Randomised controlled trial of smartphone electronic reminder to improve drug adherence during pregnancy

We aimed to evaluate the effects of daily electronic messages on drug adherence during pregnancy. A randomized controlled trial was conducted between March and September 2020 in a group of pregnant women taking multivitamin supplementation. A daily electronic message reminder was sent through smartphone by research assistants to women in the intervention group but none in the control group. Assessment of drug adherence was performed by pill-counting at 26–30 weeks and 36 weeks antenatal visits. There were a total of 225 participants, 112 in the intervention group and 113 in the control group. A trend of better drug adherence was observed at 26–30 weeks in the group receiving reminder (90.9% vs. 85.8%, difference between group, unadjusted: 5.0, 95%CI (1.0, 9.0), P = .014; adjusted: 4.0 95%CI (-0.1, 8.0), P = .053). Drug adherence at 36 weeks was comparable between the intervention and control group. 37.2% (42/113) of women believed forgetfulness was the major reason for reduced adherence in the intervention group and control group, respectively. Upon multivariable logistic regression analysis, receiving a daily reminder was identified as the only positive factor associated with adherence ≥ 80% (OR 2.19, 95% CI 1.04–4.57)). There were no differences in the pregnancy and neonatal outcomes. A daily electronic reminder may improve drug adherence during pregnancy. Registration: Clinicaltrials.gov NCT04295265, registered on 4/3/2020. URL of the registration site: https://www.clinicaltrials.gov/ct2/show/NCT04295265.