Journal articles on the topic 'Pregnancy applications (apps)'

Background Maternal and child health (MCH)–related mobile apps are becoming increasingly popular among pregnant women; however, few apps have demonstrated that they lead to improvements in pregnancy outcomes. Objective This study aims to investigate the use of MCH apps among pregnant women in China and explore associations with pregnancy outcomes. Methods A retrospective study was conducted at 6 MCH hospitals in northern China. Women who delivered a singleton baby at >28 weeks’ gestation at the study hospitals were sequentially recruited from postnatal wards from October 2017 to January 2018. Information was collected on the women’s self-reported MCH app use during their pregnancy, along with clinical outcomes. Women were categorized as nonusers of MCH apps and users (further divided into intermittent users and continuous users). The primary outcome was a composite adverse pregnancy outcome (CAPO) comprising preterm birth, birth weight <2500 g, birth defects, stillbirth, and neonatal asphyxia. The association between app use and CAPO was explored using multivariable logistic analysis. Results The 1850 participants reported using 127 different MCH apps during pregnancy. App use frequency was reported as never, 24.7% (457/1850); intermittent, 47.4% (876/1850); and continuous, 27.9% (517/1850). Among app users, the most common reasons for app use were health education (1393/1393, 100%), self-monitoring (755/1393, 54.2%), and antenatal appointment reminders (602/1393, 43.2%). Nonusers were older, with fewer years of education, lower incomes, and higher parity (P<.01). No association was found between any app use and CAPO (6.8% in nonusers compared with 6.3% in any app users; odds ratio 0.77, 95% CI 0.48-1.25). Conclusions Women in China access a large number of different MCH apps, with social disparities in access and frequency of use. Any app use was not found to be associated with improved pregnancy outcomes, highlighting the need for rigorous development and testing of apps before recommendation for use in clinical settings.

Prenatal nutrition is a key predictor of early-life development. However, despite mass campaigns to stimulate healthy nutrition during pregnancy, the diet of Dutch pregnant women is often suboptimal. Innovative technologies offer an opportunity to develop tailored tools, which resulted in the release of various apps on healthy nutrition during pregnancy. As midwives act as primary contact for Dutch pregnant women, the goal was to explore the experiences and perspectives of midwives on (1) nutritional counselling during pregnancy, and (2) nutritional mHealth apps to support midwifery care. Analyses of eleven in-depth interviews indicated that nutritional counselling involved the referral to websites, a brochure, and an app developed by the Dutch Nutrition Centre. Midwives were aware of the existence of other nutritional mHealth apps but felt uncertain about their trustworthiness. Nevertheless, midwives were open towards the implementation of new tools providing that these are trustworthy, accessible, user-friendly, personalised, scientifically sound, and contain easy-digestible information. Midwives stressed the need for guidelines for professionals on the implementation of new tools. Involving midwives early-on in the development of future nutritional mHealth apps may facilitate better alignment with the needs and preferences of end-users and professionals, and thus increase the likelihood of successful implementation in midwifery practice.

Smartphones are increasingly entangled with the most intimate areas of everyday life, providing possibilities for the continued expansion of digital self-tracking technologies. Within this context, the development of smartphone applications targeted at female reproductive health are offering novel forms and practices of knowledge production about reproductive bodies and processes. This article presents empirical research from the United Kingdom on women’s use of fertility tracking applications, known more generally as fertility apps, while trying to conceive. Drawing on material from interviews with women who had experience of using fertility apps, I demonstrate the significance of this particular form of fertility tracking for the embodied shift from pregnancy prevention to actively facilitating pregnancy, participants’ sense of self and identity and how they perceived the reproductive potentiality of their bodies. I argue that fertility apps are significantly involved in making fertility cycles known and thus configuring the pre-pregnant reproductive body.

This study aims to examine the characteristics of pregnant women who used and intended to use mobile applications (apps) for health and parenting information. We used data from a randomised controlled trial, Communicating Healthy Beginnings Advice by Telephone (CHAT), conducted in Australia. Telephone surveys were conducted in 2017 to collect information on women’s demographic characteristics, sources of health and parenting information and willingness to use mobile apps. Multiple logistic regression was used to examine the associations of women’s socio-demographic backgrounds, their mobile apps usage and their willingness to use such apps. Data included 1155 pregnant women in their third trimester. Women from culturally and linguistically diverse backgrounds and with lower income appeared to have lower uptake of mobile apps despite high ownership of smart devices. Development of evidence-based and culturally-adapted mobile apps represent an important opportunity for healthcare providers to optimise maternal and birth outcomes.

ABSTRACT Background Mobile applications (apps) are increasingly used in clinical settings, particularly among resident physicians. Apps available to patients and physicians are rapidly expanding. Objective We aimed to describe obstetrics and gynecology (ob-gyn) residents' use of and attitudes toward ob-gyn–related mobile apps. Methods We conducted a cross-sectional survey of residents at all 19 California ob-gyn programs using a web-based questionnaire. Responses were analyzed using descriptive and chi-square statistics. Results Of 386 residents contacted, 197 (51%) completed the survey. All respondents owned mobile devices (100% smartphone, 74% tablet), and 93% used apps in the clinical setting. Commonly used ob-gyn–related apps were pregnancy wheels (84%), cervical cancer screening algorithms (68%), and contraceptive eligibility guidelines (47%). Only 53% of respondents recommended apps to patients, with many reporting not being aware of appropriate apps. Sixty-two percent of respondents used apps for learning, but only 3 ob-gyn–specific apps were mentioned. Most chose apps based on recommendations from other residents. Residents viewed mobile technology as an important clinical tool (92%) that improves efficiency (89%). App use did not differ by gender, age, or postgraduate year. Conclusions Mobile technology and ob-gyn–related app use are widely used among California ob-gyn residents, who feel that apps enhance their ability to care for patients. Context of app use varies, with most residents using apps during clinical care, but only half recommending apps to patients. Recommendations from other residents are the common resource for discovering new apps, suggesting a need for more formal guidance on finding and evaluating apps.

Mobile applications (“apps”) designed for sexual health education have the potential to reach teens and young adults that are hard to reach through traditional platforms; however, little is known about availability of these apps and their adherence to existing guidelines. Following a search on the two major app stores, data from 2,693 apps were analyzed. Only 697 (25%) addressed sexual health, and only 15 (1%) of apps met inclusion criteria for comprehensive programs and their content was further analyzed. The content of most of these apps narrowly focused on sexually transmitted infections and pregnancy prevention and lacked information on puberty, sexual identity, and personal safety. Theoretically grounded strategies including self-efficacy and modeling behavior to strengthen behavior change efforts were largely absent. Last, we identified significant shortcomings in the literate design of these apps, including limited use of interactive features, such as videos, quizzes, or games. These findings indicate that the potential of apps as sexual health promotion tools has not yet been fully realized. We outline recommendations for developing theory- and evidence-based sexual education apps and provide suggestions for health educators on how to select relevant apps when working for youth.

Background: Pregnant women with high risk need education and information along with the pregnancy. Information support helps them to feel ready and confident to go through the delivery. Sources of Information that can be accessed during pregnancy include websites regarding pregnancy, smartphone applications, magazines, and books. One of the efforts to increase pregnant women's readiness to face childbirth is by providing Family Centered Maternity Care (FCMC) education through Mobile Applications.Objective: This study aims to develop and test the FCMC mobile application's effectiveness to help pregnant women's readiness with a high risk of childbirth.Method: This study employed Research & Development consisting of 4 stages, namely Literature Study, Development Stage, Validity Expert, and Trial.Results: FCMC Mobile application has been created with nine features, starting from pregnancy features to delivery preparation. The trial results showed that the application effectively increased pregnant women's readiness to face childbirth (p <0.001).Conclusion: The FCMC is a form of midwifery technology that makes it easier for health workers to educate pregnant mothers, especially mothers with high-risk pregnancies. By applying the apps, pregnant women can prepare for the process before childbirth in physical preparation, psychological preparation, financial preparation, cultural preparation, home preparation, and delivery preparation.

Background: Pregnancy has become the main constituent for women to become overweight or obese during the postpartum phase. This could lead women to suffer from postpartum depression as well. Information technology (IT) has become more prevalent in the healthcare industry. It offers patients the opportunity to manage their health conditions via the use of several applications, one being the mHealth applications. Objective: The main purpose of this study is to experiment and understand the effects the mHealth applications (i.e., fitness and nutrition applications) have on the body mass index (BMI) and depression levels amongst postpartum women. Methods: Online questionnaires were sent to postpartum women within one year after their pregnancy, of which 819 completed questionnaires were returned. The frequency of the mHealth applications usage was categorized into daily, weekly, rarely and never streams. Therefore, the frequency of use of the mHealth applications for BMI and depression levels was analyzed based on the available statistical data. Descriptive statistics, ANOVA, and Dunnet tests were applied to analyze the experimental data. Results: Out of 819 respondents, 37.9% and 42.1% of them were overweight and obese, respectively. Almost 32.9% of the respondents were likely depressed, and 45.6% were at an increased risk. This study reports that only 23.4% and 28.6% of respondents never used the fitness and nutrition applications. The impact of the frequency of using the fitness applications on BMI and depression levels was obvious. This means that with the increased use of the fitness applications, there was also a significant effect in maintaining and decreasing the BMI and depression levels amongst Malaysians postpartum women. However, from the data of weekly and daily use of fitness applications, we found that the contribution toward the BMI and depression levels was high (p = 0.000). However, nutrition applications amongst the users were not significant within the main variables (p > 0.05). From the Dunnet test, the significance of using the fitness applications within the depression levels started from daily usage, whereas for BMI, it started from weekly usage. Conclusion: The efficiency of the fitness applications toward the BMI and depression levels has been proven in this research work. While nutrition applications did not affect the BMI and depression levels, some of the respondents were still categorized as weekly and daily users. Thus, the improvements in BMI and depression levels are associated with the types of mHealth app that had been used.

Background. As pregnant mothers increasingly engage in shared decision making regarding prenatal decisions, such as induction of labor, the patient’s level of activation may influence pregnancy outcomes. One potential tool to increase patient activation in the clinical setting is mobile applications. However, research is limited in comparing mobile apps with other modalities of patient education and engagement tools. Aim. This study was designed to test the effectiveness of a mobile app as a replacement for a spiral notebook guide as a patient education and engagement tool in the prenatal clinical setting. Method. This randomized controlled trial was conducted in the Women’s Health Clinic and Family Health Clinic of three hospitals. Repeated-measures analysis of covariance was used to test intervention effects in the study sample of 205 patients. Results. Mothers used a mobile app interface to more frequently record information about their pregnancy; however, across time, mothers using a mobile app reported a significant decrease in patient activation. Discussion. The unexpected negative effects in the group of patients randomized to the mobile app prompt these authors to recommend that health systems pause before distributing their own version of mobile apps that may decrease patient activation. Conclusion. Mobile apps can be inherently empowering and engaging, but how a system encourages their use may ultimately determine their adoption and success.

BackgroundFertility awareness based (FAB) contraceptive mobile applications (apps) rely on women logging their menstrual cycle data to predict non-fertile days. Paid social media advertisements for these apps have led to hundreds of thousands of downloads. This rapidly expanding market lacks quality assurance, reflective of wider issues surrounding innovation versus regulation of digital health interventions.AimTo present the results of a literature review carried out to bring together data on FAB contraceptive apps, to better understand the validity of evidence for their use as contraceptive methods. This is combined with context on the climate of advertising and regulation, to illustrate the challenges of innovation in the digital age.MethodDatabases Medline and Embase were searched according to the strategy: ‘fertility-based awareness AND app*’. Eight articles were included in the final thematic analysis.ResultsThis study found apps being used for contraception that were not developed for this purpose; apps inaccurately reporting reliability for preventing pregnancy; there is a need for further training for women using FAB contraceptive apps; and there are limitations of current evidence base and challenges to improving this. In the context of poor regulation and advertising loop holes there is significant risk of misleading users of FAB contraceptive apps.ConclusionThe limited evidence on FAB contraceptive apps should be applied to the public with caution. Incongruities between women’s understanding and expectations of FAB apps compared to reality demonstrate the need for robust regulation around paid advertising, issues echoed elsewhere with other digital health interventions.

Introduction: The pregnancy health app is a mobile application that caters to the highly specific health interests of pregnant women who are undergoing a stage of pregnancy. These applications are helpful in tracking the ovulation period, symptoms of pregnancy, development of a baby throughout the gestation period, and care of the pregnant lady till birth Objectives: To assess the existing knowledge regarding the pregnancy health app, evaluation of the effectiveness of pamphlet regarding the same and determination of the association between post-test knowledge scores with the selected demographic variables among the late adolescent girls from selected degree colleges in Bangalore. Methodology: The research approach was an evaluative approach; the research design was quasi-experimental design and the setting was RR Advanced Studies College. The sample of this study comprised 60 final-year girls. Purpose’s sampling technique was used to draw samples for the study. Results: In the present study, majority (51.7%) of the late adolescent girls were found to have inadequate knowledge, 29.9.% of the group had moderately adequate knowledge, while 18.3%were found to have good knowledge. However, in the ‘post test’, 100% of the group members had adequate knowledge. None of them had either moderately adequate or inadequate knowledge. The knowledge was significantly associated with demographic variables and the type of diet of the late adolescent girls which is greater than the table value at respective df. Conclusion: Pregnancy health apps proved to be beneficial to understand the nutrition requirements and monitoring the overall health during the pregnancy period.

