The Paradox of Digital Monitoring: A Cross-Sectional Study of mHealth Adoption and Its Association with Psychological Distress Among Pregnant Women in Romania

Abstract

Background: Digital health (mHealth) interventions are increasingly integrated into maternity care to improve health literacy and reassure expectant mothers. However, the “double-edged sword” of continuous monitoring may be associated with heightened anxiety. This study aimed to describe mHealth usage patterns and investigate the association between technology engagement and mental health outcomes among pregnant women in Romania, where perinatal distress is a significant public health challenge. Methods: This observational, cross-sectional study included 100 pregnant and immediate postpartum women at a tertiary maternity unit in Romania. Participants were stratified into mHealth Users (n = 52) and Non-Users (n = 48). Validated instruments, including the PHQ-9, GAD-7, and EPDS, assessed depressive and anxiety symptoms. Predictors of adoption were identified using multivariable binary logistic regression. Results: mHealth users were predominantly from urban environments (80.8% vs. 54.2%, p = 0.004) and reported higher rates of daily physical activity (p < 0.001). Users experienced significantly higher median scores for depression (PHQ-9: 6 vs. 4, p = 0.047), generalized anxiety (GAD-7: 7 vs. 6, p = 0.015), and pregnancy-specific anxiety (35 vs. 29.5, p = 0.028) compared to non-users. In the multivariable model, high psychological distress (OR 0.08 for low-stress vs. high-stress, p = 0.009) and urban residency (p = 0.043) were independent predictors of mHealth adoption. Notably, 96.2% of users shared their digital data with healthcare providers. Conclusions: mHealth adoption in this population is characterized by a “paradox of monitoring,” where usage is strongly associated with pre-existing psychological vulnerability and associated with higher distress. While these tools serve as markers for mental health risk, the high rate of data sharing offers a clinical opportunity for a hybrid model of care. Obstetricians should view high digital engagement as a prompt for targeted mental health screening and proactively mediate patient-generated data to mitigate anxiety.