventions, Oelmeier and colleagues  conducted a prospective single-center trial by use of 75 video consultations in a tertiary center for obstetric care, and the results indicated that patient satisfaction was high, but technical problems were experienced in 37% of the appointments. Nur and colleagues  used a purposive sampling technique and post-test experiments on 30 pregnant women and 20 midwives to examine the effect of COVID-19 on antenatal visits on pregnant women. They found differences in the prenatal visits among pregnant women pre-and post the COVID-19 lockdown period, and in midwives participation rates in counseling, high-risk early detection on pregnancy, Hb monitoring, and provision of Fe tablets.
Telehealth for health promotion, tracking and education support during the postpartum period
In Australia, one telehealth technology study used an interrupted time-series design to assess the impact of telehealth integration into antenatal care by comparing the first 3 months of telehealth integrated care delivered between April 20 and July 26, 2020, with conventional care across low-risk and high-risk care models. We found no significant differences in the integrated care period as it relates to the number of babies with fetal growth restriction (e.g., birthweight) or pregnancies complicated by pre-eclampsia, or gestational diabetes. Overall, they noted a reduction in-person interactions during the pandemic, and recommend the use of telehealth in post-pandemic health-care models . Further, a retrospective chart review of electronic health records of all pre-and postnatal care visit encounters (558 patients, and 1788 prenatal visits) from March 19 and August 31, 2020 noted limited effectiveness measures but potential for earlier diagnosis of some prenatal conditions, and that telehealth was a feasible option .
We performed a global scoping review to synthesize the published peer-reviewed literature on the mHealth and telehealth studies conducted during the coronavirus crisis to support pregnancy care. These studies showed how mHealth and telehealth studies varied regarding the types of designs, context, interventions and/or modalities, uptake facilitators and outcomes studied.
mHealth studies constituted 72.7% of the published studies while 27.3% were telehealth studies. There were only 3 example studies that integrated digital technologies into healthcare systems [28, 98, 113] and only 3 studies that designed, developed and evaluated the feasibility of mobile apps to support one or a combination of the 3 stages of pregnancy [103, 104, 108]. Mobile apps and short-messaging services were the primary technologies employed in mHealth studies. Experimental studies, such as (RCTs) quasi-experimental studies accounted for 68.8% of mHealth studies, and only 33.3% were telehealth studies using experimental study designs. Future studies that determine whether a cause-effect relation exists between treatment and outcome during pandemics or emergencies are therefore recommended.
We identified three key functionalities of pregnancy apps and telehealth platforms including mental and physical wellness, health promotion, patient tracking, health education, and parenting support. However, the results of the synthesized studies demonstrate the similarities and differences between participant characteristics and intervention modalities used from prenatal through delivery and postpartum. For instance, there were considerable differences in study participants ages, with most studies using both the birth age of the mother and gestation age, while a few studies did not include age but referenced the age of participants as women of reproductive age  or pregnant women [68, 101, 103, 109, 124, 125], or women with children under 2 years old [105, 113, 126]. Likewise, although two studies conducted in the US used a similar mHealth intervention delivered via Headspace™ app and with patients with moderate-to-moderately-severe depression as well as duration (use of app for 10 to 20 minutes a day for 6 weeks), they focused on different stages of pregnancy, gestation age and patient birth ages. For example, Avalos and colleagues  applied the mHealth mindfulness program to support women aged at least 18 years, and within 6 months of giving birth, while Kubo and colleagues  applied it to support pregnant women age 18 years or older with less than 28 weeks of gestation.
In this scoping review, 37.5% of included studies utilized mHealth for physical activity education, mental health and wellness, mindfulness meditation, psychological and psychosocial (e.g., maternal self-efficacy, social support, anxiety -postpartum specific and coronavirus related stress). This provides noble interest and motivation of using mHealth technologies and content-driven education to facilitate maternal self-efficacy. In addition, although only few studies were included, the finding highlights the psychological sequelae of COVID-19 on pregnant women, a concern raised in recent studies . The identified mHealth and telehealth platforms from this scoping review provide good evidence as digital technologies used by both women and providers to support maternity continuum of care during the pandemic. Similarly, the design of self-paced guided and instances of supervised self-care, including the use of apps without needing internet connection can enhance uptake, promote healthy pregnancies and replication in other subpopulations and clinical settings. Our findings are in line with pregnancy apps desired functionalities reported in other related reviews [80, 83, 127]. Moreover, interventions were piloted and evaluated with potential users (women and providers) before implementation.
Previous studies have indicated the enormous effect that positive parenting practices can have on children’s social, emotional, and intellectual development, especially during the early years, and parenting apps can help first-time parents access information and track child development. Five of the 16 mHealth studies focused on this important topic and revealed that mHealth technologies play a key role in supporting new parents to access information and receive health interventions because of their ease of accessibility. However, only two of the five mHealth parenting studies used experimental study designs, therefore questions remain.
In terms of the telehealth studies, pregnancy, and the COVID-19 pandemic, 37.5% included studies supported pregnancy and postpartum care via prenatal counselling, self-care training, supervised exercises, prenatal care provision, and or maintenance and behavioral health. Most studies used a combination of platforms in the delivery of telehealth interventions such as video consultations, audio PowerPoints turned into video content and sent via mobile WhatsApp, Zoom platform, or telephone. What is surprising is the limited evidence supporting telehealth interventions in obstetrics and gynecology, a finding also reported by a systematic review conducted before the COVID-19 pandemic .
In summary, although our scoping review has limitations that are embedded from the included studies to our knowledge, the current study is the first to uncover context, digital interventions, uptake facilitators, locations, study designs and outcomes in the interventions implemented during the COVID-19 pandemic to support pregnancy care. We recognized three key functionalities of both pregnancy apps and telehealth that have been studied to date, including clinical outcomes across the maternity care continuum that has been supported using the two digital technologies during the coronavirus crisis to support pregnancy care based on the theory for mHealth programs.
Our scoping review identified key functionalities of mobile apps and telehealth platforms, pregnancy and intervention outcomes, context, interventions, study designs and approaches in the included studies during the COVID-19 crisis. Most studies focused on mental health and physical wellness, and mobile phone apps were the most used modality, followed by telehealth. Few studies included the use of WhatApp, messenger and websites. Regarding methodological approaches, slightly more than half used experimental studies, and the remaining were evaluation studies, developmental or design studies. Included studies published in the past two and a half years underscore an emergent topic of study, and we anticipate more studies in the near future.
Availability of data and materials
All sharable data have been uploaded.
Coronavirus Disease 2019
Clustered randomized controlled trial
Gestational Diabetes Mellitus
IPhone operating system
Intimate partner violence
- mobile app:
Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews
Randomized controlled trial
United Nations Sustainable Development Goals
Short message service / text message
Supportive Parenting Application
United States of America
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Special thanks are extended to all those that worked tireless during the pandemic to support pregnancy care in different contexts during the pandemic. We are also grateful to those who care for others with empathy in times of emergencies.
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Moise, I.K., Ivanova, N., Wilson, C. et al. Lessons from digital technology-enabled health interventions implemented during the coronavirus pandemic to improve maternal and birth outcomes: a global scoping review. BMC Pregnancy Childbirth 23, 195 (2023). https://doi.org/10.1186/s12884-023-05454-3