Information giving and education in pregnancy using a traditional classroom and an online education (group messaging apps)Background: The efforts to improve health during pregnancy are by using a traditional classes facility to provide knowledge and information on health during pregnancy. Most community has not known some online applications that can use at positive things as suggestions for learning or health education purposes. Researchers want to innovate with social media users: WhatsApp groups to provide information and knowledge.Purpose: To analyze the differences in knowledge, activeness, motivation and behavior when information and education in pregnancy using a traditional classroom and an online education (group messaging apps).Method: Quantitative research with the design method of quasi-experiment by pretest-posttest divided in two groups. The population was Pregnant women's with the sample of 30 participants comprising 15 participants in the control group and 15 participants in the intervention group. Location in Sidenreng Rappang regency, south Sulawesi province, Indonesia.Results: In an online education (group messaging apps) group, the variables of knowledge, activeness, motivation and action influence the use of the class of pregnant women and WhatsApp media to educate problems around pregnancy, while in the control group the results of the variables of knowledge, activeness, and motivation influence class utilization pregnant women to educate problems. Meanwhile, the action variable has no effect.In order to further increase the campaign on the importance of the participation of pregnant women in implementing pregnant women classes and be able to do it regularly by involving cadres and their familiesKeywords: Information giving; Education; Pregnancy; Traditional classroom; Online education (group messaging apps)Pendahuluan : Salah satu upaya pemerintah yaitu pemberdayaan masyarakat dengan penyelenggaraan kelas ibu hamil. Fenomena masyarakat saat ini menganggap media sosial berpengaruh negative. Namun jika pemanfaatan media sosial diarahkan kehal yang positif seperti halnya penelitian ini ingin membuat inovasi dengan pemanfaat media sosial yaitu membuat group whatsapp sebagai sarana informasi, pelayanan kepada masyarakat. sehingga akan sangat besar manfaatnya kepada masyarakat khususnya ibu hamil.Tujuan: Menganalisa perbedaaan pengetahuan, keaktifan, motivasi dan tindakan ibu pada kelompok kelas ibu hamil dan aplikasi media whatsappMetode: Penelitian kuantitatif dengan metode desain quasi experiment dengan rancangan penelitian pretest- posttest two group design. Populasinya para ibu hamil dengan sampel 30 partisipan yang dibagi 2 kelompok terdiri dari 15 partisipan pada kelompok kontrol dan 15 partisipan pada kelompok intervensi. Lokasi di Kabupaten Sidenreng Rappang, Provinsi Sulawesi Selatan, Indonesia.Hasil : Pada kelompok kasus didapatakan hasil variabel pengetahuan, keaktifan , motivasi dan tindakan berpengaruh terhadap pemanfaatan kelas ibu hamil dan media whatsapp sebagai sarana edukasi masalah seputar kehamilan, sedangkan pada kelompok kontrol didapatakan hasil variabel pengetahuan, keaktifan , dan motivasi berpengaruh terhadap pemanfaatan kelas ibu hamil sebagai sarana edukasi masalah seputar kehamilan.

Abstract Objective Cultural and health service obstacles affect the quality of pregnancy care that women from vulnerable populations receive. Using a participatory design approach, the Stress in Pregnancy: Improving Results with Interactive Technology group developed specifications for a suite of eHealth applications to improve the quality of perinatal mental health care. Materials and Methods We established a longitudinal participatory design group consisting of low-income women with a history of antenatal depression, their prenatal providers, mental health specialists, an app developer, and researchers. The group met 20 times over 24 months. Applications were designed using rapid prototyping. Meetings were documented using field notes. Results and Discussion The group achieved high levels of continuity and engagement. Three apps were developed by the group: an app to support high-risk women after discharge from hospital, a screening tool for depression, and a patient decision aid for supporting treatment choice. Conclusion Longitudinal participatory design groups are a promising, highly feasible approach to developing technology for underserved populations.

Abstract Smartphone applications (apps) might be able to reach pregnant smokers who do not engage with face-to-face support. However, we do not know how far pregnant smokers will engage with smoking cessation apps or what components are likely to be effective. This study aimed to assess pregnant smokers’ engagement with the SmokeFree Baby app (v1) and to assess the short-term efficacy of selected components (“modules”) for smoking abstinence. Positive outcomes would provide a basis for further development and evaluation. SmokeFree Baby was developed drawing on behavior change theories and relevant evidence. Pregnant smokers (18+) who were interested in quitting and set a quit date were recruited. Following multiphase optimization development principles, participants (N = 565) were randomly allocated to one of 32 (2 × 2 × 2 × 2 × 2) experimental groups in a full factorial design to evaluate five modules (each in minimal and full version: identity, health information, stress management, face-to-face support, and behavioral substitution). Measures of engagement included duration and frequency of engagement with the app. Smoking abstinence was measured by self-reported number of smoke-free days up to 4 weeks from the quit date. Participants engaged with the app for a mean of 4.5 days (SD = 8.5) and logged in a mean of 2.9 times (SD = 3.1). Main effects of the modules on the number of smoke-free days were not statistically significant (identity: p = .782, health information: p = .905, stress management: p = .103, face-to-face support: p = .397, behavioral substitution: p = .945). Despite systematic development and usability testing, engagement with SmokeFree Baby (v1) was low and the app did not appear to increase smoking abstinence during pregnancy.

Background Mobile health (mHealth) technologies, such as wearable sensors, smart health devices, and mobile apps, that are capable of supporting pregnancy care are emerging. Although mHealth could be used to facilitate the tracking of health changes during pregnancy, challenges remain in data collection compliance and technology engagement among pregnant women. Understanding the interests, preferences, and requirements of pregnant women and those of clinicians is needed when designing and introducing mHealth solutions for supporting pregnant women’s monitoring of health and risk factors throughout their pregnancy journey. Objective This study aims to understand clinicians’ and pregnant women’s perceptions on the potential use of mHealth, including factors that may influence their engagement with mHealth technologies and the implications for technology design and implementation. Methods A qualitative study using semistructured interviews was conducted with 4 pregnant women, 4 postnatal women, and 13 clinicians working in perinatal care. Results Clinicians perceived the potential benefit of mHealth in supporting different levels of health and well-being monitoring, risk assessment, and care provision in pregnancy care. Most pregnant and postnatal female participants were open to the use of wearables and health monitoring devices and were more likely to use these technologies if they knew that clinicians were monitoring their data. Although it was acknowledged that some pregnancy-related medical conditions are suitable for an mHealth model of remote monitoring, the clinical and technical challenges in the introduction of mHealth for pregnancy care were also identified. Incorporating appropriate health and well-being measures, intelligently detecting any abnormalities, and providing tailored information for pregnant women were the critical aspects, whereas usability and data privacy were among the main concerns of the participants. Moreover, this study highlighted the challenges of engaging pregnant women in longitudinal mHealth monitoring, the additional work required for clinicians to monitor the data, and the need for an evidence-based technical solution. Conclusions Clinical, technical, and practical factors associated with the use of mHealth to monitor health and well-being in pregnant women need to be considered during the design and feasibility evaluation stages. Technical solutions and appropriate strategies for motivating pregnant women are critical to supporting their long-term data collection compliance and engagement with mHealth technology during pregnancy.

Objective To evaluate the validity and acceptability of the Ava bracelet for collecting heart rate, sleep, mood, and physical activity data among reproductive-aged women (pregnant and nonpregnant) under free-living conditions. Methods Thirty-three participants wore the Ava bracelet on their non-dominant wrist and reported mood and physical activity in the Ava mobile application for seven nights. Criterion validity was determined by comparing the Ava bracelet heart rate and sleep duration measures to criterion measures from the Polar chest strap and ActiGraph GTX3 + accelerometer. Construct validity was determined by comparing self-report measures and the heart rate variability ratio collected in the Ava mobile application to previously validated measures. Acceptability was evaluated using the modified Acceptability of Health Apps among Adolescents Scale. Results Mean absolute percentage error was 11.4% for heart rate and 8.5% for sleep duration. There was no meaningful difference between the Ava bracelet, ActiGraph, and construct a measure of sleep quality. Compared to construct measures, Ava bracelet heart rate variability had a significant low negative correlation ( r:−0.28), mood had a significant low positive correlation ( r : 0.39), and physical activity level had a significant low ( rlevel of physical activity: 0.56) to moderate positive correlation ( rMET−minutes/week: 0.71). The acceptability of the Ava bracelet was high for fertility and low for pregnancy tracking. Conclusion Preliminary evidence suggests the Ava bracelet and mobile application estimates of sleep and heart rate are not equivalent to criterion measures in free-living conditions. Further research is needed to establish its utility for collecting prospective, subjective data throughout periods of preconception and pregnancy.

Unhealthy weight gain and retention during pregnancy and postpartum is detrimental to mother and child. Although various barriers limit the capacity for perinatal health care providers (PHCPs) to offer healthy lifestyle counselling, they could guide women to appropriate online resources. This paper presents a project designed to provide online information to promote healthy lifestyles in the perinatal period. Focus groups or interviews were held with 116 perinatal women and 76 PHCPs to determine what online information perinatal women and PHCPs want, in what form, and how best it should be presented. The results indicated that women wanted smartphone applications (apps) linked to trustworthy websites containing short answers to everyday concerns; information on local support services; and personalised tools to assess their nutrition, fitness and weight. Suggestions for improvement in these lifestyle areas should be practical and tailored to the developmental stage of their child. PHCPs wanted evidence-based, practical information, presented in a simple, engaging, interactive form. The outcome was a clinically endorsed website and app that health professionals could recommend. Preliminary evaluation showed that 10.5% of pregnant women in Western Australia signed up to the app. Use of the app appeared to be equitable across urban and rural areas of low to middle socioeconomic status.

Background Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged women. Mobile health (mHealth) apps with game and social support elements seem promising to support smoking cessation. Objective This study aims to describe the user-centered design and usability evaluation of Kindle, an mHealth app with game and social support elements, to support disadvantaged young women during and after pregnancy through the first stages of smoking cessation. Methods Disadvantaged women (n=9), members of their social networks (n=4), and nurses supporting these women (n=51) were informants throughout the iterative prototype development of Kindle according to the International Organization for Standardization 9241-11:2018. Specific phases included understanding the context of use through secondary analysis of qualitative interview data (phase 1), establishing the user and organizational requirements (phase 2), production of design solutions (phase 3), and usability inspection of the prototype through a heuristic evaluation (3 experts) along with user testing by a think aloud method (5 disadvantaged women and 5 nurses; phase 4). Usability problems were categorized according to the principles of the Healthcare Information and Management Systems Society. Results Phase 1 resulted in an understanding of the VoorZorg program and the needs of VoorZorg nurses and clients (eg, focus on early stages of change and building new supportive networks to aid clients in smoking cessation). In phase 2, we established requirements (n=22; eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring at early stages of change in smoking cessation). Phase 3 resulted in a prototype of Kindle, combining the interface for nurses and clients, including the following functionalities: personal goal setting with earning points; secured chat function between nurses and other clients; and tips, diary, and profile creation. The heuristic evaluation and thinking aloud method in phase 4 revealed 78 usability problems in the interfaces. Most usability problems concerned simplicity (eg, unclear clickable button) and naturalness (eg, unclear icon). Conclusions The user-centered design and usability testing of the mHealth app Kindle yielded useful insights. The involvement of end users, specifically socioeconomically disadvantaged women during and after their pregnancy, resulted in a prototype that met their needs and requirements (eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring to the early stages of change in smoking cessation) to achieve readiness for smoking cessation. Moreover, the usability evaluation by end users and experts revealed unique usability problems for this population. These insights allow for further optimization of Kindle and encourage future studies to engage disadvantaged populations in all phases of mHealth intervention design and usability testing.

Pregnant women are increasingly using mobile apps as a source of supplemental information. These pregnancy-related mobile apps present women with contradictory risk recommendations without the medical research to support their claims. The content analysis describes a sample of the pregnancy-tracking mobile application environment open to pregnant mothers and uses the social amplification of risk framework. Within this framework, written recommendations and the presence or absence of corresponding citations on controversial topics in pregnancy were recorded and risk was coded as received contradictory information. Of the 48 pregnancy-tracking mobile apps downloaded, 11 (22.9%) were associated with either a seller or a developer with a medical background. Only 24 of 48 (50.0%) of the apps cited a source, such as a health professional agency or peer-reviewed research journal for health recommendations. In our results, we show a sampling of contradictory risk recommendations made by mobile apps that cite or do not cite their source for that recommendation on 8 controversial topics in pregnancy. Findings suggest providers treating pregnant women must be aware of the complex information environment and help them navigate the risk information they encounter on some of the most popular pregnancy-tracking mobile apps.

Background Women consult information in mobile apps (apps) during pregnancy, and even obstetrics specialists highlight that pregnancy is the ideal moment for the use of apps as consultation sources. However, the high number of apps designed for pregnancy requires a careful assessment to determine their suitability before recommendation. Objective The aim of this study is to identify the apps available in Spanish that can be recommended based on their content, behavior change techniques (BCTs), and quality as a complementary tool during pregnancy. Methods A systematic search on app stores to identify apps was performed in the Apple App Store and Google Play with the subject term “pregnancy.” The apps meeting the following criteria were chosen: pregnancy-related content, free, and available in Spanish. An app was excluded if it was classified as a game or entertainment and thus lacking an educational or health aim and if it did not target the population under study. The selected apps were downloaded, and their quality was assessed using the Mobile Application Rating Scale (MARS), with the BCTs included evaluated using the BCT taxonomy version 1 and its content. Results A total of 457 apps were identified, 25 of which were downloaded for assessment (5.6%). The median for objective and subjective quality was 2.94 (IQR 2.71-3.46) and 1.75 (IQR 1.25-2.25), respectively. Regarding content, the median of topics included in the apps was 23 (IQR 16-23), with weight gain, nutrition, fetal development, and physical activity being the most common. The median number of BCTs was 12 (IQR 0.5-3.5). The most frequently identified BCTs in the apps were “Self-Monitoring of Outcomes,” followed by “Goal Behavior” and “Instructions.” Statistically significant correlations were observed between objective quality and content (ρ=0.624; P=.001), subjective quality and content (ρ=0.638; P=.001), objective quality and BCTs (ρ=0.672; P<.001), subjective quality and BCTs (ρ=0.623; P<.001), and BCTs and content (ρ=0.580; P=.002). Conclusions The results of this study suggest that only a small percentage of free pregnancy apps available in Spanish should be recommended. The apps with the best MARS scores were those that addressed a higher number of topics and included a higher number of BCTs. Those with the best content and quality, and a higher number of BCTs included could be recommended by health professionals.

Objective To identify health literacy issues when providing maternity care to culturally and linguistically diverse (CALD) women, and the strategies needed for health professionals to collaboratively address these issues. Methods A qualitative case study design was undertaken at one large metropolitan Australian hospital serving a highly CALD population. Semistructured interviews were conducted with a range of maternity healthcare staff. The data were analysed thematically. The study is informed by a framework of cultural competence education interventions for health professionals and a health literacy framework. Results Eighteen clinicians participated in the interviews (seven midwives, five obstetricians, five physiotherapists, one social worker, and one occupational therapist). Emergent themes of health literacy-related issues were: patient-based factors (communication and cultural barriers, access issues); provider-based factors (time constraints, interpreter issues); and enablers (cultural awareness among staff, technology). Conclusions There are significant health literacy and systemic issues affecting the hospital’s provision of maternity care for CALD women. These findings, mapped onto the four domains of cultural competence education interventions will inform a technology-delivered health literacy intervention for CALD maternity patients. This approach may be applied to other culturally diverse healthcare settings to foster patient health literacy. What is known about the topic? There are health inequities for pregnant women of culturally and linguistically diverse (CALD) backgrounds. Low health literacy compounded by language and cultural factors contribute to these inequities and access to interpreters in pregnancy care remains an ongoing issue. Pregnancy smart phone applications are a popular source of health information for pregnant women yet these apps are not tailored for CALD women nor are they part of a regulated industry. What does this paper add? This paper provides clinician and language service staff perspectives on key health literacy issues that are both patient-based and provider-based. This research confirms that the complex interplay of social and practical factors contributes to and perpetuates low health literacy, creating barriers to health access; it also highlights several enablers for increasing CALD health literacy and access. These include greater health practitioner awareness and accommodation of CALD women’s needs and the provision of culturally and linguistically appropriate eHealth resources. What are the implications for practitioners? eHealth resources are emerging as valuable enabling tools to address the health literacy and information needs of pregnant women. However, these resources need to be used adjunctively with health practitioner communication. Both resource developers and health practitioners need to understand issues affecting CALD patients and their needs. Developers need to consider how the resource addresses these needs. Training of health professionals about culture-specific issues may help to enhance communication with, and therefore health literacy among, individual cultural groups. Further, formalised language and interpreting training of bi- or multilingual health professionals is advised to ensure that they are able to interpret to a professional standard when called on to do so.

