# Digital versus non-digital health interventions to improve iron supplementation in pregnant women: a systematic review and meta-analysis

## TL;DR

Digital health interventions improve iron supplement adherence and hemoglobin levels in pregnant women compared to non-digital methods.

## Contribution

This study provides evidence that digital health interventions are more effective than non-digital ones for improving iron supplementation adherence in pregnancy.

## Key findings

- Digital health interventions significantly improve objective adherence rates to iron supplementation in pregnant women.
- Digital interventions also improve hemoglobin levels compared to non-digital methods.
- Subjective adherence behavior and tablet consumption are enhanced with digital health approaches.

## Abstract

To investigate the effects of digital health interventions for improving adherence to oral iron supplementation in pregnant women.

Five databases were searched from their inception to October 2023 with no date restrictions.

Randomized controlled trials (RCTs) that assessed the effects of digital health interventions on adherence to oral iron supplementation (e.g., tablets and capsules) compared to non-digital health interventions for pregnant women were eligible.

We calculated standardized mean differences (SMDs) and mean differences (MDs) with 95% confidence intervals (CIs) for continuous variables using the inverse variance method. We calculated odds ratios (OR) with 95%CI for categorical variables using the Mantel–Haenszel model. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The risk of bias of the included RCTs was assessed using the Cochrane risk of bias tool 2.0.

Ten trials with 1,633 participants were included. Based on 7 trials, digital health interventions can improve objective adherence rate comparing with non-digital health interventions (1,289 participants, OR = 4.07 [2.19, 7.57], p < 0.001, I2 = 69%) in pregnant women. Digital health interventions can improve subjective adherence behavior comparing with non-digital health interventions (3 trials, 434 participants, SMD = 0.82 [0.62, 1.01], p < 0.001, I2 = 0%) in pregnant women. Based on 3 trials, digital health interventions can improve tablets consumption comparing with non-digital health interventions (333 participants, SMD = 1.00 [0.57, 1.42], p < 0.001, I2 = 66%) in pregnant women. Digital health interventions can improve hemoglobin level comparing with non-digital health interventions (7 trials, 1,216 participants, MD = 0.59 [0.31, 0.88], p < 0.001, I2 = 93%) in pregnant women.

Digital health interventions were effective at improving adherence to oral iron supplementation and hemoglobin levels in pregnant women.