Skip to main content
SpringerLink
Log in

An ethical exploration of pregnancy related mHealth: does it deliver?

  • Scientific Contribution
  • Published:
Medicine, Health Care and Philosophy Aims and scope Submit manuscript

Abstract

Many pregnant women use pregnancy related mHealth (PRmHealth) applications, encompassing a variety of pregnancy apps and wearables. These are mostly directed at supporting a healthier fetal development. In this article we argue that the increasing dominance of PRmHealth stands in want of empirical knowledge affirming its beneficence in terms of improved pregnancy outcomes. This is a crucial ethical issue, especially in the light of concerns about increasing pressures and growing responsibilities ascribed to pregnant women, which may, in turn, be reinforced by PRmHealth. A point can be made that it would be ethically askew if PRmHealth does not lead to improved pregnancy outcomes, while at the same time increasing maternal duties to closely monitor fetal development. We conclude that more research is needed to get a view on the benefits and burdens of PRmHealth in order to ethically assess whether the latter are proportionate to the former. If not, there is a case in saying that endorsement of PRmHealth is overdemanding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. There are, in addition, also apps directed at fertility monitoring and preconception care.

  2. This is the main focus of this article.

  3. It is in this respect interesting to note that attention to the aesthetic dimension of wearable technologies functions as a way to prevent disruptive reactions in the user, and targets a smooth integration in daily life instead (Lupton 2016).

  4. Also see Barassi’s (2017) reflections on choice and digital participation more general.

  5. In low and middle-income countries, PRmHealth can increase antenatal and postnatal care attendance, with observed benefits regarding reduced perinatal mortality, though no general consistent effects on neonatal health outcomes are reported (Sondaal et al. 2016; Dol et al. 2019). The systematic review by Dol et al. (2019) concludes that in these contexts the effect of PRmHealth on maternal and infant health remains unclear, at least in part because of suboptimal reporting on these outcomes which complicates generalizing key findings.

  6. As far as wearable ultrasound technology is concerned, there are relevant ethical discussions on the safety of non-medical use of fetal ultrasound. Professional bodies discourage non-medical use (but not the use of diagnostic ultrasound) though there is no evidence of harmful biological effects linked to ultrasound scanning (Salem et al. 2014). Concerns over non-medical use are related to the ungoverned level of fetal energy exposure. In the past, De Crespigny et al. (2009) argued that the disapproval of non-medical ultrasound is inconsistent, given that technical functioning of non-medical and diagnostic application is similar (e.g. both with appropriate power levels). For the PulseNmore tele-ultrasound application, for instance, details of technical specifications are not accessible, though it is stated that the duration of each scan is limited. In the online mode with physician guidance, however, scan time is unlimited.

References

  • Åhman, Annika, Kristina Edvardsson, Tove A. Fagerli, Elisabeth Darj, Sophia Holmlund, Rhonda Small, and Ingrid Mogren. 2019. A much valued tool that also brings ethical dilemmas - a qualitative study of Norwegian midwives’ experiences and views on the role of obstetric ultrasound. BMC Pregnancy and Childbirth. https://doi.org/10.1186/s12884-019-2178-x.

    Article  Google Scholar 

  • Barassi, Veronica. 2017. BabyVeillance? expecting parents, online surveillance and the cultural specificity of pregnancy apps. Social Media + Society. https://doi.org/10.1177/2056305117707188.

    Article  Google Scholar 

  • Bianchi, Diana W. 2012. From prenatal genomic diagnosis to fetal personalized medicine: Progress and challenges. Nature Medicine 18: 1041–1051.

    Article  Google Scholar 

  • Bonte, Pieter, Guido Pennings, and Sigrid Sterckx. 2014. Is there a moral obligation to conceive children under the best possible conditions? A preliminary framework for identifying the preconception responsibilities of potential parents. BMC Medical Ethics. https://doi.org/10.1186/1472-6939-15-5.

    Article  Google Scholar 

  • Brown, Hannah M., Tamara Bucher, Clare E. Collins, and Megan E. Rollo. 2019. A review of pregnancy iPhone apps assessing their quality, inclusion of behaviour change techniques, and nutrition information. Maternal & Child Nutrition. https://doi.org/10.1111/mcn.12768.

