Hans van den Heuvel

2 METHODS A systematic literature search was performed in PubMed and EMBASE in June 2017, combining various synonyms for perinatal care and telemedicine and e-health (See Multimedia Appendix 1 for the search strategy). Studies reporting the use of e-health during prenatal, perinatal and postnatal care were included. Because of the rapid developments in this field and our contemporary scope, we excluded articles describing outdated technologies, for example fax communication, phonocardiography and home visits or home care. Screening and reviewing the abstracts and full articles was done by two independent authors (JH and KG). Given the heterogeneity in study methods, used technologies and outcome measurements, results were analysed and presented in a narrative overview of the literature. RESULTS Literature search and reference screening provided 71 studies of interest (See Multimedia Appendix 1 for flow diagram of selection of studies). All articles were categorized in six domains, which will be addressed accordingly: Information and e-health use, Lifestyle (gestational weight gain, exercise and smoking cessation), Gestational Diabetes, Mental Health, Low- and middle income countries and Telemonitoring/teleconsulting (See also Figure 1). Table 1 and 2 show the overview of 71 publications in six domains of perinatal care in which e-health use in patient care was described, implemented or compared with standard care. Information and e-health use in pregnancy In 15 studies the characteristics of e-health users in the perinatal period were described (Table 1). Around 88% (31 of 35 participants) owned a smartphone. 11 Usage of websites and pregnancy apps for medical information varies from 50-98%.7, 11-14 Online information seeking behavior is common in pregnant women in general and it is not restricted to women with a special profile based on age, education or social support. 7 Increased knowledge on pregnancy complications has also shown to reduce maternal anxiety and costly hospital visits. 15 16 Factors associated with app use in pregnancy are younger age, nulliparity, lower self-rated health and higher education. Furthermore, 25% (56/219) of questioned women showed interest in a tailored pregnancy app initiated by their healthcare provider. 7,14 The most searched topics are fetal development, pregnancy complications, healthy lifestyle during pregnancy, generic and specific guidance/advices during pregnancy and lactation. 13,17 Although they value the online medical information as moderately reliable, 71 to 75% (582/800) of the women do not discuss the information found on Internet with their gynecologist. 17,18 One study reported that their lifestyle app helped women to initiate the LITERATURE OVERVIEW OF E-HEALTH IN PERINATAL CARE 21