Mobile Health Solutions for Hypertensive Disorders in Pregnancy: Scoping Literature Review

Abstract

BackgroundHypertensive 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.ObjectiveThe 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.MethodsA 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.ResultsThe 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.ConclusionsmHealth 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.

Neonatal, infant and child health in South Africa: Reflecting on the past towards a better future

“…Although there is increasingly robust evidence for the effectiveness of these platforms, data from mHealth interventions implemented at scale are lacking. [78][79][80][81][82][83][84] An exception is the NDoH's MomConnect programme, which provides pregnant and postpartum women with health information via text messages twice a week, has a help desk for patient queries and serves as a platform for patient feedback to facilities. [85,86] It has reached approximately 63% of all pregnant women attending their first antenatal appointment and covers over 95% of public health facilities in SA.…”

Avaliação de aplicativos móveis para promoção da saúde de gestantes com pré-eclâmpsia

“…This is a necessary step to support the integration of prototypes, as well as protocols reported in health systems, to improve current clinical practice. (14) It is worth mentioning that the research presented limitations on the searches, in which there are differences of Apps from one smartphone to another, which differs according to the operating system and the update of these systems. Another important limitation is that the questionnaire used to evaluate the Apps, although easy to understand, has not yet been translated and validated into Portuguese.…”

“…The ICT could be used to aid in diagnosis, monitoring, management, self-care, communication between patients and professionals, education, and patient empowerment. (14) Some of the risk factors for PE are: advanced maternal age (over 40 years), family history, previous pregnancy with PE, chronic hypertension or chronic kidney disease or both, diabetes mellitus type I or II, obesity, in vitro fertilization, and others. (10) Because this is a serious public health problem that is responsible for not only maternal but also fetal morbidity, one can note the growth of Apps related to hypertensive disorders, especially PE, emphasizing its risk factors.…”

“…(16) It is also important to emphasize that the promotion of a healthy lifestyle through ICTs can be a powerful and useful tool for pregnant women with hypertensive disorders. (14) The most common health Apps used by women are those related to pregnancy, delivery and child care. (15) One study showed that more primiparous women (53.9%) use Apps compared to multiparous women (46.1%).…”

Cardiometabolic Risk Factors in Pregnancy and Implications for Long-Term Health: Identifying the Research Priorities for Low-Resource Settings

“…Mobile health (mHealth) technologies have the potential to increase equity, quality and efficiency of service delivery in LMICs (28). mHealth technologies have contributed to reductions in delays in accessing maternal health in LMICs (29), and can be useful in the diagnosis, monitoring, providing clinical decision support, education and health promotion (30,31).…”