    Article  Google Scholar 

  • Burton-Jeangros, Claudine. 2011. Surveillance of risks in everyday life: The agency of pregnant women and its limitations. Social Theory & Health 9: 419–436.

    Article  Google Scholar 

  • Cawley, Caroline, Hannelore Buckenmeyer, Trina Jellison, Joseph B. Rinaldi, and Keri B. Vartanian. 2020. Effect of a health system-sponsored mobile app on perinatal health behaviors: Retrospective cohort study. JMIR mHealth and uHealth. https://doi.org/10.2196/17183.

    Article  Google Scholar 

  • Chan, Ko Ling, and Mengtong Chen. 2019. Effects of social media and mobile health apps on pregnancy care: Meta-analysis. JMIR mHealth and uHealth. https://doi.org/10.2196/11836.

    Article  Google Scholar 

  • Chervenak, Frank A., and Laurence B. McCullough. 1997. Ethics in obstetrics and gynecology. An overview. European Journal of Obstetrics, Gynecology, and Reproductive Biology 75: 91–94.

    Article  Google Scholar 

  • Cortez, Nathan. 2014. The mobile health revolution? UC Davis Law Review 47: 1173–1230.

    Google Scholar 

  • Daly, Lisa M., Dell Horey, Philippa F. Middleton, Frances M. Boyle, and Vicki Flenady. 2018. The effect of mobile app interventions on influencing healthy maternal behavior and improving perinatal health outcomes: Systematic review. JMIR mHealth and uHealth. https://doi.org/10.2196/10012.

    Article  Google Scholar 

  • Daly, Lisa M., Frances M. Boyle, Kristen Gibbons, Han Le, Janine Roberts, and Vicki Flenady. 2019. Mobile applications providing guidance about decreased fetal movement: Review and content analysis. Women and Birth. https://doi.org/10.1016/j.wombi.2018.07.020.

    Article  Google Scholar 

  • DeBruin, Debra A., and Mary Faith Marshall. 2019. Policing women to protect fetuses: Coercive interventions during pregnancy. In Analyzing violence against women, ed. Wanda Teays, 95–111. Cham: Springer International Publishing.

    Chapter  Google Scholar 

  • Crespigny, De., Thomas Douglas Lachlan, Dominic Wilkinson, and Julian Savulescu. 2009. Risky business: Applying risk/benefit analysis consistently in entertainment ultrasound. Ultrasound in Obstetrics and Gynecology 34: 613–615.

    Article  Google Scholar 

  • Denbow, Jennifer. 2019. Good mothering before birth: Measuring attachment and ultrasound as an affective technology. Engaging Science, Technology, and Society. https://doi.org/10.17351/ests2019.238.

    Article  Google Scholar 

  • Dol, Justine, Brianna Richardson, Gail Tomblin Murphy, Megan Aston, Douglas McMillan, and Marsha Campbell-Yeo. 2019. Impact of mobile health (mHealth) interventions during the perinatal period for mothers in low- and middle-income countries: A systematic review. JBI Database of Systematic Reviews and Implementation Reports 17: 1634–1667. https://doi.org/10.11124/JBISRIR-2017-004022.

    Article  Google Scholar 

  • Dondorp, Wybo, and Guido de Wert. 2020. Ethical issues in maternal-fetal medicine. In Fetal medicine, ed. Pranav Pandya, Ronald Wapner, Dick Oepkes, and Neil Sebire, 139–147. Beijing: Elsevier.

    Chapter  Google Scholar 

  • Dondorp, Wybo, Lieve G. C. Page-Christiaens, and Guido de Wert. 2016. Genomic futures of prenatal screening: Ethical reflection. Clinical Genetics 89: 531–538.

    Article  Google Scholar 

  • Duffy, James M. N., Rachel Rolph, Chris Gale, Martin Hirsch, Khalid S. Khan, Sue Ziebland, and Richard J. McManus. 2017. Core outcome sets in women’s and newborn health: A systematic review. BJOG 124: 1481–1489. https://doi.org/10.1111/1471-0528.14694.

    Article  Google Scholar 

  • Duplaga, Mariusz, and Anna Tubek. 2018. mHealth-areas of application and the effectiveness of interventions. Public Health Management/zdrowie Publiczne i Zarządzanie 16: 155–166.