Background Despite the availability of thousands of health apps worldwide, when considering those addressing children’s first 1000 days of life, most apps fail to consider the continuity between the prenatal and postnatal stages, and their joint impact on maternal and child health. The reliability, quality, and effectiveness of these apps are largely unknown, and the provided content seems questionable in terms of completeness, updating, and trustworthiness. Objective This study evaluates available Italian pregnancy and postnatal care apps to highlight the main gaps to be overcome and the resulting future challenges to be met in this mobile health–related field. Methods A systematic search was conducted on the Apple App Store and Google Play Store, and basic information was collected for all identified apps. After deduplication and further selection based on the exclusion criteria, an in-depth analysis of each app was performed by two researchers independently. A 71-item six-domain questionnaire about the desirable features of apps was used to assess information, functionalities, and technical features, while the Mobile Application Rating Scale (MARS) was employed for app quality evaluation. Results From an initial sample of 684 apps, 22 were deeply analyzed. Most apps did not fulfill the expectations, as just one achieved 50% of all desirable aspects. Postnatal care and counselling for both the mother and child was the least accomplished domain. Moreover, the quality of app information was generally rated more negatively than the quality of their functionality and esthetic features. The lacking aspects were information about methods for postpartum family planning and birth spacing (1/22, 5%) and immunization (2/22, 9%). Conclusions The identified gaps could serve as a basis for designing and implementing increasingly high-quality, targeted, and effective apps for pregnancy and postnatal health care, which provide comprehensive, reliable, and evidence-based information, as well as appropriate esthetic and functional characteristics, with relevant implications in terms of maternal and newborn health prevention and promotion.

Abstract STUDY QUESTION To what extent does the use of mobile computing apps to track the menstrual cycle and the fertile window influence fecundability among women trying to conceive? SUMMARY ANSWER After adjusting for potential confounders, use of any of several different apps was associated with increased fecundability ranging from 12% to 20% per cycle of attempt. WHAT IS KNOWN ALREADY Many women are using mobile computing apps to track their menstrual cycle and the fertile window, including while trying to conceive. STUDY DESIGN, SIZE, DURATION The Pregnancy Study Online (PRESTO) is a North American prospective internet-based cohort of women who are aged 21–45 years, trying to conceive and not using contraception or fertility treatment at baseline. PARTICIPANTS/MATERIALS, SETTING, METHODS We restricted the analysis to 8363 women trying to conceive for no more than 6 months at baseline; the women were recruited from June 2013 through May 2019. Women completed questionnaires at baseline and every 2 months for up to 1 year. The main outcome was fecundability, i.e. the per-cycle probability of conception, which we assessed using self-reported data on time to pregnancy (confirmed by positive home pregnancy test) in menstrual cycles. On the baseline and follow-up questionnaires, women reported whether they used mobile computing apps to track their menstrual cycles (‘cycle apps’) and, if so, which one(s). We estimated fecundability ratios (FRs) for the use of cycle apps, adjusted for female age, race/ethnicity, prior pregnancy, BMI, income, current smoking, education, partner education, caffeine intake, use of hormonal contraceptives as the last method of contraception, hours of sleep per night, cycle regularity, use of prenatal supplements, marital status, intercourse frequency and history of subfertility. We also examined the impact of concurrent use of fertility indicators: basal body temperature, cervical fluid, cervix position and/or urine LH. MAIN RESULTS AND THE ROLE OF CHANCE Among 8363 women, 6077 (72.7%) were using one or more cycle apps at baseline. A total of 122 separate apps were reported by women. We designated five of these apps before analysis as more likely to be effective (Clue, Fertility Friend, Glow, Kindara, Ovia; hereafter referred to as ‘selected apps’). The use of any app at baseline was associated with 20% increased fecundability, with little difference between selected apps versus other apps (selected apps FR (95% CI): 1.20 (1.13, 1.28); all other apps 1.21 (1.13, 1.30)). In time-varying analyses, cycle app use was associated with 12–15% increased fecundability (selected apps FR (95% CI): 1.12 (1.04, 1.21); all other apps 1.15 (1.07, 1.24)). When apps were used at baseline with one or more fertility indicators, there was higher fecundability than without fertility indicators (selected apps with indicators FR (95% CI): 1.23 (1.14, 1.34) versus without indicators 1.17 (1.05, 1.30); other apps with indicators 1.30 (1.19, 1.43) versus without indicators 1.16 (1.06, 1.27)). In time-varying analyses, results were similar when stratified by time trying at study entry (&lt;3 vs. 3–6 cycles) or cycle regularity. For use of the selected apps, we observed higher fecundability among women with a history of subfertility: FR 1.33 (1.05–1.67). LIMITATIONS, REASONS FOR CAUTION Neither regularity nor intensity of app use was ascertained. The prospective time-varying assessment of app use was based on questionnaires completed every 2 months, which would not capture more frequent changes. Intercourse frequency was also reported retrospectively and we do not have data on timing of intercourse relative to the fertile window. Although we controlled for a wide range of covariates, we cannot exclude the possibility of residual confounding (e.g. choosing to use an app in this observational study may be a marker for unmeasured health habits promoting fecundability). Half of the women in the study received a free premium subscription for one of the apps (Fertility Friend), which may have increased the overall prevalence of app use in the time-varying analyses, but would not affect app use at baseline. Most women in the study were college educated, which may limit application of results to other populations. WIDER IMPLICATIONS OF THE FINDINGS Use of a cycle app, especially in combination with observation of one or more fertility indicators (basal body temperature, cervical fluid, cervix position and/or urine LH), may increase fecundability (per-cycle pregnancy probability) by about 12–20% for couples trying to conceive. We did not find consistent evidence of improved fecundability resulting from use of one specific app over another. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by grants, R21HD072326 and R01HD086742, from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA. In the last 3 years, Dr L.A.W. has served as a fibroid consultant for AbbVie.com. Dr L.A.W. has also received in-kind donations from Sandstone Diagnostics, Swiss Precision Diagnostics, FertilityFriend.com and Kindara.com for primary data collection and participant incentives in the PRESTO cohort. Dr J.B.S. reports personal fees from Swiss Precision Diagnostics, outside the submitted work. The remaining authors have nothing to declare. TRIAL REGISTRATION NUMBER N/A.

Chronic energy deficiency (CED) has a major impact on maternal health. Screening is carried out to prevent the risk of CED for the mother before and during pregnancy by measuring the upper arm circumference (MUAC). This study aims to explore, validate and analyze the sensitivity and specificity of the MUAC mobile application. his research is expected to help health cadres in measuring the MUAC of pregnant women. This study uses a mixed-method with a sequential exploratory strategy with a purposive sampling technique. Exploration was carried out on 3 nutritionists and 7 Posyandu cadres. Data collection was done using of in-depth interviews. The feasibility test was conducted on 5 informatics experts, 5 nutritionists and 30 Posyandu cadres using a questionnaire. Mobile apps sensitivity and specificity test LILA was performed on 37 pregnant women purposively and analyzed using Stata software. Mobile apps model exploration results MUAC for pregnant women consists of content, design, measurement techniques and accuracy. Expert test results and user tests show mobile apps MUAC pregnant women are valid and reliable. The results of the sensitivity test (91.2%) and specificity (33.3%). Mobile apps models MUAC for pregnant women was developed based on user needs. Mobile apps MUAC for pregnant women has very good sensitivity and poor specificity. Further research is required to conduct similar studies to obtain better sensitivity and specificity results.

In this work, the related risk factors and perinatal outcomes of pregnant women with gestational diabetes mellitus (GDM) were analyzed based on color Doppler ultrasound (CDU) diagnosis. Backpropagation (BP) algorithm-based CDU imaging algorithm (BPC) was constructed in this study and applied in CDU images of 80 pregnant women with GDM. Besides, amplitude and phase estimation (APES) and low-complexity adaptive beam (LCA) algorithms were introduced for comparison with BPC in turn. It was found that Dice similarity coefficient (96.44%), sensitivity (95.45%), and specificity (91.56%) of BPC were greater than those of APES (83.97%, 85.84%, 78.45%) and LCA (84.74%, 86.29%, 82.35%), while its running time (6.44 ± 1.39 s) was shorter than that of APES (11.87 ± 2.41 s) and LCA (13.76 ± 1.54 s) ( P < 0.05 ). Pregnant women in the experimental group (group B) were older than those in the control group (group A) ( P < 0.05 ). The pulsatility index (PI) and renal artery resistance index (RI) of fetuses in group B (0.95 ± 0.15) were higher than those of group A (0.57 ± 0.24) ( P < 0.05 ). In addition, pregnancy age, family history of hypertension, and abortion history were positively correlated with GDM ( P < 0.05 ). In conclusion, BPC could not only improve diagnosis accuracy in fetuses’ CDU images but also shorten calculation time. Pregnancy age, family history of hypertension, and abortion history were the related risk factors for GDM in pregnant women.

With a gigantic growth in internet and application usage, especially with the use of smartphones, ‘privacy' concerns reverberates and dealing with privacy issues from such an arena is a new task for many researchers. This wide usage of mobile application and internet opens up Pandora's box – ‘privacy concerns'. This paper tries to understand the privacy concern hovering among pregnant women. The study found that education, mHealth literacy, mobile app usage, and employment is a robust predictor of HIPC. However, age, social-economic status, maternity benefit scheme membership, pregnancy apps usage, mobile spending, mobile basic services usage does not play a significant role in HIPC. Overall, the results suggest that as users' awareness level on privacy policies and issues increase, privacy concern decreases.

We treated four pregnancy cases positive for antiphospholipid antibodies (APLs) who had experienced recurrent second trimester fetal or neonatal losses using a Japanese modified Chinese herbal medicine, Sairei-to, low dose aspirin and adrenocorticosteroid hormone. The clinical courses of their new pregnancies in conjunction with the dynamic changes in their APL titers are described in this paper, and the possible efficacy of this treatment is discussed. The concept that autoimmune abnormalities, especially positive APLs, are generative factors for a range of reproductive failures, such as recurrent abortions, intrauterine growth retardation, intrauterine fetal death and preeclampsia, is now attracting a great deal of attention in the fields of reproductive immunology and perinatal medicine (Yasuda et al., 1995). The main mechanisms in the generation of reproductive failures are considered to be direct damage to chorionic villi by APLs during the period of placentation (Rote et al., 1998), as well as the formation of thrombi intervillous spaces (Arakawa et al., 1999). Considering these mechanisms of the reproductive failure generation by APLs, the application of immune suppressive therapy in combination with anti-coagulation therapy should be reconsidered as a treatment option. In this context, we treated four pregnancy cases positive for APLs who had experienced recurrent second trimester fetal or neonatal losses using a Japanese modified Chinese herbal medicine, Sairei-to, low dose aspirin and an adrenocorticosteroid hormone.

The antiphospholipid syndrome (APS) is characterized by thrombosis and/or pregnancy morbidity with the persistent presence of antiphospholipid antibodies (aPLs). Laboratory criteria for the classification of APS include the detection of lupus anticoagulant (LAC), anti-cardiolipin (aCL) antibodies and anti-β2glycoprotein I (aβ2GPI) antibodies. Clinical criteria for the classification of thrombotic APS include venous and arterial thrombosis, along with microvascular thrombosis. Several aPLs, including LAC, aβ2GPI and anti-phosphatidylserine/prothrombin antibodies (aPS/PT) have been associated with arterial thrombosis. The Von Willebrand Factor (VWF) plays an important role in arterial thrombosis by mediating platelet adhesion and aggregation. Studies have shown that aPLs antibodies present in APS patients are able to increase the risk of arterial thrombosis by upregulating the plasma levels of active VWF and by promoting platelet activation. Inflammatory reactions induced by APS may also provide a suitable condition for arterial thrombosis, mostly ischemic stroke and myocardial infarction. The presence of other cardiovascular risk factors can enhance the effect of aPLs and increase the risk for thrombosis even more. These factors should therefore be taken into account when investigating APS-related arterial thrombosis. Nevertheless, the exact mechanism by which aPLs can cause thrombosis remains to be elucidated.

Background Mobile health apps, for example, the Tät, have been shown to be potentially effective in improving pelvic floor muscle training (PFMT) among women, but they have not yet been studied among pregnant women. Adherence to daily PFMT will improve pelvic floor muscle strength leading to urinary incontinence (UI) improvement during the pregnancy. Objective This study aims to document the validation process in developing the Kegel Exercise Pregnancy Training app, which was designed to improve the PFMT adherence among pregnant women. Methods We utilized an intervention mapping approach incorporated within the mobile health development and evaluation framework. The framework involved the following steps: (1) conceptualization, (2) formative research, (3) pretesting, (4) pilot testing, (5) randomized controlled trial, and (6) qualitative research. The user-centered design-11 checklist was used to evaluate the user-centeredness properties of the app. Results A cross-sectional study was conducted to better understand PFMT and UI among 440 pregnant women. The study reported a UI prevalence of 40.9% (180/440), with less than half having good PFMT practice despite their good knowledge. Five focus group discussions were conducted to understand the app design preferred by pregnant women. They agreed a more straightforward design should be used for better app usability. From these findings, a prototype was designed and developed accordingly, and the process conformed to the user-centered design–11 (UCD-11) checklist. A PFMT app was developed based on the mHealth development and evaluation framework model, emphasizing higher user involvement in the application design and development. The application was expected to improve its usability, acceptability, and ease of use. Conclusions The Kegel Exercise Pregnancy Training app was validated using a thorough design and development process to ensure its effectiveness in evaluating the usability of the final prototype in our future randomized control trial study.

Gestational diabetes mellitus (GDM) is a condition that appears during pregnancy and is expected to be a temporary one. While patients are encouraged to manage it themselves, research findings indicate that GDM may negatively affect the foetus; in addition, there is an increased risk of women with GDM subsequently developing Type 2 diabetes. To alleviate the risks, women with GDM are advised to maintain a record of their diet and blood glucose levels and to attend regular clinical reviews. Rather than using a paper diary, women with GDM can maintain a record of their blood glucose level readings and other relevant data using a wellness mobile application (app). However, such apps are developed for general use and may not meet the specific needs of clinical staff (physicians, dietitians, obstetricians and midwives) involved in managing GDM; for example, an app may record glucose readings but not the details of a meal taken before or after the glucose reading. Second, the apps do not permanently store the data generated by the patient and do not support the transfer of these data to a clinical system or information portal. The mobile health (mHealth) system designed and developed in this research allows one to integrate different types of user generated wellness data into a centralised database. A user-centered design (UCD) approach informed by the technology acceptance model (TAM) was adopted. This paper investigates and evaluates the effectiveness of the approach with regard to facilitating system acceptance and future adoption through an early focus on enhancing system usefulness and ease of use. The functional system requirements of the proposed system were refined through a series of interviews with the perspective of clinical users; ease-of-use and usability issues were resolved through ‘think aloud’ sessions with clinicians and GDM patients.

