Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Smartphone-based psycho-education interventions may be a low-cost, user-friendly alternative to manpower-consuming face-to-face antenatal classes to educate expectant mothers. Objective: This study aimed to examine empirically whether such intervention would lead to reduced postnatal depression (PND), anxiety, and stress, and result in a better health-related quality of life (QoL). Methods: A single-blind randomised clinical trial was conducted in Hong Kong during 2016 and 2017. All first-time expectant mothers, less than 24 weeks gestation, attending the antenatal clinic at a public hospital were included. Participants were assigned to the intervention and the control groups by the lots prepared by interviewers and randomly assigned to sealed opaque envelopes by stratified randomization. The intervention is a smartphone-based program involving a psycho-educational mobile application provided in addition to the treatment as usual (TAU) services from the hospital. Participants were followed up until 4-week postpartum. The primary outcome was the difference in the levels of pregnancy depression and PND, assessed by the Edinburgh Postnatal Depression Scale (EPDS). The intention-to-treat approach was employed in the analyses. Results: The final sample was 660 expectant mothers (nintervention = 330, ncontrol = 330). The mean difference of the EPDS scores between groups was -0.65 (95% CI = -1.29–0.00, p = .049) after adjusting for confounding factors. Associations between participation in the intervention and reduced depression, and attendance in TAU classes and increased stress levels were found. Conclusions: This smartphone-based intervention in addition to the TAU services was effective in reducing 4-week PND compared to a control condition of TAU only, validating its effectiveness as a cost-effective alternative to TAU education for expectant mothers. Major limitations included the follow-up assessment at 4 weeks postpartum only, and the inclusion of first-time mothers rather than all mothers. Clinical Trial: HKUCTR.com HKUCTR-2024

BACKGROUND: This trial aimed to assess the efficacy, acceptability, and safety of a first-trimester screen-and-prevent strategy for preterm preeclampsia in Asia. METHODS: Between August 1, 2019, and February 28, 2022, this multicenter stepped wedge cluster randomized trial included maternity/diagnostic units from 10 regions in Asia. The trial started with a period where all recruiting centers provided routine antenatal care without study-related intervention. At regular 6-week intervals, one cluster was randomized to transit from nonintervention phase to intervention phase. In the intervention phase, women underwent first-trimester screening for preterm preeclampsia using a Bayes theorem-based triple-test. High-risk women, with adjusted risk for preterm preeclampsia ≥1 in 100, received low-dose aspirin from <16 weeks until 36 weeks. RESULTS: Overall, 88.04% (42 897 of 48 725) of women agreed to undergo first-trimester screening for preterm preeclampsia. Among those identified as high-risk in the intervention phase, 82.39% (2919 of 3543) received aspirin prophylaxis. There was no significant difference in the incidence of preterm preeclampsia between the intervention and non-intervention phases (adjusted odds ratio [aOR], 1.59 [95% CI, 0.91–2.77]). However, among high-risk women in the intervention phase, aspirin prophylaxis was significantly associated with a 41% reduction in the incidence of preterm preeclampsia (aOR, 0.59 [95% CI, 0.37–0.92]). In addition, it correlated with 54%, 55%, and 64% reduction in the incidence of preeclampsia with delivery at <34 weeks (aOR, 0.46 [95% CI, 0.23–0.93]), spontaneous preterm birth <34 weeks (aOR, 0.45 [95% CI, 0.22–0.92]), and perinatal death (aOR, 0.34 [95% CI, 0.12–0.91]), respectively. There was no significant between-group difference in the incidence of aspirin-related severe adverse events. CONCLUSIONS: The implementation of the screen-and-prevent strategy for preterm preeclampsia is not associated with a significant reduction in the incidence of preterm preeclampsia. However, low-dose aspirin effectively reduces the incidence of preterm preeclampsia by 41% among high-risk women. The screen-and-prevent strategy for preterm preeclampsia is highly accepted by a diverse group of women from various ethnic backgrounds beyond the original population where the strategy was developed. These findings underpin the importance of the widespread implementation of the screen-and-prevent strategy for preterm preeclampsia on a global scale. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03941886.

We assessed the Chinese version of the Drug Abuse Screening Test (DAST-10) for identifying illicit drug use during pregnancy among Chinese population. Chinese pregnant women attending their first antenatal visit or their first unbooked visit to the maternity ward were recruited during a 4-month study period in 2011. The participants completed self-administered questionnaires on demographic information, a single question on illicit drug use during pregnancy and the DAST-10. Urine samples screened positive by the urine Point-of-Care Test were confirmed by gas chromatography-mass spectrometry. DAST-10 performance was compared with three different gold standards: urinalysis, self-reported drug use and evidence of drug use by urinalysis or self-report. 1214 Chinese pregnant women participated in the study and 1085 complete DAST-10 forms were collected. Women who had used illicit drugs had significantly different DAST-10 scores than those who had not. The sensitivity of DAST-10 for identify illicit drug use in pregnant women ranged from 79.2% to 33.3% and specificity ranged from 67.7% to 99.7% using cut-off scores from ≥1 to ≥3. The ~80% sensitivity of DAST-10 using a cut-off score of ≥1 should be sufficient for screening of illicit drug use in Chinese pregnant women, but validation tests for drug use are needed.