Mobile Health–Driven Empowerment of Midwives to Improve Maternal and Neonatal Outcomes in High-Risk Pregnancies: A Systematic Review and Meta-Analysis

BackgroundMaternal and neonatal complications in high-risk pregnancies (HRP) remain a major contributor to global morbidity and mortality, especially in low- and middle-income countries (LMICs). Midwives play a crucial role in early detection, education, and continuity of care (CoC) for high-risk mothers; however, geographical, logistical, and resource-related barriers frequently limit their ability to deliver continuous support. Mobile health (mHealth) technologies offer an innovative pathway for empowering midwives to deliver remote education, monitoring, and sustained support, potentially bridging gaps in care access. This systematic review and meta-analysis aimed to rigorously evaluate the effectiveness of midwife-led mHealth interventions on objective maternal and neonatal outcomes in HRP populations.MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA ۲۰۲۰) guidelines, comprehensive searches were conducted in PubMed, Scopus, CINAHL, Web of Science, and the Cochrane Library for studies published between ۲۰۱۰ and ۲۰۲۵. Eligible studies included randomized controlled trials (RCTs) and quasi-experimental designs (QEDs) evaluating mHealth tools—such as mobile applications, SMS follow-up, or digital counseling—implemented by professional midwives or under their direct guidance. Data extraction and risk-of-bias assessment (using Cochrane RoB ۲.۰ and JBI criteria) were performed independently by two reviewers. A random-effects meta-analysis estimated pooled effect sizes (Risk Ratio or Standardized Mean Difference) for primary outcomes: Antenatal Care (ANC) adherence and preterm birth rate.ResultsA total of ۲۲ studies (N approx ۷,۴۰۰ participants) met the inclusion criteria, spanning diverse geographic and high-risk settings. Meta-analysis revealed that mHealth interventions significantly improved adherence to the minimum recommended ANC visits (RR = ۱.۳۶; ۹۵% CI ۱.۱۹–۱.۵۵; p < ۰.۰۰۱). This enhanced engagement corresponded to a clinically important pooled reduction in the rate of preterm birth (RR = ۰.۸۸; ۹۵% CI ۰.۸۱–۰.۹۶; p = ۰.۰۰۴), representing a ۱۲% relative risk reduction compared with routine care. Furthermore, digital midwifery programs significantly enhanced maternal self-efficacy (Pooled SMD = ۰.۵۵; ۹۵% CI ۰.۳۸–۰.۷۲; p < ۰.۰۰۱) in managing HRP conditions and recognizing danger signs. Heterogeneity for the ANC adherence outcome was moderate (I^۲ = ۳۹%). Publication bias was assessed and found to be non-significant.ConclusionmHealth-driven empowerment of midwives demonstrates significant potential to enhance essential care utilization and reduce critical adverse neonatal outcomes in high-risk pregnancies. These robust findings support integrating scalable mobile technologies into maternal health policies and midwifery curricula to promote equitable, accessible, and sustainable digital care models globally, particularly focusing on two-way communication to maximize patient empowerment.

کلیدواژه ها:

Mobile Health ، Midwifery ، High-Risk Pregnancy ، Maternal Health ، Neonatal Outcomes ، Meta-Analysis