Technologies Applied to the Mental Health Care of Pregnant Women: A Systematic Literature Review

Carvalho, Laís Lage de; Teixeira, Júlia Magna da Silva; Unger, Roberto José Gervásio; Motti, Vivian Genaro; Lovisi, Giovanni Marcos; Grincenkov, Fabiane Rossi dos Santos

doi:10.1055/s-0043-1768458

Laís Lage de Carvalho Address for correspondence Laís Lage de Carvalho, MSc, Av. dos Andradas, 731, Morro da Glória, Juiz de Fora, MG, Brazil, CEP: 36036-000, Brazil (e-mail: laislagecarvalho@gmail.com).

Centro Universo Juiz de Fora, Curso de Psicologia, Juiz de Fora, MG, Brazil

https://orcid.org/0000-0001-5781-6930

Júlia Magna da Silva Teixeira

Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil

https://orcid.org/0000-0002-0333-1193

Roberto José Gervásio Unger

Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0002-1815-2585

Vivian Genaro Motti

George Mason University, Information Sciences and Technology, Fairfax, VA, United States

https://orcid.org/0000-0003-1336-3743

Giovanni Marcos Lovisi

Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0003-0521-0202

Fabiane Rossi dos Santos Grincenkov

Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil

https://orcid.org/0000-0003-0948-2635

Address for correspondence Laís Lage de Carvalho, MSc, Av. dos Andradas, 731, Morro da Glória, Juiz de Fora, MG, Brazil, CEP: 36036-000, Brazil (e-mail: laislagecarvalho@gmail.com).

Conflicts to Interest

None to declare.

Search strings

Gestantes AND Complicações da gravidez AND transtornos mentais AND Cuidado pré-natal AND Sistemas de apoio psicossocial AND Apoio social AND Fatores de risco AND Telefone celular

Pregnant women AND Pregnancy complications AND Mental disorders AND Prenatal care AND Psychosocial support systems AND social support AND Risk factors AND Telemedicine

Pregnant women AND Pregnancy complications AND Anxiety AND Prenatal care AND Psychosocial support systems AND social support AND Risk factors AND Cell phone

Pregnant women AND Pregnancy complications AND Anxiety AND Prenatal care AND Psychosocial support systems AND social support AND Risk factors AND Telemedicine

Pregnant women AND Pregnancy complications AND depression AND Prenatal care AND Psychosocial support systems AND social support AND Risk factors AND Cell phone

Pregnant women AND Pregnancy complications AND depression AND Prenatal care AND Psychosocial support systems AND social support AND Risk factors AND Telemedicine

Pregnant women AND Pregnancy complications AND Stress psychological AND Prenatal care AND Psychosocial support systems AND social support AND Risk factors AND Cell phone

Pregnant women AND Pregnancy complications AND Stress psychological AND Prenatal care AND Psychosocial support systems AND social support AND Risk factors AND Telemedicine

Pregnant women AND Mental disorders AND Prenatal care AND Psychosocial support systems AND Risk factors AND Cell phone

Pregnant women AND Mental disorders AND Cell phone

Pregnant women AND Mental disorders AND Telemedicine

Pregnant women AND Anxiety AND Cell phone

Pregnant women AND Anxiety AND Telemedicine

Pregnant women AND depression AND Cell phone

Pregnant women AND depression AND Telemedicine

Research Field	Count	Percentage
Health Sciences	8	29.6
Psychology	5	18.5
Psychiatry	5	18.5
Medical Sciences	4	14.8
Nursing	2	7.4
Anthropology	1	3.7
Social Sciences	1	3.7
Health, arts, and design	1	3.7
Total	27	100.00