    Article  Google Scholar 

  • Edvardsson, Kristina, Ann Lalos, Annika Åhman, Rhonda Small, Sophie Graner, and Ingrid Mogren. 2016. Increasing possibilities – Increasing dilemmas: A qualitative study of Swedish midwives’ experiences of ultrasound use in pregnancy. Midwifery 42: 46–53.

    Article  Google Scholar 

  • Lucy, Frith. 2018. The disposable and protected fetus: Contradictions in fetal status. In The fetus as a patient, ed. Dagmar Schmitz, Angus Clarke, and Wybo Dondorp, 17–27. London & New York: Routledge.

    Google Scholar 

  • Fuld, Hillel. 2020. Hillel's tech corner: Pregnancy care done right. Jerusalem Post. https://www.jpost.com/opinion/hillels-tech-corner-pregnancy-care-done-right-637766. Accessed 22 Jan 2021.

  • Guo, H., Y. Zhang, P. Li, P. Zhou, L.-M. Chen, and S.-Y. Li. 2019. Evaluating the effects of mobile health intervention on weight management, glycemic control and pregnancy outcomes inpatients with gestational diabetes mellitus. Journal of Endocrinological Investigation 42: 709–714.

    Article  Google Scholar 

  • Hughson, Jo-Anne Patricia., Oliver Daly, Robyn Woodward-Kron, John Hajek, and David Story. 2018. The rise of pregnancy apps and the implications for culturally and linguistically diverse women: Narrative review. JMIR mHealth and uHealth. https://doi.org/10.2196/mhealth.9119.

    Article  Google Scholar 

  • Hussain, Tasmeen, Patricia Smith, and Lynn M. Yee. 2020. Mobile phone–based behavioral interventions in pregnancy to promote maternal and fetal health in high-income countries: Systematic review. JMIR mHealth and uHealth. https://doi.org/10.2196/15111.

    Article  Google Scholar 

  • Johnson, Sophia Alice. 2014. “Maternal devices”, social media and the self-management of pregnancy, mothering and child health. Societies 4: 330–350.

    Article  Google Scholar 

  • Lagan, Briege, Marlene Sinclair, and George Kernohan. 2011. What is the impact of the internet on decision-making in pregnancy? A global study. Birth 38: 336–345.

    Article  Google Scholar 

  • Lautarescu, Alexandra, Michael Craig, and Vivette Glover. 2020. Prenatal stress: Effects on fetal and child brain development. In International review of neurobiology, ed. Angela Clow and Nina Smyth, 17–40. Cambridge: Academic Press.

    Google Scholar 

  • Leung, John Lai Yin., and Samantha Mei Che. Pang. 2009. Ethical analysis of non-medical fetal ultrasound. Nursing Ethics 16: 637–646.

    Article  Google Scholar 

  • Lowe, Pam. 2016. Reproductive health and maternal sacrifice. London: Palgrave Macmillan.

    Book  Google Scholar 

  • Lupton, Deborah, and Sarah Pedersen. 2015. What is happening with your body and your baby’s: Australian women’s use of pregnancy and parenting apps. Canberra: News Media Research Centre, University of Canberra.

    Google Scholar 

  • Lupton, Deborah. 2013. The social worlds of the unborn. New York: Palgrave Macmillan.

    Book  Google Scholar 

  • Lupton, Deborah. 2016. The quantified self. A sociology of self-tracking. Cambridge: Polity Press.

  • Lupton, Deborah. 2017. ‘It just gives me a bit of peace of mind’: Australian women’s use of digital media for pregnancy and early motherhood. Societies 27: 25–37.

    Article  Google Scholar 

  • Lyerly, Anna Drapkin, Lisa M. Mitchell, Elizabeth M. Armstrong, Lisa H. Harris, Rebecca Kukla, Miriam Kuppermann, et al. 2009. Risk and the pregnant body. Hastings Center Report 39: 34–42.

    Article  Google Scholar 

  • McMahan, Jeff. 2006. Paradoxes of abortion and prenatal injury. Ethics 116: 625–655.

    Article  Google Scholar 

  • MedGadget. 2020. PulseNmore at-home tele-ultrasound for pregnant women. MedGadget. https://www.medgadget.com/2020/08/pulsenmore-at-home-tele-ultrasound-for-pregnant-women.html. Accessed 22 Jan 2021.

