How Does Mobile Health Impact Exclusive Breastfeeding in Populations Facing Vulnerability or Disparity? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Introduction: Mobile health (mHealth) interventions have been identified as effective technologies for promoting exclusive breastfeeding (EBF). However, it is still unclear how mHealth impacts different populations, especially those in situations of vulnerability and/or disparity. Objectives: To analyze the impact of mHealth interventions on promoting EBF in populations in situations of vulnerability and/or disparity, compared with usual breastfeeding care. Methods: We conducted a systematic review with meta-analysis. Randomized clinical trials (RCTs) were systematically identified through searches of the PubMed, Embase, and Cochrane Library databases. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random effects model. Heterogeneity was assessed with I 2 statistics. Statistical analyses were conducted using the R software. Results: Of the 965 studies retrieved, 18 RCTs were incorporated into the qualitative synthesis, and 15 RCTs were incorporated into the meta-analysis. mHealth effectively increased EBF at 3 months postnatal (RR = 1.21; 95% CI: [1.10–1.33]; p = 0.001; I 2 = 64.2%, GRADE: high), corresponding to 129 (95% CI: 61–202) additional cases per 1000 participants, with direct counseling showing the most consistent effect among intervention types. In infants <2 months, mHealth also demonstrated efficacy in increasing EBF, but the certainty of this evidence was considered low. There was no effectiveness in the other periods analyzed. Conclusions: Although mHealth interventions have the potential to increase EBF in populations in situations of vulnerability and/or disparity, this effectiveness has proven to be limited. There is a need for mHealth interventions that focus on crucial periods related to breastfeeding cessation, consider the impact that vulnerabilities may have on the success of maintaining breastfeeding across different contexts, including the most complex ones (multiple vulnerabilities), and account for intervention type and intensity, prioritizing direct counseling delivered through high-intensity modalities.