Introducing an Antenatal Care Electronic Health System for Low and Middle Income Countries: A Cross-Sectional Study on 1217 Iranian Pregnant Women

Hossein Zamaninasab; Arsalan Heidarpanah; Marjan Ghaemi

doi:10.18502/jfrh.v17i4.14593

Introducing an Antenatal Care Electronic Health System for Low and Middle Income Countries: A Cross-Sectional Study on 1217 Iranian Pregnant Women

Hossein Zamaninasab

Arsalan Heidarpanah

Marjan Ghaemi

Abstract

Objective: Maternal health care is one of the main challenges worldwide, especially in low- and middle-income countries (LMICs) such as Iran. In this cross-sectional study, we introduce an electronic health software for maternal care that is active under the supervision of the Valiasr Reproductive Health Research Center of Tehran University of Medical Sciences in providing maternal health education to Iranian pregnant women. In addition to describing the details of this open-source software and encouraging LMICs health policymakers to develop such software, this manuscript also provides a cross-sectional report and statistical analysis on anonymous Iranian pregnant women who registered in this system.
Materials and methods: Since 2015, we have launched an electronic health software in Iran called "niniMED Pregnancy Calendar" in Persian. This system has multiple educational and motivational features for pregnant women, including momentary weight recommendations based on pregnancy week and recommended dates for common tests during pregnancy according to the first day of the last menstrual period in Jalali calendar format. Additionally, we measured user satisfaction with this system using a questionnaire.
Results: From 2015 to 2017, 1,217 anonymous Iranian pregnant women registered in this system. The average age of pregnant Iranian women was 30.67 years (30 years and 8 months). Users had a body mass index (BMI) of 24.68 kg.m^-2, which had a significant direct relationship with their gestational age (P=5.81e-05) and indicated an improvement in appropriate weight for Iranian women compared to previous studies. We showed that there was a significant direct relationship between the age of Iranian pregnant women and the likelihood of a high-risk pregnancy (P=0.008). We also observed a significant inverse relationship between pregnancy week and their tendency to receive pregnancy-related education (P=0.018). Finally, we found that more than 88% of pregnant Iranian women assessed membership in such systems as completely useful for pregnancy.
Conclusion: The development of such electronic health systems for informing pregnant women can provide low-cost maternal education to LMICs pregnant women and potentially assist in managing weight gain during pregnancy and reducing associated risks. It can also be widely accepted by pregnant women.