ObjectiveDescribe the development and pretest of a prototype multibehavioural change app MAMA-EMPOWER.DesignMixed-methods study reporting three phases: (1) contextual enquiry included stakeholder engagement and qualitative interviews with Aboriginal women, (2) value specification included user-workshop with an Aboriginal researcher, community members and experts, (3) codesign with Aboriginal researchers and community members, followed by a pretest of the app with Aboriginal women, and feedback from qualitative interviews and the user-Mobile Application Rating Scale (U-MARS) survey tool.SettingsAboriginal women and communities in urban and regional New South Wales, Australia.ParticipantsPhase 1: interviews, 8 Aboriginal women. Phase 2: workshop, 6 Aboriginal women. Phase 3: app trial, 16 Aboriginal women. U-MARS, 5 Aboriginal women.ResultsPhase 1 interviews revealed three themes: current app use, desired app characteristics and implementation. Phase 2 workshop provided guidance for the user experience. Phase 3 app trial assessed all content areas. The highest ratings were for information (mean score of 3.80 out of 5, SD=0.77) and aesthetics (mean score of 3.87 with SD of 0.74), while functionality, engagement and subjective quality had lower scores. Qualitative interviews revealed the acceptability of the app, however, functionality was problematic.ConclusionsDeveloping a mobile phone app, particularly in an Aboriginal community setting, requires extensive consultation, negotiation and design work. Using a strong theoretical foundation of behavioural change technique’s coupled with the consultative approach has added rigour to this process. Using phone apps to implement behavioural interventions in Aboriginal community settings remains a new area for investigation. In the next iteration of the app, we aim to find better ways to personalise the content to women’s needs, then ensure full functionality before conducting a larger trial. We predict the process of development will be of interest to other health researchers and practitioners.

Antiphospholipid syndrome (APS) is a hypercoagulable state accompanied by the presence of heterogeneous antiphospholipid antibodies (aPL), which nonspecifically affect hemostasis by the presence of lupus anticoagulans (LA), anticardiolipin antibodies (aCL), antibodies against β2-glycoprotein-I (anti-β2GPI), but also non-criteria antibodies such as antibodies against β2-glycoprotein-I domain I (anti-DI), anti-phosphatidylserine/prothrombin (anti-PS/PT), anti-annexin V, and many others. The main target of the antibodies is the activated protein C (APC) system, the elimination of which can manifest itself as a thrombotic complication. The aim of this study was to determine the thrombogenicity of antibodies using a modified protein C-activated thrombin generation assay (TGA) on a group of 175 samples suspected of APS. TGA was measured with/without APC and the ratio of both measurements was evaluated (as for APC resistance), where a cut-off was calculated ≤4.5 (90th percentile) using 21 patients with heterozygous factor V Leiden mutation (FV Leiden heterozygous). Our study demonstrates the well-known fact that multiple positivity of different aPLs is a more severe risk for thrombosis than single positivity. Of the single antibody positivity, LA antibodies are the most serious (p value < 0.01), followed by aCL and their subgroup anti-DI (p value < 0.05). Non-criteria antibodies anti-annexin V and anti-PT/PS has a similar frequency occurrence of thrombogenicity as LA antibodies but without statistical significance or anti-β2GPI1 positivity. The modified TGA test can help us identify patients in all groups who are also at risk for recurrent thrombotic and pregnancy complications; thus, long-term prophylactic treatment is appropriate. For this reason, it is proving increasingly beneficial to include the determination antibodies in combination with modified TGA test.

Background: Mobile applications and social media serve their users as convenient tools to improve and monitor diseases and conditions such as pregnancy. These tools exert a positive impact on Gestational diabetes mellitus (GDM) self-management. Introduction: Despite the expansion of mobile health apps for the management of GDM, no study has evaluated these apps using a valid tool. This study aimed to search and review the apps developed for this purpose providing overall and specific rating scores for each aspect of MARS. Method: Two cases of app stores (IOS and Google Play) were searched in January 2019 for apps related to GDM. Search keywords included “gestational diabetes”, “pregnant diabetes”, and “Health apps”. Eligibility criteria include: capable of running on Android or IOS operating systems, in the English language, especially for GDM, and available in Iran. After removal of duplicates, then, they were reviewed, rated, and evaluated independently by two reviewers with Mobile App Rating Scale (MARS) tools. Results: Initially, 102 apps were identified after the exclusion process, five selected apps were downloaded and analyzed. All apps were classified into four categories according to contents and their interactive capabilities. In most quadrants of MARS, the Pregnant with Diabetes app received the highest scores. Also, in general, the maximum app quality mean score belonged to Pregnant with Diabetes (3.10 / 5.00). Conclusion: Findings revealed that apps designed for GDM are small in number and poor in quality based on MARS tools. Therefore, considering pregnant women’s need for using the capabilities of these apps in pregnancy management and promoting community-based care, it seems essential to develop and design a series of high-quality apps in all four specified categories (only giving comments, obtaining data and giving comments, diagnosis of GDM, and diet calculator).

AbstractThere are currently 318,000 health mobile applications (apps) available via the major app stores, with new apps appearing at a rate of approximately 200 per day. Pregnancy represents the largest sub-type within the health-related app market, providing a key route via which women who are pregnant or planning a pregnancy can obtain health information, and a cost and time efficient alternative to traditional face-to-face healthcare interactions. However the content of these applications, and therefore their ability to facilitate appropriate and safe behaviour change, is largely unmonitored and unregulated. This study aimed to objectively review the availability, affiliation and nutritional content of pregnancy apps, and specifically their adherence to current NICE guidance for optimal nutrition during pregnancy (promotion of Vitamin D and folic acid supplementation, promotion of breastfeeding). Apps (n = 68) were retrieved from Googleplay and the Appstore using a keyword search. After exclusions (n = 39, non-English, focused on pre- or post-pregnancy, not free to access, non-functional), 29 apps were evaluated using the previously developed Mobile Application Rating Scale (MARS). The original tool was modified to include additional sub-scales to assess the nutritional content of the apps and to rate their privacy settings. A higher score for each sub scale and for the MARS score overall represents a higher quality application. Median nutrition sub-scale score (out of 5) for all apps was 3 (25%: 2, 75%: 4.5) with folic acid requirements most likely to be covered and breastfeeding least. Over one third of the apps reviewed (38%) achieved a nutrition score ≥ 4 and 14% (n = 4) scored 5 out of 5. Nutrition score was significantly associated with overall MARS score (r = 0.615, p < 0.01). Total MARS score (out of 5; median 3 (3, 4)) was not associated with platform (android or apple), app rating or affiliation (e.g. Commercial, Government, NGO or academic institution), though sample size was reduced for these secondary variables. Free to access English language mobile phone applications targeted at pregnant women provide a variable quantity and quality of nutrition information. Those adhering more closely to current NICE guidelines for optimal diet in pregnancy are also more likely to be rated higher across other quality domains, however user rating does not predict information quality. This work will be used to direct interventions to improve e-health literacy amongst vulnerable groups such as pregnant women and to design more appropriate applications which are able to more effectively combine usability and acceptability with a robust evidence base.

BackgroundPregnancy to postpartum (PtP) applications (apps) are becoming more common tools to document everything from pregnancy and delivery to nutrient allocation, life taboos, and infant medical examinations. However, the dependability, quality, and efficacy of these apps remain unclear. This study examined the features and functions of mobile PtP care apps accessible in China and the United States and to identify the major gaps that need to be addressed.MethodsApps were selected by searching the Apple App Store and Android Markets (in the US and China) for the terms “pregnancy” and “postpartum” in Chinese and English. The apps' security, quality, and effectiveness were investigated, and chi-square tests and analysis of variance were performed to examine the differences in characteristics between apps available in the US and China.ResultsA total of 84 mobile PtP care apps (45 from the US and 39 from China) were included. A total of 89.7% (35/39) of Chinese mobile apps did not provide safety statements or supporting evidence. The objective app quality ratings for Chinese and US apps were 3.20 ± 0.48 (mean ± standard deviation) and 3.56 ± 0.45, respectively (p &gt; 0.05). A greater number of Chinese apps provided app-based monitoring functions, namely recording fetal size (n = 18, 46.2% in China vs. n = 3, 6.7% in the US), contractions (n = 11, 28.2% in China vs. n = 0, 0% in the US), pregnancy weight (n = 11, 28.2% in China vs. 0, 0% in the US), and pregnancy check-up reminders (n = 10, 25.6% in China vs. n = 0, 0% in the US). Meanwhile, a greater number of US apps provided exercise modules, namely pregnancy yoga (n = 2, 5.1% in China vs. n = 21, 46.7% in the US), pregnancy workouts (n = 2, 5.1% in China vs. n = 13, 28.9% in the US), and pregnancy meditation (n = 0, 0% in China vs. 10, 22.2% in the US) (p &lt; 0.01). A medium security risk was identified for 40% (18/45) of apps in the US and 82.1% (32/39) of apps in China (p &lt; 0.01).ConclusionsThe functionality and characteristics of in-store mobile apps for PtP care varied between China and the US. Both countries' apps, particularly Chinese apps, encountered issues related to a lack of evidence-based information, acceptable content risk, and program evaluations. Both countries' apps lacked proper mental health care functions. The findings suggest that the design of app features should be enhanced in both countries, and increased interaction between app creators and users is recommended.

Abstract Background The use of digital technology in healthcare has been found to be useful for data collection, provision of health information and communications. Despite increasing use of medical mobile phone applications (apps), by both clinicians and patients, there appears to be a paucity of peer-reviewed publications evaluating their use, particularly in pregnancy. This scoping review explored the use of mobile phone apps for clinical decision support in pregnancy. Specific objectives were to: 1. determine the current landscape of mobile phone app use for clinical decision support in pregnancy; 2. identify perceived benefits and potential hazards of use and 3. identify facilitators and barriers to implementation of these apps into clinical practice. Methods Papers eligible for inclusion were primary research or reports on the development and evaluation of apps for use by clinicians for decision support in pregnancy, published in peer-reviewed journals. Research databases included Medline, Embase, PsychoInfo, the Cochrane Database of Systematic Reviews and the online digital health journals JMIR mHealth and uHealth. Charting and thematic analysis was undertaken using NVivo qualitative data management software and the Framework approach. Results After screening for eligibility, 13 papers were identified, mainly reporting early stage development of the mobile app, and feasibility or acceptability studies designed to inform further development. Thematic analysis revealed four main themes across the included papers: 1. acceptability and satisfaction; 2. ease of use and portability; 3. multi-functionality and 4. the importance of user involvement in development and evaluation. Conclusions This review highlights the benefits of mobile apps for clinical decision support in pregnancy and potential barriers to implementation, but reveals a lack of rigorous reporting of evaluation of their use and data security. This situation may change, however, following the issue of FDA and MHRA guidelines and implementation of UK government and other international strategies. Overall, the findings suggest that ease of use, portability and multi-functionality make mobile apps for clinical decision support in pregnancy useful and acceptable tools for clinicians.

Prediction of peak fertility is critical yet challenging in both planning and preventing pregnancy. Period tracking applications for the smartphone are ubiquitous, free of charge, and user friendly with many providing ovulation estimates. The objective of this study was to analyze the period tracking applications (apps)’ ability to accurately predict fertility windows and ovulation. Three medical students tracked their menstrual cycle over four months in seven commercially available menstrual period tracking applications. Six of the apps were analyzed for fertility window, ovulation prediction, and usability. Two home ovulation kits were utilized to confirm ovulation. The sensitivity to predict the fertility window ranged from 35% to 94% (p<0.05) while sensitivity to predict ovulation ranged from 0% to 31% (p>0.05). Four of the apps allowed for menstrual cycle lengths greater than 35 day and offered an adjustable algorithm. Apps had increased sensitivity due to an expanded fertility window with increased number of predicted fertile days, but a low ovulation sensitivity and an inability to predict the day of ovulation. Additionally, apps allowed for additional personal information to be added with some apps sharing this data with a third party, raising the question of data protection for users. Solely using period tracking apps is not the gold standard for contraception or conception. The use of these apps in conjunction with luteinizing hormone home kits for detection of physiologic ovulation provides an accurate tool that allows a woman to take charge of her reproductive health.

IntroductionThere has been a phenomenal worldwide increase in the development and use of mobile health applications (mHealth apps) that monitor menstruation and fertility. Critics argue that many of the apps are inaccurate and lack evidence from either clinical trials or user experience. The aim of this scoping review is to provide an overview of the research literature on mHealth apps that track menstruation and fertility.MethodsThis project followed the PRISMA Extension for Scoping Reviews. The ACM, CINAHL, Google Scholar, PubMed and Scopus databases were searched for material published between 1 January 2010 and 30 April 2019. Data summary and synthesis were used to chart and analyse the data.ResultsIn total 654 records were reviewed. Subsequently, 135 duplicate records and 501 records that did not meet the inclusion criteria were removed. Eighteen records from 13 countries form the basis of this review. The papers reviewed cover a variety of disciplinary and methodological frameworks. Three main themes were identified: fertility and reproductive health tracking, pregnancy planning, and pregnancy prevention.ConclusionsMotivations for fertility app use are varied, overlap and change over time, although women want apps that are accurate and evidence-based regardless of whether they are tracking their fertility, planning a pregnancy or using the app as a form of contraception. There is a lack of critical debate and engagement in the development, evaluation, usage and regulation of fertility and menstruation apps. The paucity of evidence-based research and absence of fertility, health professionals and users in studies is raised.

