Hybrid prenatal health care delivery effective

Hybrid prenatal health care delivery effective | Image Credit: © tippapatt - © tippapatt - stock.adobe.com.

According to a recent study published in JAMA Network Open, a model of prenatal health care combining in-person visits with telemedicine sessions is effective when compared to in-person only prenatal care.

Pregnant individuals have traditionally needed frequent in-person health care visits, making this population challenged by the COVID-19 pandemic. The health care industry rapidly adapted to telemedicine during the pandemic, creating a new potential avenue for prenatal health care delivery.

Telemedicine can reach rural areas and address barriers to health care. However, there is little data on the use of telemedicine in prenatal health care outcomes. To determine the efficacy of a multimodel of telemedicine and in-person visits for prenatal health care, investigators conducted a cohort study.

The study was conducted at Kaiser Permanente Northern California, a health care delivery system including over 4.5 million individuals. Electronic health record data was consulted for live birth and stillbirth deliveries from July 1, 2018, to October 21, 2021.

Diagnoses and procedures were determined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes. Deliveries before March 13, 2020, were performed using a standard schedule from theAmerican College of Obstetricians and Gynecologists, while changes were implemented for those afterward.

After March 13, 2020, low-risk patients and those with moderate risk conditions received the 4 standard prenatal care visits through telemedicine. Pregnancies were categorized based on date of birth, with those from July 1, 2018, to February 29, 2020, being unexposed, March 1, 2020, to December 5, 2020, being partially exposed, and December 6, 2020, to October 31, 2021, being fully exposed.

Partially exposed individuals did not receive the multimodel prenatal health care delivery. However, this model was received by individuals who were fully exposed.

Preeclampsia and eclampsia rates, cesarean delivery, preterm birth, severe maternal morbidity, and neonatal intensive care unit (NICU) admission were the primary outcomes of the study. Preeclampsia and eclampsia were defined by ICD-10 codes or 2 blood pressure readings over 140/90 mm Hg at least 4 hours apart and onset of proteinuria, thrombocytopenia, or pulmonary edema.

Severe maternal morbidity was defined by CDC criteria, while preterm birth was defined as delivery under 37 weeks. Cesarean deliveries and NICU admissions were defined by ICD-10 codes.

Secondary outcomes included depression, gestational hypertension, gestational diabetes (GD) venous thromboembolism, newborn Apgar score, birth weight, and transient tachypnea. Covariates included residential address, age and ethnicity, preferred language, smoking, prepregnancy height and weight, parity, and health outcomes.

There were 151,464 patients with a live birth or stillbirth during the study period, aged a mean 31.3 years. Of these, 50.1% were unexposed to the multimodel, 23% were partially exposed, and 26.9% were fully exposed. Sociodemographic and clinical characteristics did not significantly differ between these groups.

The mean number of prenatal health care visits was similar between the prepandemic and pandemic periods, but an increase in the mean number of telemedicine visits increased from the unexposed to the partially exposed period, and from the partially exposed to the fully exposed period. 

The mean number of telemedicine visits were 1.04, 1.92, and 1.95, respectively, with proportions of 11.1%, 20.9%, and 21.3%, respectively. Most telemedicine visits occurred over telephone, but the mean numbers of both telephone visits and video conferences increased between each period.

No clinically significant differences were observed in the mean numbers of blood pressure measurements, depression screenings, or GD rates across the 3 periods. These results were consistent across different races and ethnicities.

NICU admissions slightly varied, from 9.2% in the unexposed period, to 8.3% in the partially exposed period, to 8.6% in the fully exposed period. Risks of preeclampsia and eclampsia, severe maternal morbidity, cesarean delivery, and preterm birth also did not significantly change over time.

Overall, these results indicated similar efficacy from a prenatal health care delivery multimodel of in-person and telemedicine sessions when compared to a model using in-person sessions only. Investigators concluded these results support the use of a multimodel going forward.

Reference:

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