The Value of Mobile Health in Improving Breastfeeding Outcomes Among Perinatal or Postpartum Women: Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Background Breastfeeding is essential for maintaining the health of mothers and babies. Breastfeeding can reduce the infection rate and mortality in newborns, and can reduce the chances of overweight and obesity in children and adolescents. For mothers, a longer duration of breastfeeding can reduce the risk of breast cancer, ovarian cancer, and type 2 diabetes. Although breastfeeding has many benefits, the global breastfeeding rate is low. With the progress of time, the popularity of mobile devices has increased rapidly, and interventions based on mobile health (mHealth) may have the potential to facilitate the improvement of the breastfeeding status. Objective The main objective of this study was to analyze the existing evidence to determine whether mHealth-based interventions can improve the status of breastfeeding. Methods We systematically searched multiple electronic databases (PubMed, Web of Science, The Cochrane Library, Embase, CNKI, WanFang, and Vip ) to identify eligible studies published from 1966 to October 29, 2020. Included studies were randomized controlled trials (RCTs) studying the influence of mHealth on breastfeeding. The Cochrane Collaboration Risk of Bias tool was used to examine the risk of publication bias. RevMan 5.3 was used to analyze the data. Results A total of 15 RCTs with a total sample size of 4366 participates met the inclusion criteria. Compared with usual care, interventions based on mHealth significantly increased the postpartum exclusive breastfeeding rate (odds ratio [OR] 3.18, 95% CI 2.20-4.59; P<.001), enhanced breastfeeding self-efficacy (mean difference [MD] 8.15, 95% CI 3.79-12.51; P=.002; I2=88%), reduced health problems in infants (OR 0.62, 95% CI 0.43-0.90; P=.01; I2=0%), and improved participants’ attitudes toward breastfeeding compared with usual care (MD 3.94, 95% CI 1.95-5.92; P<.001; I2=0%). There was no significant difference in the initiation of breastfeeding within an hour of birth between the intervention group and the usual care group (OR 1.26, 95% CI 0.55-2.90; P=.59). In addition, subgroup analysis was carried out according to different subjects and publication times. The results showed that the breastfeeding rate was not limited by the types of subjects. The breastfeeding rate based on mHealth at 1 month and 2 months after delivery did not change over the time of publication (2009 to 2020), and the breastfeeding rate based on mHealth at 3 months and 6 months after delivery gradually increased with time (2009 to 2020). Conclusions Interventions based on mHealth can significantly improve the rate of postpartum exclusive breastfeeding, breastfeeding efficacy, and participants’ attitudes toward breastfeeding, and reduce health problems in infants. Therefore, encouraging women to join the mHealth team is feasible, and breastfeeding-related information can be provided through simple measures, such as text messages, phone calls, and the internet, to improve the health of postpartum women and their babies.

Perinatal support for breastfeeding using mHealth: A mixed methods feasibility study of the My Baby Now app

“…Research into the development and testing of evidence‐based mHealth interventions for breastfeeding is growing. A recent systematic review and meta‐analysis (Qian et al, 2021) of 15 randomised controlled trials (RCT) of mHealth breastfeeding interventions found that these interventions significantly increased exclusive breastfeeding rates at 1, 2, 3 and 6 months post‐partum and improved breastfeeding self‐efficacy, though not breastfeeding attitudes. Nearly half ( n = 7) of these studies were in low‐ to middle‐income countries: most used SMS and/or telephone support as the main delivery mode, two used web‐based interventions, and none used a mobile phone app.…”

Interventions and Programs to Promote Breastfeeding in Arabic-Speaking Countries: A Scoping Review

“…Their usage, and mHealth in particular, could transform health systems especially when technological and regulatory challenges are addressed (Alsswey et al, 2021 ; Elden et al, 2022 ). Global evidence shows that mHealth interventions significantly improves exclusive breastfeeding (Alnasser et al, 2018 ; Qian et al, 2021 ). Given the widespread use of mobile phone, further intervention research on using mHealth to promote exclusive breastfeeding in the region is needed to determine how best they can be used to promote breastfeeding.…”

To the Editors of the Journal of Fertility, Gynecology, and Andrology

“…Internet-based prenatal educational programs are found to be effective in alleviating maternal postpartum depression (16). Studies also showed that using mobile devices for health purposes can significantly improve the rate of exclusive breastfeeding, breastfeeding efficacy, and women's attitudes toward breastfeeding and reduce health problems in infants (17). As an example, Hui et al (2021) evaluated the effect of remote prenatal education on the breastfeeding rate and prenatal program participation of pregnant women in rural and remote communities of northern Canada.…”