BackgroundMobile applications (apps) are becoming increasingly prevalent as tools for improving maternal health behaviors. However, the recently updated content and quality of these apps remain unknown. This research investigated the fundamental characteristics, functional modules, and overall quality of maternal apps available in the United States and China to reveal critical nutrition and physical activity gaps.MethodsA systematic search was performed in Android and iOS app stores (China and the United States). Apps were eligible if they targeted pregnant or postpartum women, focused on nutrition or physical activity, and had interfaces in English or Chinese. The basic characteristics, functional modules, and overall quality of the apps were evaluated, and differences between apps available in China or the United States were determined using analysis of variance and chi-square tests. Pearson correlations were utilized to investigate links between objective quality and user rating.ResultsA total of 65 maternity-related nutrition and physical activity apps (34 from China and 31 from the United States) were eligible. Among them, 68% (21/31) of US apps and 56% (19/34) of Chinese apps did not provide supporting evidence for their content. A greater number of Chinese apps provided app-based general education modules, namely food nutrition knowledge (n = 0, 0% in the United States vs. n = 30, 88.2% in China). Meanwhile, a greater number of US apps provided exercise modules, namely pregnancy yoga (n = 21, 67.7% in the United States vs. n = 2, 5.9% in China). The overall app quality rating in the United States was lower than it was in China (mean: 3.5, SD: 0.6 in China vs. mean: 3.4, SD: 0.7 in the United States). There was no relationship between the overall app quality rating and the user rating in either country (rho = 0.11 in China and rho = –0.13 in the United States).ConclusionThe characteristics and functional modules of in-store apps for maternal nutrition and physical activity differed between the United States and China. Both countries’ apps, especially Chinese apps, lacked evidence-based information, and there was no correlation between app quality and user rating. The results therefore suggest that user ratings cannot be used as an objective indicator of app quality and that it is necessary to improve the empirical basis and credibility of apps in both countries.

IntroductionLike other forms of embodiment, pregnancy has increasingly become subject to representation and interpretation via digital technologies. Pregnancy and the unborn entity were largely private, and few people beyond the pregnant women herself had access to the foetus growing within her (Duden). Now pregnant and foetal bodies have become open to public portrayal and display (Lupton The Social Worlds of the Unborn). A plethora of online materials – websites depicting the unborn entity from the moment of conception, amateur YouTube videos of births, social media postings of ultrasounds and self-taken photos (‘selfies’) showing changes in pregnant bellies, and so on – now ensure the documentation of pregnant and unborn bodies in extensive detail, rendering them open to other people’s scrutiny. Other recent digital technologies directed at pregnancy include mobile software applications, or ‘apps’. In this article, we draw on our study involving a critical discourse analysis of a corpus of pregnancy-related apps offered in the two major app stores. In so doing, we discuss the ways in which pregnancy-related apps portray pregnant and unborn bodies. We place a particular focus on the ludification and gamification strategies employed to position pregnancy as a playful, creative and fulfilling experience that is frequently focused on consumption. As we will demonstrate, these strategies have wider implications for concepts of pregnant and foetal embodiment and subjectivity.It is important here to make a distinction between ludification and gamification. Ludification is a broader term than gamification. It is used in the academic literature on gaming (sometimes referred to as ‘ludology’) to refer to elements of games reaching into other aspects of life beyond leisure pursuits (Frissen et al. Playful Identities: The Ludification of Digital Media Cultures; Raessens). Frissen et al. (Frissen et al. "Homo Ludens 2.0: Play, Media and Identity") for example, claim that even serious pursuits such as work, politics, education and warfare have been subjected to ludification. They note that digital technologies in general tend to incorporate ludic dimensions. Gamification has been described as ‘the use of game design elements in non-game contexts’ (Deterding et al. 9). The term originated in the digital media industry to describe the incorporation of features into digital technologies that not explicitly designed as games, such as competition, badges, rewards and fun that engaged and motivated users to make them more enjoyable to use. Gamification is now often used in literatures on marketing strategies, persuasive computing or behaviour modification. It is an important element of ‘nudge’, an approach to behaviour change that involves persuasion over coercion (Jones, Pykett and Whitehead). Gamification thus differs from ludification in that the former involves applying ludic principles for reasons other than the pleasures of enjoying the game for their own sake, often to achieve objectives set by actors and agencies other than the gamer. Indeed, this is why gamification software has been described by Bogost (Bogost) as ‘exploitationware’. Analysing Pregnancy AppsMobile apps have become an important medium in contemporary digital technology use. As of May 2015, 1.5 million apps were available to download on Google Play while 1.4 million were available in the Apple App Store (Statista). Apps related to pregnancy are a popular item in app stores, frequently appearing on the Apple App Store’s list of most-downloaded apps. Google Play’s figures show that many apps directed at pregnant women have been downloaded hundreds of thousands, or even millions, of times. For example, ‘Pregnancy +’, ‘I’m Expecting - Pregnancy App’ and ‘What to Expect - Pregnancy Tracker’ have each been downloaded between one and five million times, while ‘My Pregnancy Today’ has received between five and ten million downloads. Pregnancy games for young girls are also popular. Google Play figures show that the ‘Pregnant Emergency Doctor’ game, for example, has received between one and five million downloads. Research has found that pregnant women commonly download pregnancy-related apps and find them useful sources of information and support (Hearn, Miller and Fletcher; Rodger et al.; Kraschnewski et al.; Declercq et al.; Derbyshire and Dancey; O'Higgins et al.). We conducted a comprehensive analysis of all pregnancy-related smartphone apps in the two major app stores, Apple App Store and Google Play, in late June 2015. Android and Apple’s iOS have a combined market share of 91 percent of apps installed on mobile phones (Seneviratne et al.). A search for all pregnancy-related apps offered in these stores used key terms such as pregnancy, childbirth, conception, foetus/fetus and baby. After eliminating apps listed in these searches that were clearly not human pregnancy-related, 665 apps on Google Play and 1,141 on the Apple App Store remained for inclusion in our study. (Many of these apps were shared across the stores.)We carried out a critical discourse analysis of these apps, looking closely at the app descriptions offered in the two stores. We adopted the perspective that sees apps, like any other form of media, as sociocultural artefacts that both draw on and reproduce shared norms, ideals, knowledges and beliefs (Lupton "Quantified Sex: A Critical Analysis of Sexual and Reproductive Self-Tracking Using Apps"; Millington "Smartphone Apps and the Mobile Privatization of Health and Fitness"; Lupton "Apps as Artefacts: Towards a Critical Perspective on Mobile Health and Medical Apps"). In undertaking our analysis of the app descriptions in our corpus, attention was paid to the title of each app, the textual accounts of its content and use and the images that were employed, such as the logo of the app and the screenshots that were used to illustrate its content and style. Our focus in this article is on the apps that we considered as including elements of entertainment. Pregnancy-related game apps were by far the largest category of the apps in our corpus. These included games for young girls and expectant fathers as well as apps for ultrasound manipulation, pregnancy pranks, foetal sex prediction, choosing baby names, and quizzes. Less obviously, many other apps included in our analysis offered some elements of gamification and ludification, and these were considered in our analysis. ‘Pregnant Adventures’: App Games for GirlsOne of the major genres of apps that we identified was games directed at young girls. These apps invited users to shop for clothes, dress up, give a new hair style, ‘make-over’ and otherwise beautify a pregnant woman. These activities were directed at the goal of improving the physical attractiveness and therefore (it was suggested) the confidence of the woman, who was presented as struggling with coming to terms with changes in her body during pregnancy. Other apps for this target group involved the player assuming the role of a doctor in conducting medical treatments for injured pregnant women or assisting the birth of her baby.Many of these games represented the pregnant woman visually as looking like an archetypal Barbie doll, with a wardrobe to match. One app (‘Barbara Pregnancy Shopping’) even uses the name ‘Barbara’ and the screenshots show a woman similar in appearance to the doll. Its description urges players to use the game to ‘cheer up’ an ‘unconfident’ Barbara by taking her on a ‘shopping spree’ for new, glamorous clothes ‘to make Barbara feel beautiful throughout her pregnancy’. Players may find ‘sparkly accessories’ as well for Barbara and help her find a new hairstyle so that she ‘can be her fashionable self again’ and ‘feel prepared to welcome her baby!’. Likewise, the game ‘Pregnant Mommy Makeover Spa’ involves players selecting clothes, applying beauty treatments and makeup and adding accessories to give a makeover to ‘Pregnant Princess’ Leila. The ‘Celebrity Mommy’s Newborn Baby Doctor’ game combines the drawcard of ‘celebrity’ with ‘mommy’. Players are invited to ‘join the celebrities in their pregnancy adventure!’ and ‘take care of Celebrity Mom during her pregnancy!’.An app by the same developer of ‘Barbara Pregnancy Shopping’ also offers ‘Barbara’s Caesarean Birth’. The app description claims that: ‘Of course her poor health doesn’t allow Barbara to give birth to her baby herself.’ It is up to players to ‘make everything perfect’ for Barbara’s caesarean birth. The screenshots show Barbara’s pregnant abdomen being slit open, retracted and a rosy, totally clean infant extracted from the incision, complete with blonde hair. Players then sew up the wound. A final screenshot displays an image of a smiling Barbara standing holding her sleeping, swaddled baby, with the words ‘You win’.Similar games involve princesses, mermaids, fairies and even monster and vampire pregnant women giving birth either vaginally or by caesarean. Despite their preternatural status, the monster and vampire women conform to the same aesthetic as the other pregnant women in these games: usually with long hair and pretty, made-up faces, wearing fashionable clothing even on the operating table. Their newborn infants are similarly uniform in their appearance as they emerge from the uterus. They are white-skinned, clean and cherubic (described in ‘Mommy’s Newborn Baby Princess’ as ‘the cutest baby you probably want’), a far cry from the squalling, squashed-faced infants smeared in birth fluids produced by the real birth process.In these pregnancy games for girls, the pain and intense bodily effort of birthing and the messiness produced by the blood and other body fluids inherent to the process of labour and birth are completely missing. The fact that caesarean birth is a major abdominal surgery requiring weeks of recovery is obviated in these games. Apart from the monsters and vampires, who may have green- or blue-hued skin, nearly all other pregnant women are portrayed as white-skinned, young, wearing makeup and slim, conforming to conventional stereotypical notions of female beauty. In these apps, the labouring women remain glamorous, usually smiling, calm and unsullied by the visceral nature of birth.‘Track Your Pregnancy Day by Day’: Self-Monitoring and Gamified PregnancyElements of gamification were evident in a large number of the apps in our corpus, including many apps that invite pregnant users to engage in self-tracking of their bodies and that of their foetuses. Users are asked to customise the apps to document their changing bodies and track their foetus’ development as part of reproducing the discourse of the miraculous nature of pregnancy and promoting the pleasures of self-tracking and self-transformation from pregnant woman to mother. When using the ‘Pregnancy+’ app, for example, users can choose to construct a ‘Personal Dashboard’ that includes details of their pregnancy. They can input their photograph, first name and their expected date of delivery so that that each daily update begins with ‘Hello [name of user], you are [ ] weeks and [ ] days pregnant’ with the users’ photograph attached to the message. The woman’s weight gain over time and a foetal kick counter are also included in this app. It provides various ways for users to mark the passage of time, observe the ways in which their foetuses change and move week by week and monitor changes in their bodies. According to the app description for ‘My Pregnancy Today’, using such features allows a pregnant woman to: ‘Track your pregnancy day by day.’ Other apps encourage women to track such aspects of physical activity, vitamin and fluid intake, diet, mood and symptoms. The capacity to visually document the pregnant user’s body is also a feature of several apps. The ‘Baby Bump Pregnancy’, ‘WebMD Pregnancy’, ‘I’m Expecting’,’iPregnant’ and ‘My Pregnancy Today’ apps, for example, all offer an album feature for pregnant bump photos taken by the user of herself (described as a ‘bumpie’ in the blurb for ‘My Pregnancy Today’). ‘Baby Buddy’ encourages women to create a pregnant avatar of themselves (looking glamorous, well-dressed and happy). Some apps even advise users on how they should feel. As a screenshot from ‘Pregnancy Tracker Week by Week’ claims: ‘Victoria, your baby is growing in your body. You should be the happiest woman in the world.’Just as pregnancy games for little girls portrayal pregnancy as a commodified and asetheticised experience, the apps directed at pregnant women themselves tend to shy away from discomforting fleshly realities of pregnant and birthing embodiment. Pregnancy is represented as an enjoyable and fashionable state of embodiment: albeit one that requires constant self-surveillance and vigilance.‘Hello Mommy!’: The Personalisation and Aestheticisation of the FoetusA dominant feature of pregnancy-related apps is the representation of the foetus as already a communicative person in its own right. For example, the ‘Pregnancy Tickers – Widget’ app features the image of a foetus (looking far more like an infant, with a full head of wavy hair and open eyes) holding a pencil and marking a tally on the walls of the uterus. The app is designed to provide various icons showing the progress of the user’s pregnancy each day on her mobile device. The ‘Hi Mommy’ app features a cartoon-like pink and cuddly foetus looking very baby-like addressing its mother from the womb, as in the following message that appears on the user’s smartphone: ‘Hi Mommy! When will I see you for the first time?’ Several pregnancy-tracking apps also allow women to input the name that they have chosen for their expected baby, to receive customised notifications of its progress (‘Justin is nine weeks and two days old today’).Many apps also incorporate images of foetuses that represent them as wondrous entities, adopting the visual style of 1960s foetal photography pioneer Lennart Nilsson, or what Stormer (Stormer) has referred to as ‘prenatal sublimity’. The ‘Pregnancy+’ app features such images. Users can choose to view foetal development week-by-week as a colourful computerised animation or 2D and 3D ultrasound scans that have been digitally manipulated to render them aesthetically appealing. These images replicate the softly pink, glowing portrayals of miraculous unborn life typical of Nilsson’s style.Other apps adopt a more contemporary aesthetic and allow parents to store and manipulate images of their foetal ultrasounds and then share them via social media. The ‘Pimp My Ultrasound’ app, for example, invites prospective parents to manipulate images of their foetal ultrasounds by adding in novelty features to the foetal image such as baseball caps, jewellery, credit cards and musical instruments. The ‘Hello Mom’ app creates a ‘fetal album’ of ultrasounds taken of the user’s foetus, while the ‘Ultrasound Viewer’ app lets users manipulate their 3/4 D foetal ultrasound images: ‘Have fun viewing it from every angle, rotating, panning and zooming to see your babies [sic] features and share with your family and friends via Facebook and Twitter! … Once uploaded, you can customise your scan with a background colour and skin colour of your choice’.DiscussionPregnancy, like any other form of embodiment, is performative. Pregnant women are expected to conform to norms and assumptions about their physical appearance and deportment of their bodies that expect them to remain well-groomed, fit and physically attractive without appearing overly sexual (Longhurst "(Ad)Dressing Pregnant Bodies in New Zealand: Clothing, Fashion, Subjectivities and Spatialities"; Longhurst "'Corporeographies’ of Pregnancy: ‘Bikini Babes'"; Nash; Littler). Simultaneously they must negotiate the burden of bodily management in the interests of risk regulation. They are expected to protect their vulnerable unborn from potential dangers by stringently disciplining their bodies and policing to what substances they allow entry (Lupton The Social Worlds of the Unborn; Lupton "'Precious Cargo': Risk and Reproductive Citizenship"). Pregnancy self-tracking apps enact the soft politics of algorithmic authority, encouraging people to conform to expectations of self-responsibility and self-management by devoting attention to monitoring their bodies and acting on the data that they generate (Whitson; Millington "Amusing Ourselves to Life: Fitness Consumerism and the Birth of Bio-Games"; Lupton The Quantified Self: A Sociology of Self-Tracking).Many commentators have remarked on the sexism inherent in digital games (e.g. Dickerman, Christensen and Kerl-McClain; Thornham). Very little research has been conducted specifically on the gendered nature of app games. However our analysis suggests that, at least in relation to the pregnant woman, reductionist heteronormative, cisgendered, patronising and paternalistic stereotypes abound. In the games for girls, pregnant women are ideally young, heterosexual, partnered, attractive, slim and well-groomed, before, during and after birth. In self-tracking apps, pregnant women are portrayed as ideally self-responsible, enthused about their pregnancy and foetus to the point that they are counting the days until the birth and enthusiastic about collecting and sharing details about themselves and their unborn (often via social media).Ambivalence about pregnancy, the foetus or impending motherhood, and lack of interest in monitoring the pregnancy or sharing details of it with others are not accommodated, acknowledged or expected by these apps. Acknowledgement of the possibility of pregnant women who are not overtly positive about their pregnancy or lack interest in it or who identify as transgender or lesbian or who are sole mothers is distinctly absent.Common practices we noted in apps – such as giving foetuses names before birth and representing them as verbally communicating with their mothers from inside the womb – underpin a growing intensification around the notion of the unborn entity as already an infant and social actor in its own right. These practices have significant implications for political agendas around the treatment of pregnant women in terms of their protection or otherwise of their unborn, and for debates about women’s reproductive rights and access to abortion (Lupton The Social Worlds of the Unborn; Taylor The Public Life of the Fetal Sonogram: Technology, Consumption and the Politics of Reproduction). Further, the gamification and ludification of pregnancy serve to further commodify the experience of pregnancy and childbirth, contributing to an already highly commercialised environment in which expectant parents, and particularly mothers, are invited to purchase many goods and services related to pregnancy and early parenthood (Taylor "Of Sonograms and Baby Prams: Prenatal Diagnosis, Pregnancy, and Consumption"; Kroløkke; Thomson et al.; Taylor The Public Life of the Fetal Sonogram: Technology, Consumption and the Politics of Reproduction; Thomas).In the games for girls we examined, the pregnant woman herself was a commodity, a selling point for the app. The foetus was also frequently commodified in its representation as an aestheticised entity and the employment of its image (either as an ultrasound or other visual representations) or identity to market apps such as the girls’ games, apps for manipulating ultrasound images, games for predicting the foetus’ sex and choosing its name, and prank apps using fake ultrasounds purporting to reveal a foetus inside a person’s body. As the pregnant user engages in apps, she becomes a commodity in yet another way: the generator of personal data that are marketable in themselves. In this era of the digital data knowledge economy, the personal information about people gathered from their online interactions and content creation has become highly profitable for third parties (Andrejevic; van Dijck). Given that pregnant women are usually in the market for many new goods and services, their personal data is a key target for data mining companies, who harvest it to sell to advertisers (Marwick).To conclude, our analysis suggests that gamification and ludification strategies directed at pregnancy and childbirth can serve to obfuscate the societal pressures that expect and seek to motivate pregnant women to maintain physical fitness and attractiveness, simultaneously ensuring that they protect their foetuses from all possible risks. In achieving both ends, women are encouraged to engage in intense self-monitoring and regulation of their bodies. These apps also reproduce concepts of the unborn entity as a precious and beautiful already-human. These types of portrayals have important implications for how young girls learn about pregnancy and childbirth, for pregnant women’s experiences and for concepts of foetal personhood that in turn may influence women’s reproductive rights and abortion politics.ReferencesAndrejevic, Mark. Infoglut: How Too Much Information Is Changing the Way We Think and Know. New York: Routledge, 2013. Print.Bogost, Ian. "Why Gamification Is Bullshit." The Gameful World: Approaches, Issues, Applications. Eds. Steffen Walz and Sebastian Deterding. Boston, MA: MIT Press, 2015. 65-80. Print.Declercq, E.R., et al. Listening to Mothers III: Pregnancy and Birth. New York: Childbirth Connection, 2013. Print.Derbyshire, Emma, and Darren Dancey. "Smartphone Medical Applications for Women's Health: What Is the Evidence-Base and Feedback?" International Journal of Telemedicine and Applications (2013).Deterding, Sebastian, et al. "From Game Design Elements to Gamefulness: Defining Gamification." Proceedings of the 15th International Academic MindTrek Conference: Envisioning Future Media Environments. ACM, 2011. Dickerman, Charles, Jeff Christensen, and Stella Beatríz Kerl-McClain. "Big Breasts and Bad Guys: Depictions of Gender and Race in Video Games." Journal of Creativity in Mental Health 3.1 (2008): 20-29. Duden, Barbara. Disembodying Women: Perspectives on Pregnancy and the Unborn. Trans. Lee Hoinacki. Cambridge, MA: Harvard University Press, 1993. Frissen, Valerie, et al. "Homo Ludens 2.0: Play, Media and Identity." Playful Identities: The Ludification of Digital Media Cultures. Eds. Valerie Frissen et al. Amsterdam: University of Amsterdam Press, 2015. 9-50. ———, eds. Playful Identities: The Ludification of Digital Media Cultures. Amsterdam: Amsterdam University Press, 2015. Hearn, Lydia, Margaret Miller, and Anna Fletcher. "Online Healthy Lifestyle Support in the Perinatal Period: What Do Women Want and Do They Use It?" Australian Journal of Primary Health 19.4 (2013): 313-18. Jones, Rhys, Jessica Pykett, and Mark Whitehead. "Big Society's Little Nudges: The Changing Politics of Health Care in an Age of Austerity." Political Insight 1.3 (2010): 85-87. Kraschnewski, L. Jennifer, et al. "Paging “Dr. Google”: Does Technology Fill the Gap Created by the Prenatal Care Visit Structure? Qualitative Focus Group Study with Pregnant Women." Journal of Medical Internet Research. 16.6 (2014): e147. Kroløkke, Charlotte. "On a Trip to the Womb: Biotourist Metaphors in Fetal Ultrasound Imaging." Women's Studies in Communication 33.2 (2010): 138-53. Littler, Jo. "The Rise of the 'Yummy Mummy': Popular Conservatism and the Neoliberal Maternal in Contemporary British Culture." Communication, Culture & Critique 6.2 (2013): 227-43. Longhurst, Robyn. "(Ad)Dressing Pregnant Bodies in New Zealand: Clothing, Fashion, Subjectivities and Spatialities." Gender, Place & Culture 12.4 (2005): 433-46. ———. "'Corporeographies’ of Pregnancy: ‘Bikini Babes'." Environment and Planning D: Society and Space 18.4 (2000): 453-72. Lupton, Deborah. "Apps as Artefacts: Towards a Critical Perspective on Mobile Health and Medical Apps." Societies 4.4 (2014): 606-22. ———. "'Precious Cargo': Risk and Reproductive Citizenship." Critical Public Health 22.3 (2012): 329-40. ———. The Quantified Self: A Sociology of Self-Tracking. Cambridge: Polity Press, 2016. ———. "Quantified Sex: A Critical Analysis of Sexual and Reproductive Self-Tracking Using Apps." Culture, Health & Sexuality 17.4 (2015): 440-53. ———. The Social Worlds of the Unborn. Houndmills: Palgrave Macmillan, 2013. Marwick, Alice. "How Your Data Are Being Deeply Mined." The New York Review of Books (2014). Millington, Brad. "Amusing Ourselves to Life: Fitness Consumerism and the Birth of Bio-Games." Journal of Sport & Social Issues 38.6 (2014): 491-508. ———. "Smartphone Apps and the Mobile Privatization of Health and Fitness." Critical Studies in Media Communication 31.5 (2014): 479-93. Nash, Meredith. Making 'Postmodern' Mothers: Pregnant Embodiment, Baby Bumps and Body Image. Houndmills: Palgrave Macmillan, 2013. O'Higgins, A., et al. "The Use of Digital Media by Women Using the Maternity Services in a Developed Country." Irish Medical Journal 108.5 (2015). Raessens, Joost. "Playful Identities, or the Ludification of Culture." Games and Culture 1.1 (2006): 52-57. Rodger, D., et al. "Pregnant Women’s Use of Information and Communications Technologies to Access Pregnancy-Related Health Information in South Australia." Australian Journal of Primary Health 19.4 (2013): 308-12. Seneviratne, Suranga, et al. "Your Installed Apps Reveal Your Gender and More!" Mobile Computing and Communications Review 18.3 (2015): 55-61. Statista. "Number of Apps Available in Leading App Stores as of May 2015." 2015. Stormer, Nathan. "Looking in Wonder: Prenatal Sublimity and the Commonplace 'Life'." Signs 33.3 (2008): 647-73. Taylor, Janelle. "Of Sonograms and Baby Prams: Prenatal Diagnosis, Pregnancy, and Consumption." Feminist Studies 26.2 (2000): 391-418. ———. The Public Life of the Fetal Sonogram: Technology, Consumption and the Politics of Reproduction. New Brunswick, NJ: Rutgers University Press, 2008. Thomas, Gareth M. "Picture Perfect: ‘4d’ Ultrasound and the Commoditisation of the Private Prenatal Clinic." Journal of Consumer Culture. Online first, 2015. Thomson, Rachel, et al. Making Modern Mothers. Bristol: Policy Press, 2011. Thornham, Helen. “'It's a Boy Thing'.” Feminist Media Studies 8.2 (2008): 127-42. Van Dijck, José. "Datafication, Dataism and Dataveillance: Big Data between Scientific Paradigm and Ideology." Surveillance & Society 12.2 (2014): 197-208. Whitson, Jennifer. "Gaming the Quantified Self." Surveillance & Society 11.1/2 (2013): 163-76.