  • Mhajna, Muhammad, Nadav Schwartz, Loren Levit-Rosen, Steven Warsof, Michal Lipschuetz, Martin Jakobs, Jack Rychik, Christof Sohn, and Simcha Yagel. 2020. Wireless, remote solution for home fetal and maternal heart rate monitoring. American Journal of Obstetrics & Gynecology MFM. https://doi.org/10.1016/j.ajogmf.2020.100101.

    Article  Google Scholar 

  • Musgrave, Loretta M., Caroline S. E. Homer, Nathalie V. Kizirian, and Adrienne Gordon. 2019. Addressing preconception behaviour change through mobile phone apps: A protocol for a systematic review and meta-analysis. Systematic Reviews. https://doi.org/10.1186/s13643-019-0996-6.

    Article  Google Scholar 

  • Neff, Gina, and Dawn Nafus. 2016. Self-tracking. Cambridge: MIT Press.

    Book  Google Scholar 

  • O’Donnell, Betsy, Adam K. Lewkowitz, Juan Vargas, and Marya Zlatnik. 2016. Examining pregnancy-specific smartphone applications: What are patients being told? Journal of Perinatology 36: 802–807.

    Article  Google Scholar 

  • Ovaere, Céline., Alex Eggink, Jute Richter, Titia E. Cohen-Overbeek, Frank Van Calenbergh, Katrien Jansen, Dick Oepkes, Roland Devlieger, Luc De Catte, and Jan Deprest. 2015. Prenatal diagnosis and patient preferences in patients with neural tube defects around the advent of fetal surgery in Belgium and Holland. Fetal Diagnosis and Therapy 37: 226–234.

    Article  Google Scholar 

  • Overdijdink, Sanne B., Adeline Velu, Ageeth N. Rosman, Monique D. M. van Beukering, Marjolein Kok, and Regine P. M. Steegers-Theunissen. 2018. The usability and effectiveness of mobile health technology–based lifestyle and medical intervention apps supporting health care during pregnancy: Systematic review. JMIR mHealth and uHealth. https://doi.org/10.2196/mhealth.8834.

    Article  Google Scholar 

  • Palmer, Melissa J., Nicholas Henschke, Hanna Bergman, Gemma Villanueva, Nicola Maayan, Tigest Tamrat, Garrett L. Mehl, Claire Glenton, Simon Lewin, Marita S. Fønhus, and Caroline Free. 2020. Targeted client communication via mobile devices for improving maternal, neonatal, and child health. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD013679.

    Article  Google Scholar 

  • PulseNmore. 2020. Specifications. PulseNmore. https://pulsenmore.com/pulsenmore-es. Accessed 22 Jan 2021.

  • Ramakrishnan, Usha, Frederick Grant, Tamar Goldenberg, Amanda Zongrone, and Reynaldo Martorell. 2012. Effect of women’s nutrition before and during early pregnancy on maternal and infant outcomes: A systematic review. Paediatric and Perinatal Epidemiology 26: 285–301.

    Article  Google Scholar 

  • Romanis, Elizabeth Chloe, Dunja Begović, Margot R. Brazier, and Alexandra Katherine Mullock. 2020. Reviewing the womb. Journal of Medical Ethics. https://doi.org/10.1136/medethics-2020-106160.

    Article  Google Scholar 

  • Runkle, Jennifer, Maggie Sugg, Danielle Boase, Shelley L. Galvin, and Carol C. Coulson. 2019. Use of wearable sensors for pregnancy health and environmental monitoring: Descriptive findings from the perspective of patients and providers. Digital Health. https://doi.org/10.1177/2055207619828220.

    Article  Google Scholar 

  • Salem, Shia, Kenneth Lim, Michiel HofVanden, and SOGC Diagnostic Imaging Committee. 2014. Joint SOGC/CAR policy statement on non-medical use of fetal ultrasound. Journal of Obstetrics and Gynaecology Canada 36: 184–185.

    Article  Google Scholar 

  • Julian, Savulescu. 2007. Future people, involuntary medical treatment in pregnancy and the duty of easy rescue. Utilitas 19: 1–20.

