The curriculum of our mobile-based prenatal education was designed and implemented by a multidisciplinary maternal care team at the PUMCH in Beijing, China. This team includes obstetricians, nutritionists, psychologists, dentists, dermatologists, and rehabilitation specialists, all possessing extensive expertise with over 20 years of traditional prenatal education. Drawing upon evidence-based insights gathered from pregnant women [21,22], the PUMCH team developed a comprehensive curriculum comprising a total of 436 courses, organized into 9 topics, which are obstetrical knowledge, gestational nutrition, daily health care, complications, obstetric examination, pregnancy psychology, painless childbirth, neonatal care, and postpartum recovery.

To optimize the learning experience, the courses were structured to span the entire duration of pregnancy. Roughly 1-2 courses were made available for each topic daily, and each course required just about 5 minutes to complete. This scheduling accommodated the busy routines of pregnant women, enabling them to learn effectively during shorter, fragmented periods of time. Furthermore, 2 external nurses conducted individual reviews of the developed courses to maintain the quality of our content. To enhance the knowledge acquisition experience, these courses were presented in a multimedia format, including articles and videos.

In addition, all courses were seamlessly integrated into the official PUMCH app, which provides a wide range of patient services, including registration, payment, and health education. Upon visiting the obstetrician and completing the registration process, pregnant women were granted authorized access to the PUMCH mobile prenatal education curriculum through this official app. This convenient platform allowed pregnant women to access comprehensive prenatal education at their convenience, free from the constraints of location and time that are often associated with traditional prenatal programs.

Recognizing that different trimesters of pregnancy require specific knowledge, we automated the course recommendations for pregnant women based on their current pregnancy trimester. Throughout the pregnancy journey, these tailored course recommendations were delivered daily, ensuring that expectant mothers received knowledge precisely suited to their specific stage of pregnancy.

To evaluate the effectiveness of the PUMCH mobile prenatal education program, we conducted multiple comparisons to assess its impacts on the pregnancy outcomes of registered pregnant women. This evaluation aimed to (1) determine whether completing courses can reduce the occurrence of adverse pregnancy outcomes in comparison to not participating in any courses, and (2) examine the impact of learning specific topics on pregnancy outcomes among pregnant women who completed the courses.

As we used anonymized and deidentified data and did not constitute human research, the need for written informed consent was waived by the Ethics Review Board of the PUMCH due to the retrospective nature of the study. This study was approved by the Ethics Review Board of the PUMCH (I-22PJ122). All procedures were performed in accordance with the Declaration of Helsinki.

In this study, we implemented a total of 436 mobile-based prenatal courses with valuable support from the PUMCH multidisciplinary maternal care team. These courses included 234 educational videos and 202 articles. An illustrative example of course titles and formats for 3 topics is presented in Table 1.

These courses were accessible to pregnant women through the official PUMCH app. In addition to receiving daily course recommendations tailored to their trimesters, pregnant women had the flexibility to explore other courses of interest, allowing them to acquire prenatal knowledge according to their individual needs. Figure 2 provides snapshots of the PUMCH mobile prenatal education interface. The first snapshot reveals the easy accessibility of our program on the main page of the official app, seamlessly integrated with other medical services. The second snapshot highlights the prenatal course recommended to pregnant women, taking into account their specific pregnancy stage in terms of the number of days. As illustrated in the third and fourth snapshots, all courses were available in either article or video format.

A total of 1941 pregnant women were included in the study, with 1521 of them not completing any courses, while 420 completed at least 1 course. Table 2 presents the maternal characteristics of participants in these 2 groups. The average age of participants in both groups is approximately 32 years. In the group that did not complete the courses, the proportion of participants of advanced maternal age (35 years of age or older) is 25.05% (381/1521), which is about 3% higher than the group that completed courses. There is a statistically significant difference in prepregnancy BMI values (kg/m²) between the 2 groups (P=.04), with participants in the completing group having higher BMI values than those in the not completing group. Additionally, parity and gravidity also exhibit significant differences between the 2 groups with very small P values (P<.001). In the completing group, participants have a higher proportion of nullipara, primigravida, or both.

In the PUMCH mobile prenatal education program, we have a total of 436 courses available, with 234 presented in video format and 202 in article format. These courses are categorized into 1 topic, and the topic with the highest number of courses is obstetrical knowledge, accounting for approximately 24.5% (107/436) of the total course count. Among the 420 pregnant women who completed at least 1 course, we observed that 43.8% (184/420) of them began completing courses during their first trimester, and a significant 86% (361/420) started course completion during their first and second trimesters. Table 3 shows that the topics of obstetrical knowledge and daily health care were the most popular, with completion rates over 80% (351/420 and 344/420). Furthermore, when considering the average number of participants per course, it was obvious that the topics of pregnancy psychology and postpartum recovery had the most attention. Detailed participant counts for each topic are provided in Table 3.

Table 4 displays the comparisons of adverse pregnancy outcomes between the 2 groups. There are statistically significant differences in adverse pregnancy outcomes for GDM, postpartum infection, induced abortion, fetal intrauterine distress, and neonatal malformation between the 2 groups. For instance, the odds ratio (OR) value for the noncompleting group compared with the completing group in GDM is 0.3043, which means that the odds of GDM in the completing group are approximately 30% lower than the odds in the noncompleting group. This significant OR value indicates that participants in the completing group have a lower risk of GDM compared with noncompleting group. Except for neonatal malformation, for which there were no cases in the completing group, multiple logistic regressions were conducted for each significant adverse pregnancy outcome, adjusted by maternal age group, BMI group, parity, and gravidity. GDM, postpartum infection, and fetal intrauterine distress remained statistically significant. Detailed results are provided in Table S1 in Multimedia Appendix 1. However, there were no significant differences observed between the 2 groups for gestational hypertension, preterm birth, PROM, macrosomia, and small for gestational age (SGA).