Author Year	Study design	Study population	Sample size	Technology features
Carissoli et al. (2017)³⁰30 Carissoli C, Villani D, Gasparri D, Riva G. Enhancing psychological wellbeing of women approaching the childbirth: a controlled study with a mobile application. Annu Rev Cybertherapy Telemed. 2017;15:45–50	Longitudinal	Italian women, primiparous and in the third trimester of pregnancy	78	BenEssere Mamma is a mobile app consisting of a four-week pregnancy wellness self-help program. The app includes an experimental area with a set of daily relaxation exercises and guided imagery exercises and an emotional awareness area with a mood diary in which the user can record notes about her emotional state, thoughts and events that happen during the session.
Carissoli et al. (2016)¹³13 Carissoli C, Villani D, Triberti S, Riva G. User experience of BenEssere Mamma, a pregnancy app for women wellbeing. Annu Rev CyberTher Telemed.. 2016;14:195–198	Longitudinal	women who participate in an aquatic gymnastics course for pregnant women, being over 18 years of age in low-risk pregnancies.	12	BenEssere Mamma is a mobile app consisting of a four-week pregnancy wellness self-help program. The app includes an experimental area with a set of daily relaxation exercises and guided imagery exercises and an emotional awareness area.
Davis et al. (2014)¹⁴14 Davis AM, Wambach KA, Nelson EL, et al. Health behavior change in pregnant women: a two-phase study. Telemed J E Health. 2014; 20(12):1165–1169. Doi: 10.1089/tmj.2013.0374 https://doi.org/10.1089/tmj.2013.0374...	Longitudinal	Study 1 and 2: Pregnant women attending appointments at the Obstetrics and Gynecology Clinic at the University of Kansas Medical Center	Study 1: 68; Study 2: 5	daily text messages (a total of five text messages per week, successively focused on one of three health topics) and three 20-minute voice-over-PowerPoints
Oyeyemi and Wynn (2015)¹⁷17 Oyeyemi SO, Wynn R. The use of cell phones and radio communication systems to reduce delays in getting help for pregnant women in low- and middle-income countries: a scoping review. Glob Health Action. 2015;8:28887. Doi: 10.3402/gha.v8.28887 https://doi.org/10.3402/gha.v8.28887...	Revision	Healthy pregnant women in Bangkok, Thailand	68	Simple use of cell phones or radio communication to either make calls or send text messages/short message services (SMS)
Dalton et al. (2018)³¹31 Dalton JA, Rodger D, Wilmore M, et al. The Health-e Babies App for antenatal education: Feasibility for socially disadvantaged women. PLoS One. 2018;13(05):e0194337. Doi: 10.1371/journal. pone.0194337 https://doi.org/10.1371/journal.pone.019...	Cross-sectional	Pregnant women between 10 and 14 weeks	124	Focus groups with pregnant women to define the information needed in the app, in terms of design, literature, content and usability. Control group and later the experimental group.
Chilelli et al. (2014)¹⁵15 Chilelli NC, Dalfrà MG, Lapolla A. The emerging role of telemedicine in managing glycemic control and psychobehavioral aspects of pregnancy complicated by diabetes. Int J Telemed Appl. 2014; 2014:621384. Doi: 10.1155/2014/621384 https://doi.org/10.1155/2014/621384...	Theoretical study Revision	Theoretical study of Telemedicine for the care of gestational risk caused by diabetes	n/a	Telemedicine has the potential to revolutionize current methods to manage pregnancy complicated by diabetes, bringing benefits to both patients and healthcare
Whittaker et al. (2012)³²32 Whittaker R, Matoff-Stepp S, Meehan J, et al. Text4baby: development and implementation of a national text messaging health information service. Am J Public Health. 2012;102(12):2207–2213. Doi: 10.2105/AJPH.2012.300736 https://doi.org/10.2105/AJPH.2012.300736...	Longitudinal	Pregnant women and mothers of infants.	100	Analysis with specialists and informal groups with pregnant women to determine the themes.
Felder et al. (2017)³³33 Felder JN, Segal Z, Beck A, et al. An open trial of web-based mindfulness-based cognitive therapy for perinatal women at risk for depressive relapse. Cognit Behav Pract. 2017;24(01):26–37. Doi: 10.1016/j.cbpra.2016.02.002 https://doi.org/10.1016/j.cbpra.2016.02....	Longitudinal	Women at risk of postpartum depression	123	Eight-session Web-based program, with guided mindfulness and yoga practices, cognitive-behavioral strategies, and psychoeducation, consistent with MBCT
Osma et al. (2016)³⁴34 Osma J, Barrera AZ, Ramphos E. Are pregnant and postpartum women interested in health-related apps? Implications for the prevention of perinatal depression. Cyberpsychol Behav Soc Netw. 2016;19(06):412–415. Doi: 10.1089/cyber.2015.0549 https://doi.org/10.1089/cyber.2015.0549...	Cross-sectional	English and Spanish speaking women, currently pregnant or within 1 year of giving birth	509	Anonymous online survey to assess access to Information and Communication Technology tools, examine the frequency of searching for health information through online and mobile methods, and identify behaviors related to the access of pregnant and postpartum women to health-related applications.