Abstract Background Gestational diabetes mellitus (GDM) emerges worldwide and is closely associated with short- and long-term health issues in women and their offspring, such as pregnancy and birth complications respectively comorbidities, Type 2 Diabetes (T2D), metabolic syndrome as well as cardiovascular diseases. Against this background, mobile health applications (mHealth-Apps) do open up new possibilities to improve the management of GDM. Therefore, we analyzed the clinical effectiveness of specific mHealth-Apps on clinical health-related short and long-term outcomes in mother and child. Methods A systematic literature search in Medline (PubMed), Cochrane Library, Embase, CINAHL and Web of Science Core Collection databases as well as Google Scholar was performed. We selected studies published 2008 to 2020 analyzing women diagnosed with GDM using specific mHealth-Apps. Controlled clinical trials (CCT) and randomized controlled trials (RCT) were included. Study quality was assessed using the Effective Public Health Practice Project (EPHPP) tool. Results In total, n = 6 publications (n = 5 RCTs, n = 1 CCT; and n = 4 moderate, n = 2 weak quality), analyzing n = 408 GDM patients in the intervention and n = 405 in the control groups, were included. Compared to control groups, fasting blood glucose, 2-h postprandial blood glucose, off target blood glucose measurements, delivery mode (more vaginal deliveries and fewer (emergency) caesarean sections) and patient compliance showed improving trends. Conclusion mHealth-Apps might improve health-related outcomes, particularly glycemic control, in the management of GDM. Further studies need to be done in more detail.

BackgroundMobile applications (apps) present a new opportunity to study menstrual cycles and time to pregnancy. Understanding the characteristics of cycle tracking app users is important to evaluate the feasibility of recruiting participants for preconception research.MethodsUsers of a cycle tracking smartphone app, Ovia Fertility, aged 18 or older in the U.S. were randomly invited via email to complete a “fertility research” questionnaire that included demographic and reproductive characteristics. Among those attempting pregnancy without medical assistance, attempt duration, factors influencing pregnancy planning, health history and behaviors while attempting to conceive were queried. Respondents could choose to enter a raffle for a $50 gift card.ResultsInitially, 639 people responded to the demographics portion of the survey representing 49 states and Washington DC. Of these, 344 (54%) were trying to conceive and of those, 297 (86%) were not using medical treatments. Of those not trying to conceive, 12% reported that they planned to start in the next 3 months. Most participants were ages 26–35 (63%), of White race (70%), reported non-Hispanic ethnicity (87%), had at least a bachelor's degree (56%) and an income between $50,000 and $200,000 (58%). One-third were of recommended BMI (35%), 24% overweight, and 41% obese. Most participants reported no fertility-related health conditions (58%). Forty-eight participants (17%) had been trying to conceive for 1 month or less, 88 (31%) had been trying for 2 months or less, and 122 (43%) for 3 months or less. Interruptions in pregnancy attempts were common, 31% reported periods without intercourse. Of those attempting pregnancy, 47% of partners completed their own questionnaire.ConclusionThis first-of its-kind analysis describes users of a cycle-tracking smartphone app who could be eligible for recruitment to a prospective time-to-pregnancy study. Survey respondents were diverse with respect to geographic location, BMI, and income. However, special recruitment efforts will be needed to recruit participants and partners who identify as other than non-Hispanic White. Participants with fertility-related conditions are not overly represented among app users who are trying to conceive. Targeting and pre-enrolling app users who are planning to begin a pregnancy attempt in the next 3 months may be an advantage of app-based recruitment.

This article analyses the manner in which mobile health applications contribute to the empowerment of patients. The theoretical background included m-health, user empowerment and value co-creation. Quantitative and qualitative methods were used to investigate the representative case study of the Kangaroo application, a free app designed by a health-tech start-up and a reference Brazilian hospital which seeks to make Brazilian women empowered for a healthy pregnancy. The data collection effort comprised application log analysis of 6 months of records of almost one-hundred thousand users, a mobile-based survey with approximately 400 women, and 16 in-depth interviews. The results demonstrated that the app’s social features impacted more than personal features. This research’s results suggested that the perception of patient empowerment is not greater for the active users of the application, so the patient is not related to ‘doing’, but rather to ‘being able to do’. The participation of specialised professionals, who moderate and interact with the app community, is valued by the users and mentioned as a differential among other health information sources available on the Web. This study was approved by the Brazilian Research Ethics Committee.

AbstractThe Better Understanding the Metamorphosis of Pregnancy (BUMP) study is a longitudinal feasibility study aimed to gain a deeper understanding of the pre-pregnancy and pregnancy symptom experience using digital tools. The present paper describes the protocol for the BUMP study. Over 1000 participants are being recruited through a patient provider-platform and through other channels in the United States (US). Participants in a preconception cohort (BUMP-C) are followed for 6 months, or until conception, while participants in a pregnancy cohort (BUMP) are followed into their fourth trimester. Participants are provided with a smart ring, a smartwatch (BUMP only), and a smart scale (BUMP only) alongside cohort-specific study apps. Participant centric engagement strategies are used that aim to co-design the digital approach with participants while providing knowledge and support. The BUMP study is intended to lay the foundational work for a larger study to determine whether participant co-designed digital tools can be used to detect, track and return multimodal symptoms during the perinatal window to inform individual level symptom trajectories.

