Smartphone pregnancy apps: systematic analysis of features, scientific guidance, commercialization, and user perception.

Background: Over 50% of pregnant women use pregnancy applications (apps). Some app s lack credibility, information accuracy, and evidence-based clinical advice, containing potentially harmful functionality. Previous studies have only conducted a limited analysis of pregnancy app functionalities, expert involvement/evidence-based content, used commercialization techniques, and user perception.

Methods: We used the keyword "pregnancy" to scrape (automatically extract) apps and app information from Apple App Store and Google Play. Unique functionalities were derived from app descriptions and user reviews. App descriptions were screened for evidence-based content and expert involvement, and apps were subsequently analyzed in detail. Apps were opened and searched for used commercialization techniques, such as advertisements or affiliate marketing. Automated text analysis (natural language processing) was used on app reviews to assess users' perception of evidence-based content/expert involvement and commercialization techniques.

Results: In total, 495 apps were scraped. 226 remained after applying exclusion criteria. Out of these, 36 represented 97%/88% of the total market share (Apple App Store/Google Play), and were thus considered for review. Overall, 49 distinct functionalities were identified, out of which 6 were previously unreported. Functionalities for fetal kick movement counting were found. All apps are commercial. Only 15 apps mention the involvement of medical experts. 10.3% of two-stars user reviews include commercial topics, and 0.6% of one-/two-/three-/five stars user reviews include references to scientific content accuracy.

Conclusion: Problematic features and inadequate advice continue to be present in pregnancy apps. App developers should adopt an evidence-based development approach and avoid implementing as many features as possible, potentially at the expense of their quality or over-complication ("feature creep"). Financial incentives, such as grant programs, could support adequate content quality. Caregivers play a key role in pregnant individuals' decision-making, should be aware of potential dangers, and could guide them to trustworthy apps.