Texting in the Fourth Trimester: mHealth for Postpartum Care

Area of Science:

• Obstetrics and Gynecology
• mHealth and Digital Health Interventions
• Maternal Health and Postpartum Care

Background:

• Rising maternal morbidity and mortality in the US is linked to the postpartum period, exacerbated by poor attendance at postpartum visits.
• Gaps in postpartum care include contraception, mental health services, and chronic condition management, contributing to adverse maternal outcomes.
• Mobile health (mHealth) shows promise in improving antenatal care adherence, suggesting potential for postpartum applications.

Purpose of the Study:

• To determine if an mHealth intervention using interactive, educational text messages can improve postpartum care adherence among women.
• To assess the impact of mHealth text messages on key postpartum outcomes, including visit attendance, breastfeeding, contraception use, and postpartum depression.

Main Methods:

• A randomized controlled trial involving 191 women receiving OB/GYN care, comparing routine care with an mHealth text message intervention.
• Intervention group received interactive, educational text messages and appointment reminders specific to delivery type.
• Primary endpoint: attendance at the 6-week postpartum visit; secondary endpoints: breastfeeding, contraception, emergency visits, and postpartum depression scores.

Main Results:

• No significant difference in 6-week postpartum visit attendance between the mHealth text message group (59%) and the control group (66%).
• The COVID-19 pandemic shifted some visits to telehealth; no significant difference in attendance rates was observed between groups for in-person or telehealth visits.
• Automated text messages alone did not improve adherence to postpartum care, even with telehealth integration.

Conclusions:

• Interactive text messages, as a standalone intervention, did not effectively increase adherence to postpartum care appointments.
• The COVID-19 pandemic presented challenges to routine postpartum care delivery, impacting study dynamics.
• Further research is necessary to explore the efficacy of mHealth interventions in postpartum care, potentially requiring augmentation with strategies like human navigators.