Introduction In the following self-reflexive (examining my own experiences) piece I discuss the methodology of my PhD thesis which, completed in 2014 (Johnson On a Tightrope), focused on how women negotiate, reject and embody the expectations associated with contemporary pregnancy and mothering. In this qualitative research project I examined the types of pregnancy and parenting practices (defined as those practices undertaken to manage and maximise the success of women’s pregnancies and parenting) women engage in with reference to contemporary sources of information. Central to this, I studied the changing nature of pregnancy and mothering practices in the context of increasing digitalisation, with a particular focus on whether and how technologies enable new spaces for experiential learning and health responsibilisation. This also allowed me to query how various discourses work to inform particular ideas of ‘good’ or ‘appropriate’ mothering behaviours and mothering ideologies, and the expert patient ideal (Johnson Maternal Devices). An examination of the different resources and technologies women draw on during their transition to first-time motherhood reveals how dominant discourses are resisted, negotiated or differentially embodied by women facing first-time pregnancy and motherhood. Since the time I began my research, there has been an explosion of applications (apps) into the market. Pregnancy and mothering have been ‘appified’. Apps offer a unique way to order, engage with and reshape our bodies and biology today. They reflect wider cultural and social changes in the understanding of our identity, our ‘lifestyle’ and our body. In my study I drew on characterisations from participants in attempting to understand the affordances of apps and the role they may play during both pregnancy and new motherhood. I found that apps format motherhood and pregnancy in new ways, instituting new rules into new devices and offering templates which actively shape meanings and practices. They provide new ways to imagine or create foetal/child identity, to monitor child activity from a distance, to gather and interpret data and the enactment of “digital” helicopter parenting (Johnson Maternal Devices). Apps also represent a ‘tidbitisation’ of information which is delivered directly into the user’s intimate sphere, sometimes ‘pushed’ into this intimate sphere, no matter where they are. This ‘device-ification’ of mothering purports to turn it into an administrative and calculable activity, valuing data over subjective experiences and changing the meaning of what it is to mother and be a mother. Apps also represent the contemporary intersection between social media, medical advice, expectations of self-management and notions of convenience. They also creates new social relations and valuing practices, such as ‘likeability’ on Facebook, which have the potential to alter our understandings of health and identity. Increasing numbers of health initiatives are adopting apps in their promotional marketing campaigns and the appification of health means that medical knowledge is being increasingly incorporated into new sorts of social interactions. Ongoing research must consider the multiplicity of women’s engagement with these apps across the transition to first-time motherhood and for parents who are trying to manage child health. It would be productive to direct focus onto the lived experiences associated with apps rather than lauding or criticising the content of apps. Background The initial question that motivated my research was: ‘How do women draw on, weave together, and reject aspects of the dominant advice which configures contemporary perceptions of maternal subjectivity, encompassing specifically the transition to first-time motherhood?’ I was interested in what women in the transition to first-time motherhood experienced and how they reflected on and interpreted these experiences. The subjective accounts of women tell a particular story, so, rather than administering a survey to a large group of women I focused on in-depth, semi-structured but flexible interviews as a way of discovering participant experiences as expressed in their own words. Having only a small number of interview participants meant that I was able to analyse my data closely in a way that would be difficult with a larger sample. In total, I conducted twenty-two interviews with twelve women during January and September, 2012. This included two interviews with ten participants and one interview with the remaining two participants. The first interview was conducted during the third trimester of pregnancy, ranging from 32 to 38 weeks. The second interview was undertaken postnatally when the babies ranged from 3 to 7 months of age. For participant demographic information, please refer to earlier publications (Johnson Maternal Devices; Intimate Mothering Publics). Interviewing late in pregnancy and early in new motherhood provided a realistic sense of the changes, both positive and negative, which occur during this transition as well as the – at times – deep rift between experience and expectation. The time between interviews was important as it allowed women time to adjust somewhat to life as a new mum, allowed time for reflection on both the pregnancy and the early months of mothering. The interviews were conversational and relaxed in nature and allowed to flow in the direction the participant chose to take. The women were generous in sharing intimate details of their experiences from conception through to motherhood. Their responses revealed different ways of being pregnant, being supported and responsibilised during pregnancy, and the different ways women cope with stress, anxiety and more. The stories also demonstrate the amount of work, thought and often deliberate self-transformation which occurs throughout pregnancy, and as a new mother. I believe my personal biography influenced the data that I collected during the interviews. My age and sex advantaged my position as an interviewer. Being a relatively young female researcher it was easy to develop rapport with the participants. In addition, being a woman likely increased my access, as a researcher, to the intimate experiences women shared throughout the interviews, especially considering the gendered and personal nature of the research. It was also apparent that my absence of first-hand experience of pregnancy and mothering enhanced the depth of interview data, encouraging participants to provide access to details and feelings that they may have believed were unnecessary to discuss had I also been a mother. Rebecca Horn discusses a similar experience in her research with prison inmates and police staff, which she describes as being due to her projected image as an “innocent abroad” (96). It also meant that participants were more likely to share details because my lack of experience meant that I was not in a position to judge these experiences against my own. Throughout the interviews, the participants often wanted to know more about me, asking me questions like: How old are you? Have you ever been pregnant? Do you have a partner? Does doing this research turn you off having children? Does doing this research make you want to have children? What do you plan to do after you’ve finished your thesis? Similar to other researchers who discuss their interview experiences in self-reflexive pieces Edwards, Finch and Oakley, I found that by sharing some of my own personal experiences I was able to establish trust and develop rapport with the participants. Like Kasper I worked with the assumption that each interview is a collaborative and consensual enterprise among women. I focused on earning trust, displaying sensitivity and fairness, and showing support. The participants expressed genuine interest in my research and the findings it was generating, with most women keen to read any published findings from the research. Many participants asked to have a copy of their interview transcripts for posterity or to reflect on with friends or in future pregnancies. ‘Getting Personal’ Now that I am contemplating the extension of my research into the future I must think about how my position as a researcher has changed. As one of my key interests is the ways in which digital technologies impact on parenting I have to ask myself whether I will use this broad range of technologies myself, as a parent. If I do use these technologies, will I insert myself into my research asking questions about my own user experiences and considering whether my partner uses these technologies in a different way to myself? If so, how, and what are the implications of this? I also need to consider my child amongst this, as both a parent and a researcher. Am I comfortable with my child having a digital life from a young age? I have already contemplated this question and made the conscious decision not to discuss or mention my pregnancy on social media, Facebook in particular. This question will again be important when my partner and I make decisions around the different ways we choose to announce the birth of our first child. These questions will continue to be important to me as a parent in an increasingly digitalised world. Until I become a mother, (some time in the next five weeks) I believe I cannot answer these questions. Rather, this article functions as a sounding board, allowing me to begin contemplating these questions in my future dual role as a mother and a researcher. Becoming a mother will change my position as a researcher in other important ways. I will no longer be the inexperienced, childless researcher. I will continue to treat my participants as partners in my research but being a mother myself, intersubjectivity, “the acknowledgment of the reciprocal sharing of knowledge and experience between the researcher and the researched” (Shields and Dervin 67), will become all the more essential to my approach. In this way I would hope to continue to de-emphasise the conventional hierarchies and dichotomies of research by focusing on the dialectical relationship between myself and my research ‘partners’. It will be imperative that I not only listen to these women without judgement but that I also share the intricacies of my research project and my own experiences as a maternal subject. These women are the experts of their own lives (Kasper) and I am sure this research would benefit from their involvement from an early phase where they would be invited to share in the design of research questions and the collection and interpretation of results. This is particularly important when designing research on new technologies where the only experiences I can currently draw from are my own and perhaps those of friends, family and colleagues. Digital research methodologies are still in their infancy, as this special issue attests, and although research into the use of apps is growing, there continues to be little research into the user experiences of apps. Apps as Tools of Convenience? As noted above, apps create a “tidbitisation” of information (Johnson Maternal Devices), where information is convenient and accessible in small ‘tidbits’ that anyone can access anywhere, anytime on their smartphone. This is something I have already utilised during my pregnancy (checking symptoms, reading about baby’s development) and I am sure this will be useful for me as a new mum. I have also been using my smartphone for other baby-related resources such as gathering lists of lullabies and nursery rhymes. These few examples indicate that smartphones do offer a great number of conveniences to new parents. But, they could also appear worrisome – raising questions around smartphones as distractions from parenting or relying on smartphones to track health conditions or baby habits, and perhaps even the deferral of responsibility, for example, busy parents using apps to entertain children. At this stage we actually know very little about the user experience of apps for mothers and new parents and new research in this area needs to ask questions such as: Who uses apps and why? What are users paying attention to and what is ignored or ‘switched off’? Do push notifications actually work? Do they create a new form of responsibilisation and if so, what are the repercussions of this, particularly if these apps are directed towards women as new parents, rather than men? This last question is particularly important for a scholar such as myself in the field of Gender and Cultural Studies where questions of gender and gendering are often central to our research. I have found that, as apps continue to be developed at an alarming rate, those specific to parenting are, more often than not targeted to women rather than men. Those that are targeted to men are often patronising and poorly executed, lacking detailed information and emphasising gendered stereotypes (for examples, see Johnson Maternal Devices). This is important to note because I found in my study that app use constitutes part of the intimate relationship of parents-to-be and new parents. Male partners rarely read guidebooks or significant detail from other information sources and so apps played a role in their day-to-day gathering of knowledge, usually via their partner. Rather than reading a chapter of a book or googling a pregnancy symptom, quiet time chatting on the couch after work often included the sharing of information from apps or regular email updates on a variety of topics. Men used the same apps as women but this was usually on their partner’s phone, rather than their own. This raises another important question. How do we research indirect use of apps? Is this even possible? The obvious way to answer this question would be through the use of qualitative interviews. This is made difficult through the mere fact that we first must know who uses these apps indirectly before we recruit them into our research. Researching Digital Technologies through Discourse Analysis In my PhD the use of smartphones and apps only emerged as a theme of interest late into the research project. The constant mention of various apps during the interviews prompted me to examine a number of key pregnancy and parenting apps in terms of the discourses they mobilise and their functionality (Johnson Maternal Devices). As Dorothy Smith attests, we live in a textually mediated world. Pregnancy and parenting books, magazines, technologies such as apps and other forms of popular advice represent a mediated version of motherhood, parenthood and fatherhood. If these texts can influence and be influenced by patterns of parenting discourse then critical discourse analysis can contribute to an understanding of the ways in which mothering can be influenced or constructed by popular media and discourse. Thus, in my PhD research I applied discourse analysis to the study of apps. Discourse analysis examines how language constructs social phenomena and investigates the ways in which it produces certain social realities and expectations (Sunderland). Discourse analysis is valuable because of the questions it enables us to ask about the constructed nature of our experiences and the texts that we are exposed to. Smartphone apps, social media and the Internet are growing resources for women in the transition to first-time motherhood. These technologies require further research as they represent a particular way for women to engage with the neoliberal project of responsibilisation. Targeting first-time mothers and parents research allows access to users of digital technologies who most likely have a vested interest (i.e. the health and development of their children) in understanding the way new technologies are increasingly intervening in our everyday lives. Maternal subjects are likely to view such technologies as a means to monitor her pregnancies and her children’s health and development. A central aim of my research is to render visible the enduring nature of ideologies and expectations of motherhood – which include the ways in which women as mothers are responsibilised – and the ways in which different variants of mothering are inserted in new ways into tools of self-help, social media and new ‘pushy’ technologies (apps). This will reveal how discourse is constituted by mothers and how mothering discourse can work to constitute particular maternal practices and beliefs or expectations. Thus I argue that discourse analysis is central to the research of pregnancy/parenting apps. My research demonstrates how women draw on new technologies in rebellious, ironic or affirmative ways to enact different technologies of the self (Foucault). The texts can be viewed as disciplinary in a Foucauldian sense, and by analysing these different forms of advice it is possible to provide an ongoing demonstration of the difficulty of complying with the various demands of motherhood. Women’s interactions with a range of parenting discourses and attempts to create their own version of motherhood can be seen to constitute one component of the work of motherhood and the ways women practice and enact motherhood (this is discussed in detail in an article currently under review). Although researching the potential affordances of apps is important this research must be connected to user experience. In other words, are apps used in the ways we think they are? In order to move forward and ask questions such as: “Are women responsibilised and their conduct shaped in a new way via their smartphones in what I have characterised ‘push responsibilisation’?” we must move beyond discourse analysis and ask questions that focus on the user experience of apps. It would be useful to draw on existing research in other fields, which have started to develop a range of ethnographic methods and tools for research into computer-user interactions, applications and social media including Tinder, Grindr and Instagram. Other questions I wish to include in a future empirical study include: Who adopts these apps and why? Are there variations in the ways different generational users adopt apps? Who rejects these apps and why? Are push notifications ignored, considered obtrusive or do they prompt specific practices or actions? How are apps used? How do apps maintain already existing gender inequalities in parenting? In asking these questions I believe we could also begin to interrogate a much broader question, that is: “What can the use of devices during this particular ‘life stage’ tell us more broadly about mapping, tracking and quantifying the self?” This brings me again to the central question in this piece: How do we do this research? In this article I have not attempted to answer this question but rather to provoke discussion and encourage debate. In particular, I would like to consider new research methodologies which have the potential to extend our research capabilities and those whom we are able to involve in our research. An example would be conducting research online through pre-existing discussion forums. I have attended numerous academic events in the past two years where academics have started to ponder these questions more generally but my hope is that this article can act as encouragement for further debate. References Edwards, Rosalind. “Connecting Method and Epistimology: A White Woman Interviewing Black Women.” Women's Studies International Forum 13 (1990): 477-490. Finch, Janet. “It’s great to have someone to talk to”: The Ethics and Politics of Interviewing Women. Social Researching: Politics, Problems, Practice. Eds. Colin Bell and Helen Roberts. London: Routledge, 1984. Foucault, Michel. "Technologies of the Self: A Seminar with Michel Foucault." Technologies of the Self: A Seminar with Michel Foucault. Eds. Luther Martin, Huck Gutman, and Patrick Hutton. Amherst: University of Massachusetts Press, 1998. Horn, Rebecca. “Reflexivity in Placement: Women Interviewing Women.” Feminism & Psychology 5 (1995): 94-98. Johnson, Sophia. “On a Tightrope? Technologies of Motherhood in Neoliberal Society.” PhD Thesis. Sydney: Department of Gender and Cultural Studies, University of Sydney, 2014. Johnson, Sophia. “‘Maternal Devices’, Social Media and the Self-Management of Pregnancy, Mothering and Child Health”. Societies 4.2 (2014): 330-350. Johnson, Sophia. “‘Intimate Mothering Publics’: Comparing Face-To-Face Support Groups and Internet Use for Women Seeking Information and Advice in the Transition to First-Time Motherhood.” Culture, Health and Sexuality: An International Journal for Research, Intervention and Care 17.2 (2015): 237-251. Kasper, Anne. “A Feminist, Qualitative Methodology: A Study of Women with Breast Cancer.” Qualitative Sociology 17.3 (1994): 263-281. Oakley, Ann. “Interviewing Women: A Contradiction in Terms.” Doing Feminist Research. Ed. Helen Roberts. London: Routledge and Kegan Paul, 1981. Shields, Vickie Rutledge, and Brenda Dervin. “Sense-Making in Feminist Social Science Research: A Call to Enlarge the Methodological Options of Feminist Studies.” Women's Studies International Forum 16.1 (1993): 65-81. Smith, Dorothy. The Everyday World as Problematic: A Feminist Sociology. Boston: Northern University Press, 1987. Sunderland, J. “'Parenting' or 'Mothering'? The Case of Modern Childcare Magazines.” Discourse & Society 17.4 (2006): 503-528.

