Effectiveness of Digital Tools on Lifestyle & Health-Related Outcomes Across the Full Continuum of the Maternal Journey: A Systematic Review.

BACKGROUND: Maternal health is a global public health priority and a key determinant of generational and societal well-being. Healthy lifestyle behaviors from preconception through postpartum can be promoted by mobile applications, telehealth and chatbots, but evidence on their effectiveness remains limited despite their growing acceptance and use. OBJECTIVES: To assess the effectiveness of digital tools targeting lifestyle and health-related outcomes across the maternal journey. METHODS: Following the PRISMA 2020 guidelines, a comprehensive search was conducted across PubMed, Scopus, Web of Science, and CENTRAL from January 2020 to May 2025. Eligible studies involved randomized controlled trials (RCTs) with digital components targeting nutrition, physical activity, sleep, smoking, and/or alcohol consumption among women during preconception, pregnancy, or up to six months postpartum. Risk of bias was assessed using the RoB2 tool (PROSPERO: CRD420251075108). RESULTS: Thirty-one RCTs (n = 7,153 women) were included, conducted during preconception (n = 3), pregnancy (n = 20), and postpartum (n = 15). Across interventions, reminders (64.5%), self-monitoring (58.1%), and goal-setting (48.4%) were the most commonly used behavior change features. Digital interventions showed beneficial effects related to nutrition (e.g., improved dietary intake, micronutrient supplementation), physical activity, sleep quality, and insomnia during pregnancy. Among women with overweight/obesity who used digital tools, consistent reductions in gestational weight gain were observed. In contrast, preconception and postpartum interventions demonstrated only modest or inconsistent effects, particularly for anthropometrics and metabolic outcomes. Surprisingly, very few studies reported engagement or usage statistics. CONCLUSIONS: Digital health tools may improve lifestyle behaviors during pregnancy, but evidence for sustained preconception or postpartum benefits remains limited. The heterogeneity in study design and high risk of bias drive the need for long-term RCTs with standardized measures and engagement metrics to optimize digital strategies for maternal health promotion.