    Article  Google Scholar 

  • Schmitz, Dagmar, Angus Clarke, and Wybo Dondorp. 2018. The fetus as a patient: A sustainable approach for clinical interactions in the field of new prenatal medicine? In The fetus as a patient, ed. Dagmar Schmitz, Angus Clarke, and Wybo Dondorp, 3–14. London & New York: Routledge.

    Chapter  Google Scholar 

  • Schramm, Katharina, Niklas Grassl, Juliane Nees, Janine Hoffmann, Holger Stepan, Thomas Bruckner, Markus W. Haun, Imad Maatouk, Markus Haist, Timm C. Schott, Christof Sohn, and Sarah Schott. 2019. Women’s attitudes toward self-monitoring of their pregnancy using noninvasive electronic devices: Cross-sectional multicenter study. JMIR mHealth and uHealth. https://doi.org/10.2196/11458.

    Article  Google Scholar 

  • Smith, Chris, Judy Gold, Thoai D. Ngo, Colin Sumpter, and Caroline Free. 2015. Mobile phone-based interventions for improving contraception use. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD011159.pub2.

    Article  Google Scholar 

  • Segers, Seppe, Guido Pennings, and Heidi Mertes. 2020. The ethics of ectogenesis-aided foetal treatment. Bioethics 34: 364–370.

    Article  Google Scholar 

  • Smajdor, Anna. 2011. Ethical challenges in fetal surgery. Journal of Medical Ethics 37: 88–91.

    Article  Google Scholar 

  • Sondaal, Stephanie Felicie, Joyce Linda Victoria, Mary Amoakoh-Coleman. Browne, Alexander Borgstein, Andrea Solnes Miltenburg, et al. 2016. Assessing the effect of mhealth interventions in improving maternal and neonatal care in low- and middle-income countries: A systematic review. PLoS ONE. https://doi.org/10.1371/journal.pone.0154664.

    Article  Google Scholar 

  • Sundelin-Wahlsten, Viveka, Gunilla Hallberg, and Anders Helander. 2017. Higher alcohol consumption in early pregnancy or low-to-moderate drinking during pregnancy may affect children’s behaviour and development at one year and six months. Acta Paediatrica 106: 446–453.

    Article  Google Scholar 

  • Thomas, Gareth M., and Lupton Deborah. 2016. Threats and thrills: Pregnancy apps, risk and consumption. Health, Risk & Society 17: 495–509.

    Article  Google Scholar 

  • Tripp, Nadia, Kirsten Hainey, Anthony Liu, Alison Poulton, Michael Peek, Jinman Kim, and Ralph Nanan. 2014. An emerging model of maternity care: Smartphone, midwife, doctor? Women and Birth: Journal of the Australian College of Midwives 27: 64–67.

    Article  Google Scholar 

  • van den Heuvel, Josephus, Katrien Groenhof, Jan Veerbeek, Wouter van Solinge, Titia Lely, Arie Franx, and Mireille N. Bekker. 2018. eHealth as the next-generation perinatal care: An overview of the literature. Journal of Medical Internet Research. https://doi.org/10.2196/jmir.9262.

    Article  Google Scholar 

Download references

Funding

This paper is part of a Ghent University Special Research Fund research project titled ‘The fetal patient and the future of prenatal medicine: a philosophical and ethical inquiry.’

Author information

Authors and Affiliations

  1. Department of Philosophy and Moral Sciences, Bioethics Institute Ghent, Ghent University, Ghent, Belgium

    Guido Pennings

  2. Department of Philosophy and Moral Sciences, Bioethics Institute Ghent & METAMEDICA, Ghent University, Ghent, Belgium

    Seppe Segers & Heidi Mertes

Authors
  1. Seppe Segers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heidi Mertes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guido Pennings
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SS is the primary author and conceptualised the manuscript. HM and GP coauthored and revised critically for important intellectual content. All authors approved the final version.

Corresponding author

Correspondence to Seppe Segers.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Segers, S., Mertes, H. & Pennings, G. An ethical exploration of pregnancy related mHealth: does it deliver?. Med Health Care and Philos 24, 677–685 (2021). https://doi.org/10.1007/s11019-021-10039-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11019-021-10039-y

Keywords

Search

Navigation