1. Butcher BW, Eaton TL, Montgomery-Yates AA, Sevin CM. Meeting the Challenges of Establishing Intensive Care Unit Follow-up Clinics. Am J Crit Care 2022;31(4):324-328
2. Maternal mortality. UNICEF DATA. https://data.unicef.org/topic/maternal-health/maternal-mortality/. Published March 22, 2023. Accessed April 18, 2023.
3. Congenital disorders. World Health Organization. https://www.who.int/health-topics/congenital-anomalies. Accessed April 18, 2023.
4. New Year's Babies: Over 370,000 children will be born worldwide on New Year's day - UNICEF. https://www.unicef.org/press-releases/new-years-babies-over-370000-children-will-be-born-worldwide-new-years-day-unicef. Accessed April 18, 2023.
5. Rubio C, Simón C. Embryo Genetics. Genes (Basel) 2021;12(1):118.
6. Shahat ARS, Greco G. The Economic Costs of Childhood Disability: A Literature Review. Int J Environ Res Public Health 2021;18(7):3531.
7. Zanconato G, Msolomba R, Guarenti L, Franchi M. Antenatal care in developing countries: the need for a tailored model. Semin Fetal Neonatal Med 2006 (1):15-20. Epub 2005.
8. Carruth BR, Skinner JD. Practitioners beware: regional differences in beliefs about nutrition during pregnancy. J Am Diet Assoc 1991 (4):435-40.
9. Gaillard R, Steegers EA, Hofman A, Jaddoe VW. Associations of maternal obesity with blood pressure and the risks of gestational hypertensive disorders. The Generation R Study. J Hypertens 2011 (5):937-44.
10. Lopez-Jaramillo P, Barajas J, Rueda-Quijano SM, Lopez-Lopez C, Felix C. Obesity and Preeclampsia: Common Pathophysiological Mechanisms. Front Physiol 2018; 9:1838.
11. Torloni MR, Betrán AP, Horta BL, Nakamura MU, Atallah AN, Moron AF, et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev 2009 (2):194-203. Epub 2008.
12. Obesity and pregnancy. ACOG. https://www.acog.org/womens-health/faqs/obesity-and-pregnancy. Accessed April 18, 2023.
13. Yang J, Cummings EA, O'connell C, Jangaard K. Fetal and neonatal outcomes of diabetic pregnancies. Obstet Gynecol 2006;108(3 Pt 1):644-50.
14. WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. Geneva: World Health Organization; 2016. PMID: 28079998.
15. Finlayson K, Downe S. Why do women not use antenatal services in low- and middle-income countries? A meta-synthesis of qualitative studies. PLoS Med. 2013;10(1):e1001373. Epub 2013.
16. Dowswell T, Carroli G, Duley L, Gates S, Gülmezoglu AM, Khan-Neelofur D, et al. Alternative versus standard packages of antenatal care for low-risk pregnancy. Cochrane Database Syst Rev. 2010;(10):CD000934. Update in: Cochrane Database Syst Rev. 2015;7:CD000934.
17. Pregnancy-related deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017-2019. Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/data-mmrc.html. Published September 19, 2022. Accessed April 18, 2023.
18. Divane A, Carter NP, Spathas DH, Ferguson-Smith MA. Rapid prenatal diagnosis of aneuploidy from uncultured amniotic fluid cells using five-colour fluorescence in situ hybridization. Prenat Diagn 1994 (11):1061-9.
19. Whiteman DAH, Klinger K. Efficiency of rapid in situ hybridization methods for prenatal diagnosis of chromosome abnormalities causing birth defects. Am J Hum Genet 1991;49:A1279
20. Aimukhametova G, Ukybasova T, Hamidullina Z, Zhubanysheva K, Harun-Or-Rashid M, Yoshida Y, et al. The impact of maternal obesity on mother and neonatal health: study in a tertiary hospital of Astana, Kazakhstan. Nagoya J Med Sci 2012;74(1-2):83-92.
21. Rhayem A, Mhiri MB, Drira K, et al. A semantic‐enabled and context‐aware monitoring system for the internet of medical things. Expert Systems 2020;38(2).
22. Nove A, Ten Hoope-Bender P, Boyce M, Bar-Zeev S, de Bernis L, Lal G. The State of the World's Midwifery 2021 report: findings to drive global policy and practice. Hum Resour Health. 2021;19(1):146.
23. Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci 2012;35(3):194-204.
24. Johnsen H, Blom KF, Lee A, Nørgaard B. Using eHealth to Increase Autonomy Supportive Care: A Multicenter Intervention Study in Antenatal Care. Comput Inform Nurs. 2018;36(2):77-83.
25. Velu AV, van Beukering MD, Schaafsma FG, Frings-Dresen MH, Mol BW, van der Post JA, et al. Barriers and Facilitators for the Use of a Medical Mobile App to Prevent Work-Related Risks in Pregnancy: A Qualitative Analysis. JMIR Res Protoc. 2017;6(8):e163.