Forsell et al. (2017)²¹21 Forsell E, Bendix M, Holländare F, et al. Internet delivered cognitive behavior therapy for antenatal depression: A randomised controlled trial. J Affect Disord. 2017;221:56–64. Doi: 10.1016/j. jad.2017.06.013 https://doi.org/10.1016/j. jad.2017.06.0...	Longitudinal	Pregnant women, with a gestational age between 12-28 weeks and with major depression	42	A modified version of an existing online CBT model was added/adapted to questions closer to the relationship between depression and pregnancy
Nair et al. (2018)²²22 Nair U, Armfield NR, Chatfield MD, Edirippulige S. The effectiveness of telemedicine interventions to address maternal depression: A systematic review and meta-analysis. J Telemed Telecare. 2018;24(10):639–650. Doi: 10.1177/1357633X18794332 https://doi.org/10.1177/1357633X18794332...	Revision	Studies recruited postnatal, perinatal, prenatal, and postpartum women	42 to 852	Traditional phone calls, email and smartphone apps, websites, and chatrooms.
Hantsoo et al. (2017)³⁵35 Hantsoo L, Podcasy J, Sammel M, Epperson CN, Kim DR. Pregnancy and the acceptability of computer-based versus traditional mental health treatments. J Womens Health (Larchmt). 2017;26(10): 1106–1113. Doi: 10.1089/jwh.2016.6255 https://doi.org/10.1089/jwh.2016.6255...	Cross-sectional	Pregnant women, non-pregnant women and men	312	TTVideo - Patient conducts psychotherapy sessions with the therapist via a web camera, using video chat technology, rather than participating in in-person sessions at the therapist’s office. TAComp -The patient completes the psychoeducational modules (usually CBT) through a computer interface. This is complemented with brief face-to-face sessions with a therapist. TOSelf-guided - The patient selects and administers an online program without any interaction with a therapist. The patient completes computer-based exercises at home at their own pace.
Evans et al. (2017)¹⁶16 Evans EC, Deutsch NL, Drake E, Bullock L. Nurse-patient interaction as a treatment for antepartum depression: a mixed-methods analysis. J Am Psychiatr Nurses Assoc. 2017;23(05):347–359	Longitudinal	Women who started the study with scores indicative of depression	318	A nurse-delivered telephone support
Faherty et al. (2017)²³23 Faherty LJ, Hantsoo L, Appleby D, Sammel MD, Bennett IM, Wiebe DJ. Movement patterns in women at risk for perinatal depression: use of a mood-monitoring mobile application in pregnancy. J Am Med Inform Assoc. 2017;24(04):746–753. Doi: 10.1093/jamia/ocx005 https://doi.org/10.1093/jamia/ocx005...	Longitudinal	Women attending antenatal care at an obstetric clinic affiliated with an urban teaching hospital, serving predominantly minority, racial and ethnic backgrounds, where patients are routinely screened for perinatal depression	36	An application administered by daily surveys (2 questions) and weekly (PHQ-9 and GAD-7). The app measured daily mobility (distance traveled on foot) and travel radius.
Kingston et al. (2017)³⁶36 Kingston D, Austin MP, Veldhuyzen van Zanten S, et al. Pregnant women’s views on the feasibility and acceptability of web-based mental health e-screening versus paper-based screening: a randomized controlled trial. J Med Internet Res. 2017;19(04):e88. Doi: 10.2196/jmir.6866 https://doi.org/10.2196/jmir.6866...	Cross-sectional	Pregnant women	636	A web-based automated electronic screening intervention group and a paper-based control group
Bischoff et al. (2019)³⁷37 Bischoff M, Howland V, Klinger-König J, et al. Save the children by treating their mothers (PriVileG-M-study) - study protocol: a sequentially randomized controlled trial of individualized psychotherapy and telemedicine to reduce mental stress in pregnant women and young mothers and to improve Child’s health. BMC Psychiatry. 2019;19(01):371. Doi: 10.1186/s12888-019-2279-0 https://doi.org/10.1186/s12888-019-2279-...	Longitudinal	Pregnant women at the end of the second trimester with of without a psychiatric diagnose.	240	Phone calls and messages from nurses to women who have had a group CBT intervention
Gureje et al. (2015)³⁸38 Gureje O, Oladeji BD, Araya R, et al. Expanding care for perinatal women with depression (EXPONATE): study protocol for a randomized controlled trial of an intervention package for perinatal depression in primary care. BMC Psychiatry. 2015;15:136. Doi: 10.1186/s12888-015-0537-3 https://doi.org/10.1186/s12888-015-0537-...	Longitudinal	Pregnant women with a gestational age between 16 and 28 weeks who tested positive on the Edinburgh Postnatal Depression Scale (EPDS score ≥ 12)	686	Clinical support and supervision, provided mainly by mobile phone, were provided by general practitioners and psychiatrists. Automated text voice messages, also delivered by cell phones, were used to facilitate patient adherence to clinical appointments and ’homework’ tasks.
