Effect of Nursing Intervention Supported by Mobile Health Applications on Asthma Control, Maternal and Neonatal Outcomes Among Pregnant Women with Asthma.

BACKGROUND: Asthma during pregnancy is associated with adverse maternal and neonatal outcomes. Nursing education, self-management support, and mobile health (mHealth) technologies may support asthma management during pregnancy. AIM: This study evaluated the effect of a structured nursing intervention supported by an mHealth application on asthma control, treatment adherence, and self-monitoring, and maternal and neonatal outcomes among pregnant women with asthma. DESIGN AND SETTING: A quasi-experimental pretest-posttest design with a control group was conducted at two Maternal and Child Health Centers in Shebin El-Kom, Menoufia Governorate, Egypt. PARTICIPANTS: A convenience sample of 140 pregnant women with physician-diagnosed asthma was recruited and allocated non-randomly according to the center attended to a study group (n = 70) and a control group (n = 70). The sample size was calculated a priori based on a previous study using a 5% significance level and 80% statistical power, with a 1:1 allocation ratio, resulting in a required sample of 70 participants per group. All recruited participants completed the study, with no withdrawals or loss to follow-up. INTERVENTION: The study group received routine antenatal care plus an eight-week structured nursing intervention consisting of four individualized weekly educational sessions (60-90 min each) addressing asthma management, medication adherence, self-monitoring, trigger avoidance, warning signs, inhaler technique, lifestyle modification, and rhythmic breathing exercises. Participants were trained to use the Airlyn mHealth application for guided breathing exercises, practiced 2-3 times daily, and received telephone/WhatsApp follow-up during weeks 6-8. The control group received routine antenatal care according to usual MCH center procedures. MEASURES: Asthma control was assessed using the Asthma Control Test (ACT). Treatment adherence and self-monitoring were assessed using the Asthma Adherence and Self-Monitoring Questionnaire. Maternal outcomes included hypertensive disorders, gestational diabetes, infections, preterm labor/PPROM, hemorrhage, and mode of delivery. Neonatal outcomes included birth weight, Apgar scores, respiratory distress and respiratory support, NICU admission and length of stay, and condition at discharge. The researcher-developed instruments underwent expert assessment of content validity and assessment of internal consistency before use. RESULTS: Baseline ACT scores were comparable between the study and control groups (14.5 ± 4.2 vs. 14.1 ± 4.3; mean difference = 0.4; p = 0.580). Following the intervention, ACT scores were higher in the study group than in the control group (19.7 ± 3.6 vs. 15.2 ± 4.2; mean difference = 4.5; 95% CI: 3.189-5.811; p < 0.001; Cohen's d = 1.147). Well-controlled asthma was observed in 75.7% of the study group compared with 17.1% of the control group (p < 0.001). Treatment adherence and self-monitoring scores were also better in the study group (5.6 ± 2.7 vs. 9.1 ± 3.1; mean difference = -3.5; 95% CI: -4.476 to -2.524; p < 0.001; Cohen's d = 1.199). The overall maternal outcome score was more favorable in the study group (3.5 ± 1.7 vs. 6.1 ± 2.6; mean difference = -2.6; 95% CI: -3.340 to -1.860; p < 0.001; Cohen's d = 1.174), as was the overall neonatal outcome score (7.7 ± 2.2 vs. 5.5 ± 2.1; mean difference = 2.2; 95% CI: 1.480-2.920; p < 0.001; Cohen's d = 1.022). Significant between-group differences were also observed in birth weight, Apgar scores, respiratory distress, and NICU admission. CONCLUSIONS: Participants who received the structured nursing intervention supported by the Airlyn mHealth application were associated with improved asthma control, treatment adherence, and self-monitoring, as well as more favorable maternal and neonatal outcomes, compared with those receiving routine antenatal care. However, the quasi-experimental design, convenience sampling, and non-randomized allocation limit causal interpretation and the generalizability of the findings. Therefore, the findings should be interpreted cautiously. RECOMMENDATIONS: Larger randomized controlled trials with standardized protocols, adequate sample sizes to evaluate maternal and neonatal outcomes, and longer follow-up periods are recommended to confirm these findings and further assess their clinical relevance.