26. Zakane SA, Gustafsson LL, Tomson G, Loukanova S, Sié A, Nasiell J, et al. Guidelines for maternal and neonatal "point of care": needs of and attitudes towards a computerized clinical decision support system in rural Burkina Faso. Int J Med Inform 2014;83(6):459-69. Epub 2014.
27. Bonnell S, Griggs A, Avila G, Mack J, Bush RA, Vignato J, et al. Community Health Workers and Use of mHealth: Improving Identification of Pregnancy Complications and Access to Care in the Dominican Republic. Health Promot Pract 2018;19(3):331-340. Epub 2017.
28. Agarwal S, Perry HB, Long LA, Labrique AB. Evidence on feasibility and effective use of mHealth strategies by frontline health workers in developing countries: systematic review. Trop Med Int Health 2015;20(8):1003-14. Epub 2015.
29. Redman LM, Gilmore LA, Breaux J, Thomas DM, Elkind-Hirsch K, Stewart T, et al. Effectiveness of SmartMoms, a Novel eHealth Intervention for Management of Gestational Weight Gain: Randomized Controlled Pilot Trial. JMIR Mhealth Uhealth. 2017 13;5(9):e133.
30. Feroz A, Perveen S, Aftab W. Role of mHealth applications for improving antenatal and postnatal care in low and middle income countries: a systematic review. BMC Health Serv Res 2017;17(1):704.
31. Amoakoh-Coleman M, Borgstein AB, Sondaal SF, Grobbee DE, Miltenburg AS, Verwijs M, et al. Effectiveness of mHealth Interventions Targeting Health Care Workers to Improve Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review. J Med Internet Res. 2016;18(8):e226.
32. Little A, Medhanyie A, Yebyo H, Spigt M, Dinant GJ, Blanco R. Meeting community health worker needs for maternal health care service delivery using appropriate mobile technologies in Ethiopia. PLoS One 2013;8(10):e77563. Erratum in: PLoS One. 2014;9(1).
33. Glushkova S, Belotserkovich D, Morgunova N, Yuzhakova Y. The role of smartphones and the internet in developing countries. Revista ESPACIOS 2019;40(27).
34. Mayes J, White A, Byrne M, Mogg J. How smartphone technology is changing healthcare in developing countries. The Columbia University Journal of Global Health 2016;6(2):36-8.
35. N AS. WHO EMRO's approach for supporting e-health in the Eastern Mediterranean Region. East Mediterr Health J. 2006;12 Suppl 2:S238-52.
36. Cormick G, Kim NA, Rodgers A, Gibbons L, Buekens PM, Belizán JM, et al. Interest of pregnant women in the use of SMS (short message service) text messages for the improvement of perinatal and postnatal care. Reprod Health 2012;9:9.
37. Xuto P, Toyohiko K, Prasitwattanaseree P, Sriarporn P. Effect of Receiving Text Messages on Health Care Behavior and State Anxiety of Thai Pregnant Women: A Randomized Controlled Trial. Int J Community Based Nurs Midwifery 2022;10(1):18-29.
38. Chan KL, Chen M. Effects of Social Media and Mobile Health Apps on Pregnancy Care: Meta-Analysis. JMIR Mhealth Uhealth 2019 ;7(1):e11836.
39. Sieracki JM. Failsafe software design: Mission-Critical and Safety-Critical Systems Handbook. 2010:83-133. doi:10.1016/b978-0-7506-8567-2.00002-0
40. StartBootstrap. StartBootstrap/startbootstrap-SB-admin-2: A free, open source, bootstrap admin theme created by Start Bootstrap. GitHub. https://github.com/StartBootstrap/startbootstrap-sb-admin-2. Accessed April 18, 2023.
41. Internet security research group. https://www.abetterinternet.org/documents/2020-ISRG-Annual-Report.pdf. Accessed April 18, 2023.
42. Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight Gain During Pregnancy: Reexamining the Guidelines. Rasmussen KM, Yaktine AL, editors. Washington (DC): National Academies Press (US); 2009. PMID: 20669500.
43. Bakhshi E, Seifi B, Biglarian A, Mohammad K. Changes in Body Mass Index across Age Groups in Iranian Women: Results from the National Health Survey. J Nutr Metab 2012;2012:848403. Epub 2012.

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Issue	Vol 17, No 4 (December 2023)
Section	Original Articles
DOI	https://doi.org/10.18502/jfrh.v17i4.14593
Keywords
Antenatal Care Electronic Health (E-Health) Pregnancy Maternal Health Care

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Zamaninasab H, Heidarpanah A, Ghaemi M. Introducing an Antenatal Care Electronic Health System for Low and Middle Income Countries: A Cross-Sectional Study on 1217 Iranian Pregnant Women. J Family Reprod Health. 2023;17(4):216-228.

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