Green et al. (2019)²⁴24 Green EP, Pearson N, Rajasekharan S, et al. Expanding access to depression treatment in Kenya through automated psychological support: protocol for a single-case experimental design pilot study. JMIR Res Protoc. 2019;8(04):e11800. Doi: 10.2196/11800 https://doi.org/10.2196/11800...	Longitudinal	Pregnant women	10	Healthy Moms, uses an existing artificial intelligence system called Tess (Zuri in Kenya) to conduct conversations with users. It works by engaging a patient in a conversation through a variety of trusted channels, including text messages (SMS).
Lee et al. (2016)²⁵25 Lee SH, Nurmatov UB, Nwaru BI, Mukherjee M, Grant L, Pagliari C. Effectiveness of mHealth interventions for maternal, newborn and child health in low- and middle-income countries: Systematic review and meta-analysis. J Glob Health. 2016;6(01):010401. Doi: 10.7189/jogh.06.010401 https://doi.org/10.7189/jogh.06.010401...	Revision	Pregnant women	n/a	Health information via SMS, psychological intervention, and personalized exercises via audio recordings
Scherer et al. (2014)³⁹39 Scherer S, Urech C, Hösli I, et al. Internet-based stress management for women with preterm labour–a case-based experience report. Arch Women Ment Health. 2014;17(06):593–600. Doi: 10.1007/s00737-014-0454-3 https://doi.org/10.1007/s00737-014-0454-...	Longitudinal	Pregnant women between 18 and 32 weeks of gestation diagnosed with preterm delivery	1	An online self-help program for managing anxiety and stress for pregnant women with preterm labor
Gilbert et al. (2015)⁴⁰40 Gilbert J, Schnoll R, Morrison MF, et al. Smoking and cellular telephone use among pregnant women seeking prenatal care: opportunities for intervention. Addict Disord Their Treat. 2015;14 (04):203–210. Doi: 10.1097/ADT.0000000000000053 https://doi.org/10.1097/ADT.000000000000...	Longitudinal	Minority pregnant women	724	A smoking cessation program using a cell phone intervention through text messaging and medication use
van den Heuvel et al. (2018)⁴¹41 van den Heuvel JF, Groenhof TK, Veerbeek JH, et al. eHealth as the next-generation perinatal care: an overview of the literature. J Med Internet Res. 2018;20(06):e202. Doi: 10.2196/jmir.9262 https://doi.org/10.2196/jmir.9262...	Revision	Studies reporting the use of eHealth during prenatal, perinatal, and postnatal care	1 to 1880	eHealth information and use, lifestyle, pregnancy risk, mental health, telemonitoring and teleconsultation.
Halili et al. (2018)⁴²42 Halili L, Liu R, Hutchinson KA, Semeniuk K, Redman LM, Adamo KB. Development and pilot evaluation of a pregnancy-specific mobile health tool: a qualitative investigation of SmartMoms Canada. BMC Med Inform Decis Mak. 2018;18(01):95. Doi: 10.1186/s12911-018-0705-8 https://doi.org/10.1186/s12911-018-0705-...	Cross-sectional	Women who were pregnant or gave birth to a baby within six months of the first scheduled focus group	13	The app includes syncing with a newer © Fitbit device, the Charge 2 fitness tracker, which offers sleep, exercise, and diet tracking, as well as daily step counts, as well as mental health and mindfulness techniques that are complemented by content from the application.
Fantinelli et al. (2019)⁴³43 Fantinelli S, Marchetti D, Verrocchio MC, Franzago M, Fulcheri M, Vitacolonna E. Assessment of psychological dimensions in telemedicine care for gestational diabetes mellitus: a systematic review of qualitative and quantitative studies. Front Psychol. 2019;10:153–168. Doi: 10.3389/fpsyg.2019.00153 https://doi.org/10.3389/fpsyg.2019.00153...	Revision	Telemedicine for Gestational Diabetes Mellitus: an assessment of the psychological dimensions	13	Telemedicine
Hantsoo et al. (2018)⁴⁴44 Hantsoo L, Criniti S, Khan A, et al. A mobile application for monitoring and management of depressed mood in a vulnerable pregnant population. Psychiatr Serv. 2018;69(01):104–107. Doi: 10.1176/appi.ps.201600582 https://doi.org/10.1176/appi.ps.20160058...	Longitudinal	Pregnant women with depressive symptoms (PHQ-9 ≥ 5) at < 32 weeks of gestation	72	A mood tracking and alerting mobile app to improve mental health care delivery in a high-risk obstetric population.
Sondaal et al. (2016)²⁰20 Sondaal SF, Browne JL, Amoakoh-Coleman M, et al. Assessing the effect of mHealth interventions in improving maternal and neonatal care in low and middle-income countries: a systematic review. PLoS One. 2016;11(05):e0154664	Cross-sectional	1) Pregnant women 2) Pregnant women with HIV	1) 61 2) 40	Unidirectional text messaging
Snaith et al. (2014)⁴⁵45 Snaith VJ, Hewison J, Steen IN, Robson SC. Antenatal telephone support intervention with and without uterine artery Doppler screening for low risk nulliparous women: a randomised controlled trial. BMC Pregnancy Childbirth. 2014;14:121. Doi: 10.1186/1471-2393-14-121 https://doi.org/10.1186/1471-2393-14-121...	Longitudinal	Low-risk nulliparous pregnant women	840	The women received a telephone support intervention