We examined whether completing specific course topics reduced adverse pregnancy outcomes among participants in the completing group. For each topic, participants were categorized into 2 groups: those who completed the topic and those who did not complete it. Table 5 presents the significant differences in adverse pregnancy outcomes between the “completing the topic” group and the “not completing the topic” group. Participants who completed the pregnancy psychology topic course experienced a reduced risk of PROM compared with the “not completing the topic” group (P=.03 and OR=0.5027). Additional results for pairs of topics and adverse pregnancy outcomes are available in Table S2 in Multimedia Appendix 1.

In this study, we have collaboratively designed a mobile-based prenatal education program with the PUMCH multidisciplinary maternal care team. This mobile-based curriculum offers 436 courses across 9 topics and is accessible through the official PUMCH app, providing pregnant women with valuable guidance throughout their entire pregnancy journey. A mixed methods study has indicated that web-based prenatal education can positively influence lifestyle choices and the ease of accessing health information during pregnancy [21]. The COVID-19 pandemic has heightened the importance of easily accessible health care resources, especially for pregnant women at increased risk of severe illness if infected [24]. The World Health Organization (WHO) advises pregnant women to avoid crowded and poorly ventilated indoor spaces to reduce the risk of COVID-19 transmission. Therefore, there is an urgent need for cost-effective and easily accessible mobile-based prenatal education programs to support expectant mothers, especially in these challenging times.

To evaluate the effectiveness of our mobile-based program, we compared adverse pregnancy outcomes between the group that completed courses and the group that registered but did not complete any courses. Our data, derived from real-world app records, revealed an imbalance between the 2 groups, with approximately 21.6% (420/1941) of registered pregnant women completing at least 1 course. Significantly, pregnant women who completed courses demonstrated a reduced risk of adverse pregnancy outcomes such as GDM, postpartum infection, induced abortion, fetal intrauterine distress, and neonatal malformation. For instance, GDM, a common pregnancy complication, is associated with the risk of hyperglycemia and adverse short- and long-term health outcomes for both mothers and infants [25]. Our curriculum addresses GDM directly, offering courses on improving physical activity and nutrition, potentially lowering the risk of GDM. Taking those courses shows the potential to lower the risk of GDM by delivering knowledge about improving physical activity, nutrition intake, etc [26,27].

Furthermore, we analyzed the behavior of pregnant women who completed specific topic courses in the completing group. While the impact of completing the specific topic courses on reducing adverse pregnancy outcomes was generally modest, we identified 2 significant findings. First, completing the pregnancy psychology course was associated with a statistically significant reduction in the risk of PROM, and second, completing the pregnancy nutrition course may prevent the occurrence of SGA infants.

Nutrition during pregnancy plays an important role in lifelong health [28], especially in terms of brain development and behavior [29]. As many adverse birth outcomes originate during pregnancy [30], awareness of nutritional balance and healthy dietary habits can reduce the risk of outcomes like SGA. SGA, typically defined as birthweight below the tenth percentile [31], is a known risk factor for stillbirth [32]. Previous research has demonstrated that nutrition interventions and adopting healthy dietary patterns can significantly lower the risk of SGA [33]. Moreover, maternal creatine supplementation during pregnancy has shown the potential to reduce the risk of neonatal asphyxia, as evidenced in small animal studies [34].

We observed that 86% (361/420) of participants started course completion during their first and second trimesters, in line with survey results on Chinese web-based prenatal education [22]. Pregnancy psychology and postpartum recovery are the most popular topics. These findings can inform the development of additional educational courses on both topics and further engage pregnant women.

Our mobile-based prenatal education program serves as a valuable source of information, enhancing pregnant women’s knowledge regarding gestational nutrition, recommended practices, and anticipated challenges. Given that pregnant women increasingly seek information on the web [35], our program not only meets the rising demand for accessible mobile prenatal education but also bridges a significant gap in this field by offering a cost-effective and efficient source of information [22,35]. By promoting this curriculum more widely, we aim to encourage healthier lifestyles and enhance pregnancy outcomes.

This study has several limitations. First, the effectiveness of our mobile-based prenatal education program was assessed among pregnant women from a single center, specifically PUMCH in Beijing, and its generalizability to other settings needs to be confirmed. Second, the analysis was based on 1 year of data, and a larger sample size with a longer duration would provide more robust estimates of the effectiveness of our mobile-based program. Third, as this is a retrospective study with outcomes and information collected post pregnancy, potential confounders and biases may have influenced the results. To establish the effectiveness of mobile-based prenatal education more conclusively, future research should consider conducting randomized controlled trials or prospective cohort studies.

This study outlined the development of a mobile-based prenatal education program and assessed its effectiveness by analyzing adverse pregnancy outcomes among pregnant women. The findings indicate that the mobile-based prenatal education curriculum has the potential to reduce adverse outcomes in pregnant women, offering valuable support for health care providers in delivering effective prenatal education services. The growing prominence of mobile prenatal education presents an opportunity to enhance pregnancy outcomes and the health of both mothers and children.