Comparison Between In-Person and Audio-Only Virtual Prenatal Visits and Perinatal Outcomes.
JAMA Netw Open
; 4(4): e215854, 2021 04 01.
Article
in English
| MEDLINE | ID: covidwho-1182077
ABSTRACT
Importance Ensuring access to prenatal care services in the US is challenging, and implementation of telehealth options was limited before the COVID-19 pandemic, especially in vulnerable populations, given the regulatory requirements for video visit technology. Objective:
To explore the association of audio-only virtual prenatal care with perinatal outcomes. Design, Setting, andParticipants:
This cohort study compared perinatal outcomes of women who delivered between May 1 and October 31, 2019 (n = 6559), and received in-person prenatal visits only with those who delivered between May 1 and October 31, 2020 (n = 6048), when audio-only virtual visits were integrated into prenatal care during the COVID-19 pandemic, as feasible based on pregnancy complications. Parkland Health and Hospital System in Dallas, Texas, provides care to the vulnerable obstetric population of the county via a high-volume prenatal clinic system and public maternity hospital. All deliveries of infants weighing more than 500 g, whether live or stillborn, were included. Exposures Prenatal care incorporating audio-only prenatal care visits. Main Outcomes andMeasures:
The primary outcome was a composite of placental abruption, stillbirth, neonatal intensive care unit admission in a full-term (≥37 weeks) infant, and umbilical cord blood pH less than 7.0. Visit data, maternal characteristics, and other perinatal outcomes were also examined.Results:
The mean (SD) age of the 6559 women who delivered in 2019 was 27.8 (6.4) years, and the age of the 6048 women who delivered in 2020 was 27.7 (6.5) years (P = .38). Of women delivering in 2020, 1090 (18.0%) were non-Hispanic Black compared with 1067 (16.3%) in 2019 (P = .04). In the 2020 cohort, 4067 women (67.2%) attended at least 1 and 1216 women (20.1%) attended at least 3 audio-only virtual prenatal visits. Women who delivered in 2020 attended a greater mean (SD) number of prenatal visits compared with women who delivered in 2019 (9.8 [3.4] vs 9.4 [3.8] visits; P < .001). In the 2020 cohort, 173 women (2.9%) experienced the composite outcome, which was not significantly different than the 195 women (3.0%) in 2019 (P = .71). In addition, the rate of the composite outcome did not differ substantially when examined according to the number of audio-only virtual visits attended. Conclusions and Relevance Implementation of audio-only virtual prenatal visits was not associated with changes in perinatal outcomes and increased prenatal visit attendance in a vulnerable population during the COVID-19 pandemic when used in a risk-appropriate model.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Prenatal Care
/
Telemedicine
/
Delivery, Obstetric
/
Ambulatory Care
/
COVID-19
Type of study:
Cohort study
/
Observational study
/
Prognostic study
Limits:
Adult
/
Female
/
Humans
/
Pregnancy
Country/Region as subject:
North America
Language:
English
Journal:
JAMA Netw Open
Year:
2021
Document Type:
Article
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