BACKGROUND Pregnancy mobile application (apps) are becoming increasingly popular, with parents-to-be seeking information related to their pregnancy and their baby through mobile technology. This increase raises the need for prenatal apps with evidence-based content that is to be personalized and reliable. Previous studies have looked at whether prenatal apps impact health and behavior outcomes among pregnant and postpartum individuals; however, research has been limited. OBJECTIVE The primary

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... jective of this study is to assess whether use of a health system sponsored mobile app–Circle by Providence–aimed at providing personalized and reliable health information on pregnancy, postpartum recovery, and infant care is associated with improved health outcomes and increased healthy behaviors and knowledge among users. METHODS This observational study compared app users and app non-users using a self-reported survey and electronic medical records. The study took place over 18 months and was conducted at the Providence St. Joseph Health system in Portland, Oregon. The sample included patients who received prenatal care at one of seven Providence clinics and had a live birth at a Providence hospital. Recruitment occurred on a rolling basis and only those who completed the survey were included. Survey respondents were separated into app users and app non-users and survey responses and clinical outcomes were compared across groups using univariate and adjusted multivariate logistic regression. RESULTS A total of 567 participants were enrolled in the study – 167 in the app user group and 400 in the non-user group. We found statistically significant differences between the two groups on certain behavior outcomes: subjects who used the app had 75% greater odds of breastfeeding beyond 6 months postpartum (P=0.012), were less likely to miss prenatal appointments (P=0.046), and were 50% more likely to exercise 3 or more times a week during pregnancy (P=0.044). There were no differences on nutritional measures, including whether they took prenatal vitamins, ate five fruits or vegetables a day, or drank caffeine. We found no differences on many of the infant care outcomes, however, there was an increase in awareness of "purple crying." Finally, there were no significant differences in measured clinical health outcomes, including cesarean births, length of hospital stay (in minutes), low birth weight infants, pre-term births, small for gestational age births, large for gestational age births and neonatal intensive care unit (NICU) stays. CONCLUSIONS The use of a Circle app, which provides access to personalized and evidence-based health information, was associated with an increase in certain healthy behaviors and health knowledge while there was no impact on clinical health outcomes. More research is needed to determine the impact of mobile prenatal apps on healthy pregnancies, clinical health outcomes, and infant care. CLINICALTRIAL