Categories	Strategy	Count	Percentage	Total
Cognitive behavioral therapy techniques and methods				44.12%
	Humor records	5	7.35%
	Relaxation and stress reduction techniques	4	5.88%
	Meditation	3	4.41%
	Guided discovery	3	4.41%
	Exercise not specified	3	4.41%
	Psychoeducation	3	4.41%
	Sleep hygiene	2	2.94%
	Mindfulness	1	1.47%
	Feedback/ encouragement messages	1	1.47%
	Behavior activation	1	1.47%
	Problem resolution	1	1.47%
	Journaling and Thought Records	1	1.47%
	Positive activity scheduling	1	1.47%
	unspecified self-care	1	1.47%
Social support				14.71%
	General social support	3	4.41%
	Optional exercises for partners	2	2.94%
	Support groups	1	1.47%
	Facilitated health services	1	1.47%
	Reminders to events, and appointments	1	1.47%
	Contact the practitioners	1	1.47%
	Experience reports	1	1.47%
Mother-baby Link				2.94%
	Connecting to the bay in the womb	1	1.47%
	Music listening	1	1.47%
Non-psychological aspects				23.53%
	Healthy diet	4	5.88%
	Active life	3	4.41%
	General prenatal information	2	2.94%
	Infectious disease	1	1.47%
	Fetal development	1	1.47%
	Physical changes	1	1.47%
	Orientation for medical procedures	1	1.47%
	Glucose level monitoring	1	1.47%
	General postnatal information	1	1.47%
	Breastfeeding	1	1.47%
Substance abuse				4.41%
	Alcohol	1	1.47%
	Tobacco	1	1.4 7%
	Other substances	1	1.47%
Not cited		5	7.35%	7.35%
Not applicable		2	2.94%	2.94%
Total		68	100%	100%

Pathologies	Frequency	Percentage
Depression	12	40.0
Anxiety	1	3.3
Diabetes	1	3.3
Stress	1	3.3
High risk pregnancy	1	3.3
HIV	1	3.3
Pre-term birth	1	3.3
Tobacco use	1	3.3
Not applicable	11	36.7
Total	30	100.0

[1] Address for correspondence Laís Lage de Carvalho, MSc, Av. dos Andradas, 731, Morro da Glória, Juiz de Fora, MG, Brazil, CEP: 36036-000, Brazil (e-mail: laislagecarvalho@gmail.com).

Brasil

Brasil

Technologies Applied to the Mental Health Care of Pregnant Women: A Systematic Literature Review

Tecnologias aplicadas aos cuidados em saúde mental de grávidas: revisão sistemática da literatura

Abstract

Objective:

Methods:

Results:

Conclusion: