Mobile education for preterm birth risks effective

Mobile education for preterm birth risks effective | Image Credit: © sitthiphong - © sitthiphong - stock.adobe.com.

According to a recent study published in JAMA Network Open, mobile antenatal education is an effective method of educating parents on preterm birth.

A birth at 36 weeks of gestational age (GA) or earlier is considered preterm birth, and a preterm birth occurs nearly every minute in the United States. Increased rates of mortality and disability are seen in infants born preterm despite neonatal intensive care unit (NICU) treatments available, making preterm birth the leading cause of morbidity and mortality in US infants.

Morbidity can be reduced in preterm infants through several prenatal health care decisions, such as delivering at a risk-appropriate hospital and choosing to breastfeed. There are also multiple risk factors which can help identify preterm birth risk in pregnant patients. However, preterm birth education is not provided before delivery.

Researchers developed the Preemie Prep for Parents (P3) program, a multimedia education aid design to provide smartphone-based preterm birth education. This allows education to be received in a comfortable environment for the patient and encourages the use of short, animated videos which have wide appeal and accessibility. 

Anxiety in patients may also be reduced through a smartphone-based method. To evaluate the impact of the P3 program on preterm birth knowledge, decision-making, and patient anxiety, investigators conducted a parallelgroup, randomized clinical trial. 

Guidelines from the Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists (ACOG) on information to deliver to parents at risk of preterm birth were used to design content for the P3 program. Short video scripts were created to present learning objectives.

Content included the importance of breastfeeding, risk-appropriate level of NICU, periviable birth treatment options, and factors other than GA which impact birth outcomes. The P3 program included 51 animated videos with a duration of 1 to 3 minutes on these topics.

Participants included pregnant individuals aged 13 years and older recruited between February 3, 2020, and April 12, 2021, with a risk of preterm birth. These individuals were placed in an intervention group receiving the smartphone-based video content or a control group receiving patient education webpages created by the ACOG.

Exclusion criteria included significant birth defects in pregnancy and being unable to speak English. Risk factors included multifetal gestation, history of spontaneous preterm birth, a short cervix, chronic hypertension, preeclampsia, intrauterine growth restriction, and diabetes needing medications.

A baseline assessment was performed to gather data on participant sociodemographic characteristics, typical smartphone use, preference for medical decision involvement, and perceived odds of preterm birth. Follow-up assessments occurred at weeks 25, 30, and 34 of gestation. Use of the P3 program was recorded through tracking software.

There were 120 pregnant individuals included in the analysis, with a mean age of 32.5 years. Baseline characteristics did not differ between the intervention and control groups. Preterm birth occurred in 38.7% of participants.

During the 16-week intervention, participants in the P3 group watched an averageof 54.9% of the videos, with use varying by video. Greater use was seen in videos sent earlier in pregnancy. Higher video use was seen in married participants and those with a higher education level, while Black participants and those with a history of preterm birth had decreased use.

At 25 weeks, long-term outcome knowledge was 88.5% in the intervention group and 73.2% in the control group. In post hoc analyses, 57.9% of the intervention group and only 3.6% of the control group successfully reported the 3 options for periviable birth treatment in the delivery room.
Knowledge was further improved in P3 group participants who watched more videos, with an estimated 2.2% increase in Parent Prematurity Knowledge Questionnaire scores for every 5 videos watched. Improved preparedness for a neonatal resuscitation decision was also seen in the intervention group compared to the control group at 25 weeks.

No differences in anxiety were seen between the 2 groups at baseline or during follow-up. Anxiety scores also did not change over time in either group.

Overall, the P3 intervention displayed efficacy in educating patients about preterm birth risks without increasing anxiety. Investigators concluded mobile antenatal prematurity education may benefit patients with preterm birth risk factors.

Reference

Flynn KE, McDonnell SM, Brazauskas R, et al. Smartphone-based video antenatal preterm birth education: the preemie prep for parents randomized clinical trial. JAMA Pediatr. 2023. doi:10.1001/jamapediatrics.2023.1586