Not only is a combination of in-office visits and telemedicine an effective model of prenatal care, but it can be an alternative to those who face access barriers.
In the wake of the COVID-19 pandemic, telemedicine has become an important and accessible method of receiving treatment from medical professionals. It is especially more convenient for those who may have transportation issues or limited time due to work or childcare. To assess the efficacy of a telehealth model compared with face-to-face in-office visits, Kaiser Permanente Northern California (KPNC) implemented telemedicine in prenatal health care to determine whether it could reduce potential unnecessary exposure of pregnant individuals to COVID-19.
The study evaluated a multimodal model of in-office visits and telemedicine prenatal health care during the pandemic as well as its association with maternal and newborn outcomes. The study included 151,464 individuals who delivered a live birth or stillbirth between July 1, 2018, and October 21, 2021
These patients were divided into 3 groups who utilized different models and had different time intervals: T1, unexposed, from July 1, 2018, to February 29, 2020; T2, partially exposed (did not experience the multimodal model for the entire duration of pregnancy), from March 1, 2020, to December 5, 2020; and T3, fully exposed (experienced the multimodal model for the entire duration of pregnancy), from December 6, 2020, to October 21, 2021. The proportion of telemedicine visits increased from 11.1% to 21.3%.
Throughout the 3 groups, rates of preeclampsia and eclampsia, severe maternal morbidity, cesarean delivery, preterm birth, and neonatal intensive care unit (NICU) admission were examined. In addition, the researchers evaluated gestational hypertension, gestational diabetes (GD), depression, venous thromboembolism, newborn Apgar score (<7), transient tachypnea, and birth weight. Further, there were insignificant differences in the sociodemographic and clinical characteristics between individuals in the partially exposed and fully exposed groups compared to those who were unexposed.
Mean number blood pressure measurements, GD, and depression screenings remained similar across the T2 and T3 groups. Further, there weren’t any significant changes in the primary health outcomes (i.e., preeclampsia and eclampsia, severe maternal morbidity, cesarean delivery, and preterm birth) except for NICU admission rates, which increased from the first pandemic period (T2, 8.3%) to the second (T3, 8.6%). Gestational hypertension and depression rates increased from the pre-pandemic to pandemic groups (0.43% to 1.10%, and 1.42%; 0.49% to 0.91% and 0.16% to 1.25%, respectively), but an interrupted time series analysis demonstrated that these were already increased risks.
The results from this study are consistent with an Australian study conducted among 22,323 pregnant individuals that utilized an ITS analysis to compare the prenatal health care prepandemic to the multimodal health care model. This study also found few differences between the rates of GD, preeclampsia, preterm birth, and NICU admissions across the 2 study periods. Additionally, 2 US studies with smaller numbers had reported similar findings. None of the studies had assessed whether this multimodal format of prenatal health was similar across the sociodemographic factors.
Limitations of the current study include lockdown policies that were in place during the first pandemic group (T2) and decreased individual comfort levels impacting the complete assessment of health outcomes. It was difficult to accurately define whether pregnancies were either low or high-risk due to the clinicians’ inability to provide their accurate diagnosis. Additionally, there weren’t any data on the patients’ and health care experts’ satisfaction with the telemedicine visits.
Going forward, the multimodal health care model for prenatal health care shows promise for those with issues accessing in-person care due to the comparable results between in-office visits pre-pandemic, the study authors concluded.
Ferrara A, Greenberg M, Zhu Y, et al. Prenatal Health Care Outcomes Before and During the COVID-19 Pandemic Among Pregnant Individuals and Their Newborns in an Integrated US Health System. JAMA Netw Open. 2023;6(7):e2324011. doi:10.1001/jamanetworkopen.2023.24011