Background India contributes to one-fifth of infant and maternal deaths globally. Healthy lifestyles during pregnancy combined with good quality health care can help to avoid many maternal and neonatal deaths. Access to appropriate information is important for developing or maintaining a healthy lifestyle. The increased coverage of smartphones across low- and middle-income countries (LMICs) has given rise to smartphone apps supporting healthy pregnancies. The objective of this study is to evaluate the effects of the smartphone application Together For Her on maternal health knowledge and dietary diversity among pregnant Indian women. Methods We ran a randomised single-centre pilot study in a private hospital in Maharashtra, India. We randomly selected pregnant women at ≤20 weeks of gestation who were invited to download the application, in addition to regular antenatal care. The control group only received regular antenatal care. Knowledge about a healthy lifestyle during pregnancy, self-reported dietary diversity and individual characteristics were collected via telephone interviews at baseline (T0), midline (T0 + 4 weeks) and endline (T0 + 12 weeks). Results Complete data were collected for 179 respondents (intervention:94; control:85). Respondents in the intervention group showed larger increases in their knowledge over the 12-week study period, with an overall knowledge increase of 13.4 percentage points (P<0.001). The largest effects were found in the modules anaemia, breastfeeding and skin-to-skin contact. Self-reported diversity in nutritional intake also improved significantly more in the intervention group than in the control group. Conclusions Smartphone applications can effectively supplement antenatal care by increasing women’s knowledge about a healthy lifestyle during pregnancy, which is likely to reduce the risk of adverse maternal health outcomes. Future research includes the roll-out of a larger multi-centre RCT to assess the effect of the smartphone application on health outcomes.

AbstractDiabetes mellitus increases the risk of adverse maternal and fetal outcomes. Preconception care is vital to minimise complications; however, preconception care service provision is hindered by inadequate knowledge, resources and care fragmentation. Mobile health technology, particularly smartphone apps, could improve preconception care and pregnancy outcomes for women with diabetes. The aim of this study is to co-create a preconception and diabetes information app with healthcare professionals and women with diabetes and explore the feasibility, acceptability and preliminary effects of the app. A mixed-methods study design employing questionnaires and semi-structured interviews was used to assess preliminary outcome estimates (preconception care knowledge, attitudes and behaviours), and user acceptability. Data analysis included thematic analysis, descriptive statistics and non-parametric tests. Improvements were recorded in knowledge and attitudes to preconception care and patient activation measure following the 3-month app usage. Participants found the app acceptable (satisfaction rating was 72%), useful and informative. The app’s usability and usefulness facilitated usage while manual data input and competing priorities were barriers which participants felt could be overcome via personalisation, automation and use of daily reminders. This is the first study to explore the acceptability and feasibility of a preconception and diabetes information app for women with diabetes. Triangulated data suggest that the app has potential to improve preconception care knowledge, attitudes and behaviours. However, in order for women with DM to realise the full potential of the app intervention, particularly improved maternal and fetal outcomes, further development and evaluation is required.

As the global number of human internet users passes 3 billion, and the number of things with unique IP addresses passes an estimated 15 billion, the widespread establishment of computational technologies signals a reality in which digital media are now firmly embedded, increasingly ordinary, and often invisible within cultural and material life. The digital spaces we inhabit and experience are now highly stabilized and structured, organized through regimes of commerce and datafication, and populated by content and users whose lives began already networked in digital forms of production, distribution and consumption. Yet, at the same time, the reconfiguration of internet infrastructures, connectivity, and interfacing expressed in protocols like IPv6, projects such as internet.org, and concepts like the ‘internet of things’ or ‘natural user interface’ signal processes of digital expansion that simultaneously draw our attention to conditions of ongoing change in computational technologies, as well as the patterns of both human and machine ‘use’. This issue of M/C Journal seeks to explore the beginnings of these familiar and well established, as well as emerging and uncertain, contexts of digital cultures. By focusing on the beginnings, of life, of platforms, of theoretical concepts, of research endeavours, and so on, this issue aims to bring together scholarship around the infant and initial moments of technologies and their use, as well as the processes, relations and forces that shape and are shaped by these beginnings. Alongside critical assessments of repeated cycles of hype or peril in media pasts (Gitelman; Marvin), analyses of obsolescence, amnesia and memory produced by the conditions of the digital present (Chun; van Dijck), and concerns for the monopolisation of the Internet of the future (Wu; Zittrain), studying digital beginnings may offer a way to illuminate the varied forms of meaning, mediation, and materiality at play in configuring the familiar, or perhaps highlighting the potential for alternatives produced at such interstices. Questions of beginnings feature within research traditions and theories of technology adoption, domestication and development, and so can be understood in reference to individuals and users, but also apply to the birth of applications, technologies or enterprises, to the beginnings of concepts, theories or movements, and to the early periods of research design and investigation. Studying beginnings, therefore, raises questions about digital histories, trajectories and temporalities, and to how we as scholars go about researching such situations (Allen; Brügger). Examining and explicitly surfacing a range of beginnings both highlights the finitude of various technologies and practices while simultaneously demonstrating the historical, cultural and technical contingency of identities, platforms and practices in a wide a range of sociotechnical configurations (Leaver). This issue begins with Deborah Lupton and Gareth M Thomas examining the hundreds of pregnancy-related apps available today in ‘Playing Pregnancy’. They highlight strategies of gamification and broader ludic elements which frame different forms of engagement, from the provision of information about normative growth patterns during pregnancy to playfully provoking self-tracking and quantification of the unborn. They argue that the ‘algorithmic authority’ of pregnancy tracking apps encourage users to conform to expectations of self-responsibility, self-management and normalise both self-monitoring and a regime which explicitly links the monitoring of the unborn with evidence of care. In ‘Getting Personal’, Sophia Johnson offers a self-reflective piece that contemplates emerging research methods, new technologies for parents and, more personally, the birth of her first child. She reflects on the changing nature of pregnancy and mothering practices in the contexts of increased ‘appification’, noting the ways apps format motherhood through processes like a ‘tidbitisation’ of information delivered directly into intimate spheres, and how discourses of responsibilisation embodied in the administration, calculation and valuing of data over subjective experiences are negotiated. In Crystal Abidin’s article she introduces ‘micro-microcelebrities’, the young children of East Asian microcelebrity parents, earning significant money via brand endorsement on social media. These young social media stars have a significant online presence before they are born, via ‘bump’ photos, sonograms and bespoke social media accounts activated and carefully managed by their parents. In their first years of life, micro-microcelebrities can become highly sought after brand ambassadors. Legal uncertainty about the role of children’s labour on social media leaves some significant concerns about agency and potential exploitation. Yet, as Abidin concludes, the way these micro-microcelebrities build from and negotiate these complex beginnings that will be of great interest. In their article, Donell Holloway, Lelia Green and Kylie Stevenson report on the beginnings of a research project entitled Toddlers and Tablets: exploring the risks and benefits 0-5s face online, and proposes the notion of Digitods to describe children who have ready access to touchscreen technologies since birth. Their article notes the currently limited amount of media studies research about these children’s digital media use, and argues for research grounded in the everyday life of very young children and their families. In ‘Accidental, Assisted, Automated’, Bjorn Nansen reports on research exploring infants’ everyday encounters and entanglements with mobile media in family life. Nansen identifies the ways infants’ mobile media use is assembled through touchscreen interfaces, proxy parent users, and commercial software sorting. He conceptualises infants’ communicative agency through an emerging repertoire of techniques involving: accidental, or non-purposeful interactions with touching screens inadvertently activating applications like Skype; assisted media use, facilitated by parents introducing, activating and guiding use, such as scrolling family photos; and, automated use enabled by algorithms such as YouTube’s autoplay function. Nansen’s research highlights the ubiquity of mobile media in young lives, arguing for critical and ethical, rather than resistant, responses. Esther Milne offers an historical analysis of the spreadsheet, looking into issues of format and intellectual property, before exploring the materiality and operation of the spreadsheet in everyday life to manage risk in relation to personal data management and the Quantified Self. She argues that the banality and familiarity of the spreadsheet belie its affective intensities and violence through the ways these forms, like other administrative media, operate as tools of governance. In ‘Extra-planetary Digital Cultures’, David Crouch and Katarina Damjanov explore how many of the origins of our digital culture can be located in the history of space exploration, and how contemporary digital flows are dependent upon technologies such as satellites placed in outer space, before turning to the beginnings of extra-planetary digital cultures. Drawing on thinkers such as Gilbert Simondon and Bernard Stiegler, they argue that this situation expresses the next stage in thinking about the inseparability of the human from the technological. Finally, in ‘Startling Starts’, Isabel Pedersen and Kirsten Ellison begin a critical examination of the rhetorical strategies deployed in describing and introducing smart contact lenses. They argue that between interviews, press releases, advertising and social media likes, technologies are situated as astonishing, but in a routinized trajectory. A form of technogenesis occurs where the beginnings and normalisation of a new technology lie not only in the material form, but in the descriptions, discussions and rhetoric which precede even public prototypes. The importance of beginnings lie not only in the material form, but the way that form is carefully introduced into the public imaginary. Beginnings matter: they introduce, shape and build desire for new technologies long before they actually exist. Responding to the invitation to explore digital beginnings, the articles collected in this issue of M/C Journal highlight a range of emerging issues, practices and focal points. The digital mediation of the unborn or newly born is the focus of a number of articles, from the algorithmic imperatives of pregnancy-tracking apps to baby selfies, infant brand ambassadors, and the urgent need to better understand emerging social and cultural rhythms of everyday life in which young people are always already imbricated in media systems and mediation of various forms. Also important are the implications of emerging computational devices, systems and interfaces, as well as the possibilities embedded in the beginnings of media research and cultures. Collectively, these articles offer alternative accounts of the often accepted myths or axiomatic understandings of the new or the commonplace. References Allen, Matthew. “Gaining a Past, Losing a Future: Web 2.0 and Internet Historicity.” Media International Australia, Incorporating Culture & Policy 143 (2012): 99-109. Brügger, Niels. “Web Historiography and Internet Studies: Challenges and Perspectives.” New Media & Society 15.5 (2013): 752–764. Chun, Wendy Hui Kyong. Programmed Visions: Software and Memory. Cambridge: MIT Press, 2011. Gitelman, Lisa. Always Already New: Media, History, and the Data of Culture. Cambridge: MIT Press, 2006. Leaver, Tama. “Researching the Ends of Identity: Birth and Death on Social Media.” Social Media + Society 1.1 (2015): doi: 10.1177/2056305115578877. Marvin, Carolyn. When Old Technologies Were New: Thinking about Electronic Communication in the Late Nineteenth Century. New York: Oxford University Press, 1988. Van Dijck, José. Mediated Memories in the Digital Age. Stanford: Stanford University Press, 2007. Wu, Tim. The Master Switch: The Rise and Fall of Information Empires. New York: Knopf, 2010. Zittrain, Jonathon. The Future of the Internet, and How to Stop It. New Haven: Yale University Press, 2008.

Abstract Background Gestational diabetes mellitus (GDM) is diagnosed during pregnancy, and women with a history of GDM are at a higher risk of developing type 2 diabetes mellitus (T2DM). Prevention strategies focused on lifestyle modification help to reduce long-term complications. Self-management technology-based interventions can support behaviour change and diabetes control. The Baby Steps programme, a randomised controlled trial intervention offering group education and access to a mobile web application, was evaluated to explore user experience of the app and barriers and facilitators to app usability. Methods Ten semi-structured interviews and four focus group discussions were conducted with 23 trial participants between 2018 and 2019. Interviews and focus group discussions were audiotaped, transcribed and independently analysed. The analysis was informed by thematic analysis, with the use of the Nvivo 12 software. Results Themes identified were: (1) GDM and post-pregnancy support from healthcare services; (2) Impact of Baby Steps app on lifestyle changes; (3) Facilitators and barriers to the usability of the Baby Steps app. The Baby Steps app served as a motivator for increasing self-management activities and a tool for monitoring progress. Peer support and increased awareness of GDM and T2DM enhanced engagement with the app, while poor awareness of all the components of the app and low technical skills contributed to low usability. Conclusions This study documents experiences from existing GDM support, user experiences from using the Baby Steps app, and the barriers and facilitators to app usability. The app was both a motivational and a monitoring tool for GDM self-management and T2DM prevention. Peer support was a key trait for enhanced engagement, while barriers were low technical skills and poor awareness of the app components. A digital app, such as the Baby Steps app, could strengthen existing face-to-face support for the prevention of T2DM. The results also have wider implications for digital support technologies for all self-management interventions. Further research on the effect of specific components of apps will be required to better understand the long term impact of apps and digital interventions on self-management behaviours and outcomes. Trial registration ISRCTN, ISRCTN17299860. Registered on 5 April 2017.

Background: Gestational diabetes mellitus (GDM) is an increasing health issue among pregnant women worldwide. Treatment of hyperglycemia during pregnancy improves outcomes for both mothers and infants. Effectively performing and reviewing self-monitoring of blood glucose is time-consuming for patients and care providers. In the modern era, most people having access to smartphones create opportunities for use of phone-based technologies to improve patient care in chronic diseases. This review aims to investigate the awareness and use of the smartphone application (app) with respect to management of GDM among pregnant women. Materials and Methods: Various relevant studies ( n = 522) from 3 databases named Pub Med, Cochrane Library, and Google Scholar were included. For this, the study involved designing of a 5-stage review framework, which included research question identification, identification of articles, article selection, data collection, and result reporting. Results: Initial search criteria used a combination of keywords, by which we found out 522 literatures from 3 databases. After screening the titles and abstracts, 249 articles were excluded due to duplicate literatures and 252 articles were excluded due to the following reasons: not relevant ( n = 172), editorial ( n = 43), not in English ( n = 7), and abstract only ( n = 30). Furthermore, 10 articles were excluded because apps such as MobiGuide, pregnant + app, and GDm health were not mentioned in these articles. A total of 11 articles were included for the final analysis. Conclusion: The mobile apps described in the present study (pregnant +, MobiGuide, and GDm health) provided personalized health care services, patient care improvement, and enhanced patient’s compliance toward blood glucose monitoring and treatment.