Integrating Infant Safe Sleep and Breastfeeding Education into an App: A Novel Approach to Reaching High-Risk Populations (Preprint)

Abstract

Sudden unexpected infant death (SUID) is a leading cause of death for US infants, and non-recommended sleep practices are reported in most of these deaths. SUID rates have not declined over the past 20 years despite significant educational efforts. Integration of prenatal safe sleep and breastfeeding education into a pregnancy app may be one approach to engaging pregnant individuals in education about infant care practices prior to childbirth.

To assess whether pregnant individuals would engage with prenatal safe sleep and breastfeeding education provided within a pre-existing pregnancy app. Secondary objectives were to compare engagement among those at high and low risk of losing an infant to SUID and to assess the importance of end-user push notifications for engagement.

Prospective randomized controlled study from 9/23/2019 to 3/22/24; push notifications were removed 10/26/21. TodaysBaby, a mobile health program in which safe sleep and breastfeeding video education was originally provided via texts, was embedded into the MyHealthyPregnancy app. Pregnant mothers who received prenatal care within the UPMC hospital system were randomized to receive either the safe sleep or breastfeeding education beginning at the start of the third trimester of pregnancy and ending 6 weeks post-partum. Women were designated as high-risk if they lived in the 5% of zip codes in Allegheny County, Pennsylvania with the highest rates of SUID in the county. The primary outcome was engagement, defined as watching at least one video either in response to a push notification or directly from the app’s learning center.

7572 women were enrolled in the TodaysBaby Program, 3308 with push notifications and 4264 without. The TodaysBaby engagement rate was 18.8% with push notifications and 3.0% without. Engagement was highest in the initial weeks after enrollment, with a steady decline through pregnancy and very little post-partum engagement. There was no difference in engagement between women who were low and high-risk. The most viewed videos were ones addressing the use of pacifiers, concern about infant choking, and the response of the body to the start of breastfeeding.

Integrating safe sleep and breastfeeding education within a pregnancy app may allow for rapid dissemination of infant care information to pregnant individuals. Birthing parents at high risk of losing an infant to SUID - a leading cause of infant death after 1 month of age - appear to engage with the app at the same rates as birth parents who are at low risk. Our data demonstrate that push notifications increase engagement, overall and for those in high-risk zip codes where the SUID education is likely to have the most impact.