Abstract
Background: Asthma during pregnancy is associated with adverse maternal and neonatal outcomes. Nursing education, self-management support, and mobile health (mHealth) technologies may support asthma management during pregnancy. Aim: This study evaluated the effect of a structured nursing intervention supported by an mHealth application on asthma control, treatment adherence, and self-monitoring, and maternal and neonatal outcomes among pregnant women with asthma. Design and Setting: A quasi-experimental pretest–posttest design with a control group was conducted at two Maternal and Child Health Centers in Shebin El-Kom, Menoufia Governorate, Egypt. Participants: A convenience sample of 140 pregnant women with physician-diagnosed asthma was recruited and allocated non-randomly according to the center attended to a study group (n = 70) and a control group (n = 70). The sample size was calculated a priori based on a previous study using a 5% significance level and 80% statistical power, with a 1:1 allocation ratio, resulting in a required sample of 70 participants per group. All recruited participants completed the study, with no withdrawals or loss to follow-up. Intervention: The study group received routine antenatal care plus an eight-week structured nursing intervention consisting of four individualized weekly educational sessions (60–90 min each) addressing asthma management, medication adherence, self-monitoring, trigger avoidance, warning signs, inhaler technique, lifestyle modification, and rhythmic breathing exercises. Participants were trained to use the Airlyn mHealth application for guided breathing exercises, practiced 2–3 times daily, and received telephone/WhatsApp follow-up during weeks 6–8. The control group received routine antenatal care according to usual MCH center procedures. Measures: Asthma control was assessed using the Asthma Control Test (ACT). Treatment adherence and self-monitoring were assessed using the Asthma Adherence and Self-Monitoring Questionnaire. Maternal outcomes included hypertensive disorders, gestational diabetes, infections, preterm labor/PPROM, hemorrhage, and mode of delivery. Neonatal outcomes included birth weight, Apgar scores, respiratory distress and respiratory support, NICU admission and length of stay, and condition at discharge. The researcher-developed instruments underwent expert assessment of content validity and assessment of internal consistency before use. Results: Baseline ACT scores were comparable between the study and control groups (14.5 ± 4.2 vs. 14.1 ± 4.3; mean difference = 0.4; p = 0.580). Following the intervention, ACT scores were higher in the study group than in the control group (19.7 ± 3.6 vs. 15.2 ± 4.2; mean difference = 4.5; 95% CI: 3.189–5.811; p < 0.001; Cohen’s d = 1.147). Well-controlled asthma was observed in 75.7% of the study group compared with 17.1% of the control group (p < 0.001). Treatment adherence and self-monitoring scores were also better in the study group (5.6 ± 2.7 vs. 9.1 ± 3.1; mean difference = −3.5; 95% CI: −4.476 to −2.524; p < 0.001; Cohen’s d = 1.199). The overall maternal outcome score was more favorable in the study group (3.5 ± 1.7 vs. 6.1 ± 2.6; mean difference = −2.6; 95% CI: −3.340 to −1.860; p < 0.001; Cohen’s d = 1.174), as was the overall neonatal outcome score (7.7 ± 2.2 vs. 5.5 ± 2.1; mean difference = 2.2; 95% CI: 1.480–2.920; p < 0.001; Cohen’s d = 1.022). Significant between-group differences were also observed in birth weight, Apgar scores, respiratory distress, and NICU admission. Conclusions: Participants who received the structured nursing intervention supported by the Airlyn mHealth application were associated with improved asthma control, treatment adherence, and self-monitoring, as well as more favorable maternal and neonatal outcomes, compared with those receiving routine antenatal care. However, the quasi-experimental design, convenience sampling, and non-randomized allocation limit causal interpretation and the generalizability of the findings. Therefore, the findings should be interpreted cautiously. Recommendations: Larger randomized controlled trials with standardized protocols, adequate sample sizes to evaluate maternal and neonatal outcomes, and longer follow-up periods are recommended to confirm these findings and further assess their clinical relevance.