Thin evidence base for smartphone apps targeting perinatal mental health

Smartphone applications aimed at supporting perinatal mental health are proliferating rapidly, but very few are supported by rigorous clinical evidence, according to a new narrative review assessing the US app marketplace. The findings raise concerns about the role of these tools in clinical care and highlight the need for more robust evaluation before widespread adoption.

“The objective for our narrative review was to evaluate the landscape of publicly available smartphone apps marketed to support perinatal mental health in the US and assess the extent to which these apps are supported by empirical evidence to support perinatal mental health outcomes,” said Erin Chang, an MD-ScM candidate at the Warren Alpert Medical School of Brown University.

The investigators conducted a systematic search of the 2 largest US app platforms. “We went straight to the 2 big app marketplaces in the US, the Apple App Store and the Google Play Store,” Chang said. “We use broad search terms like ‘maternal mental health’ and ‘postpartum health’ to capture any app aimed at supporting mental health during pregnancy or in the first year postpartum.”

Apps were then screened for those offering a true mental health intervention. “We then narrowed the list of apps that offered a true mental health intervention, things like mood tracking, psycho education, mindfulness, or even direct interfacing with behavioral health specialists,” Chang said. For each eligible app, the team searched PubMed and ClinicalTrials.gov to identify supporting studies and graded evidence using the US Preventive Services Task Force (USPSTF) framework.

The scope of the marketplace contrasted sharply with the available evidence. “We started with nearly 600 apps, and after removing duplicates and applying our inclusion criteria, only 38 apps actually focused on perinatal mental health in a meaningful way,” Chang said. “And of those 38, only 3 apps…had any published research that included patient reported outcomes. So essentially, the evidence base is extremely thin.”

Among those 3 apps, 1 had moderate-quality evidence (USPSTF Grade B), whereas 2 were supported only by insufficient evidence (Grade I). Six additional apps (16%) had ongoing randomized controlled trials evaluating efficacy.

Given this landscape, Chang emphasized caution in clinical use. “Without strong Grade A or B evidence, we're not quite at a place yet where OB/GYNs can recommend these apps as definitive treatments,” she said. “Instead, OB/GYNs should utilize these perinatal mental health apps as adjunctive tools.”

In practice, that means framing apps as supportive rather than therapeutic. “This could look like positioning apps as supportive resources, particularly those that integrate evidence-based therapeutic interventions, like psychoeducation modules, guided mindfulness, or symptom trackers that increase symptom awareness,” Chang said.

Some apps may also complement established standards of care. “Several apps can also be used in established standards of care, such as those that offer digital means of already-validated treatments or screening tools,” she said. “For example, there are several apps that offer virtual options to do the perinatal or the Edinburgh perinatal depression scale, and also apps that offer ways to virtually meet and do telehealth appointments with certified psychotherapists or psychiatrists.”

Ultimately, the authors argue that greater accountability is needed as digital mental health continues to expand. Prioritizing the development and testing of evidence-based perinatal mental health apps, they conclude, will be essential to ensure safety, efficacy, and value-based care for pregnant and postpartum patients.

Reference:

Chang E, Lewkowitz AK, Unger JA, Garfield CF, Miller ES. Smartphone applications to support perinatal mental health. Obstet Gynecol. 2026 Feb 1;147(2):229-238. doi:10.1097/AOG.0000000000006139