Exploring digital health interventions for pregnant women at high risk for pre-eclampsia and eclampsia in low-income and-middle-income countries: a scoping review

OBJECTIVE: To explore digital health interventions that have been used to support pregnant women at high risk for pre-eclampsia/eclampsia (HRPE/E) in low-income and middle-income countries (LMICs). DESIGN: Scoping review. DATA SOURCE: EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were searched between 1 January 2000 and 20 October 2020. ELIGIBILITY CRITERIA: The review included original research studies that were published in English, involved pregnant women at HRPE/E and implemented digital health interventions for PE/E in LMICs. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently completed the data extraction for each of the 19 final articles. An inductive approach was used to thematically organise and summarise the results from the included articles. RESULTS: A total of 19 publications describing 7 unique studies and 9 different digital health interventions were included. Most studies were conducted in South Asia and sub-Saharan Africa (n=16). Of nine unique digital health interventions, two served the purpose of predicting risk for adverse maternal health outcomes while seven focused on monitoring high-risk pregnant women for PE/E. Both of these purposes used mobile phone applications as interface to facilitate data collection, decision making, and communication between health workers and pregnant women. The review identified key functions of interventions including data collection, prediction of adverse maternal outcomes, integrated diagnostic and clinical decision support, and personal health tracking. The review reported three major outcomes: maternal health outcomes including maternal and neonatal morbidity and mortality (n=4); usability and acceptability including ease-of-use, and perceived usefulness, (n=5); and intervention feasibility and fidelity including accuracy of device, and intervention implementation (n=7). CONCLUSION: Although the current evidence base shows some potential for the use of digital health interventions for PE/E, more prospective experimental and longitudinal studies are needed prior to recommending the use of digital health interventions for PE/E.