. 2020 Sep 17;4:36. doi: 10.18332/ejm/126625

Table 4.

Key findings of included articles

Author(s) Year	Key findings of publication
Dalton et al.²⁷ 2014	Midwives acknowledged that pregnant women are increasingly using the internet and mobile technologies to seek pregnancy related information. Midwives recognised both the potential benefits and possible risks in the use of Information Communication Technologies (ICTs) in the delivery of pregnancy-related health information, but expressed significant concerns around the accuracy of the information available online.
Fredriksen et al.²⁸ 2018	All of the participants had experienced pregnant women having web-based knowledge either directly or indirectly Generally, participants were ambivalent towards women using eHealth to source pregnancy related information and were especially sceptical about web forums as they were deemed as misinformative. Many of the participants felt that pregnant women’s eHealth literacy challenged their professional role and authority, subsequently having a negative impact on the patient-professional relationship. Midwives felt it was time consuming to help pregnant women differentiate between accurate and untrustworthy information and that pregnant women using the internet to obtain pregnancy-related information had resulted in requests for extra consultations due to anxieties and worries around the information they had sought. Midwives were more net friendly in their clinical practice than other participants, and distributed links to trustworthy online information, encouraged against web forums and encouraged critical thinking by their patients when appraising the quality of the information they had sourced.
Grassl et al.³⁰ 2018	There is an ambivalent attitude towards the use of telemedicine amongst healthcare professionals. Midwives felt that an app which pregnant women could consult when feeling unwell or experiencing unfamiliar symptoms that would give advice or advise them to see a doctor would lead to unnecessary emergency consultations increasing their workload. 72.6% of participants had doubts about mHealth developments in antenatal care and few would recommend this to their patients.
Johnsen¹⁸ 2014 information.	Overall, midwives were mostly negative about the use of the internet by pregnant women to gather pregnancy-related information Midwives raised concerns around the reliability and accuracy of information being acquired, and felt this caused pregnant women to rely upon the midwives to authenticate this information. Midwives felt the volume of information caused information clutter, which they often had to clear. Midwives felt their knowledge and experience was undermined by information gathered by pregnant women in chatrooms, especially when they valued the information from other pregnant women more than that of the midwife. Although pregnant women were extremely updated on health information retrieved from the internet, midwives felt the women were extremely unlikely to act upon this without consulting them first.
Lagan et al.¹⁹ 2011	Midwives recognised that pregnant women are increasingly using the internet to gather pregnancy related information and just under three-quarters of participants recognised the benefits of this. Despite this 90% of participants expressed significant concerns about the accuracy of information available on the internet. 89% of midwives perceived pregnant women to be increasingly using the internet. This was noted in each individual country included in the study, except Jordan. 73% of respondents agreed or strongly agreed that the internet improves the pregnant woman’s knowledge of pregnancy-related health conditions and treatments, and gives them more control over the choices surrounding their pregnancy. In the study years of 2005–2006, 86% of midwives had had experience of women discussing information they had acquired from the internet, with the main sources cited to obtain information being Google and Yahoo.
Lagan et al.¹⁶ 2007	The results suggested an increased use of the internet to acquire pregnancy-related information. Midwives were positive about the use of the internet by pregnant women, and felt it has the ability to improve healthcare delivery and information dissemination. 69% (n=24) of midwives reported in the last year (2004–2005) a pregnant woman had discussed information with them that they had retrieved from the internet, much of which was obtained from search engines such as Yahoo or Google.
Lanssens et al.³¹ 2019	Although most of the participants had little or no experience with remote monitoring technology, they reported positive perceptions of this, and felt it was not a threat to their everyday work. Remote monitoring was perceived as an important component in the follow up of high-risk pregnancies, with 77% of midwives believing that it improved the care for high risk pregnancies and 80% reporting that it added value to pregnant women.
Soltani et al.³² 2012	Although quicker to identify limitations and risks, midwives were generally positive about the use of a text messaging service to support pregnant obese women with making healthy lifestyle choices. Midwives believe the scheme had the ability to modernise, motivate, remind and reduce the sense of isolation amongst pregnant obese women, all of which could effectively help them to make healthy lifestyle choices. Midwives were quick to identify the possibility of the service being offensive and creating pressure or guilt amongst its users. Midwives felt it important to make the service available to all pregnant women, and emphasised the message tone, content, and other forms of supportive mobile technology should be given special attention. The specialist midwife felt positive about the use of a text messaging service to promote healthy gestational weight gain as they were able to build rapport and tailor the messages, but felt negative about the logistics of the service. Relationship building was perceived as a major advantage of the initiative, as the midwife was able to create trust through appointments with the pregnant women to support them alongside the text messaging system and self-monitoring activities. The midwife felt personalised support was beneficial as she could tailor messages to encourage or praise each pregnant woman to support their healthier lifestyle changes, and she could also use the mobile technology to refer them to further support services which made this a holistic intervention. The midwife was negative about the information technology and logistics as the lists of messages to select were too long and the process of selecting them had too many stages meaning it was not as time efficient as it could have been.
Wennberg et al.²⁰ 2015	Overall, midwives felt positive about the use of the internet by pregnant women because they believed it made them well-informed, however they were concerned about the accuracy of the information that was being accessed. Midwives felt that women needed professional guidance to interpret this information as they could often be too emotionally oriented, lack rationality, and be too worried to assess the information adequately. Midwives felt that often women had too much confidence in the information they acquired, making them feel like a questioned authority. Midwives often felt less well informed than pregnant on dietary issues as they did not have time to search for the information, leading to feelings of inadequacy. Although they felt listened to, midwives felt unsure of the impact their advice had on the pregnant women’s behaviour.
Weston and Anderson ²⁹ 201	Midwives were mostly negative about the use of the internet by pregnant women due to concerns around their inappropriate use of this, and specifically expressed concerns relating to overuse creating anxiety, pregnant women becoming obsessed by internet usage to acquire information, their poor judgement of the information they acquire, and the unrealistic expectations it creates with regards to managing pregnancy. Midwives felt a beneficial aspect of the internet was that it has the ability to empower pregnant women and act as a discussion trigger, however felt it was often used by pregnant women to challenge the midwives’ provision of care and expertise, and that social media and apps are encouraging women to disbelieve midwives’ advice. Midwives were negative about discussion forums as the experiences shared do not apply to all pregnant women, but were positive about pregnant women using the NHS website
Willcox et al.²¹ 2015	Health professionals were generally negative about the use of mHealth, were quick to identify the associated risks and felt that mHealth was detrimental to the patient-professional relationship. Some health professionals felt that the emergence of technology has shifted the control of information to untrusted sources, and away from trusted health professionals and organisations. Many health professionals expressed concerns regarding the medicolegal risks associated with mHealth, such as the harm to the women (harmful information and privacy issues), and the harm to the professional integrity of health professionals and organisations (intellectual property, privacy, legitimacy concerns). However, others acknowledged mHealth was feasible if these risks were addressed. The unfamiliarity with and fear of mHealth meant some health professionals had limited engagement with and understanding of its ability to support antenatal care. Some health professionals expressed concerns regarding the accessibility of mHealth to women who may not have mobile phone access.