Widespread implementation of telehealth in the delivery of antenatal care during the COVID-19 pandemic: An observational cohort study

ABSTRACT

Introduction: Driven by the COVID-19 pandemic, our maternity service developed and implemented a new antenatal care schedule integrating telehealth across all models of pregnancy care. Given limited evidence to inform this clinical initiative we evaluated the safety of telehealth in antenatal care. Methods: We undertook a population-based cohort study using interrupted time series analysis to evaluate the impact of telehealth integration into antenatal care from 23rd March 2020. Allowing a one-month implementation period, we compared the first three months of telehealth integrated care (20th April to 2nd August 2020) to previously delivered conventional care (1st January 2018 to 22nd March 2020). Main pregnancy outcomes measured were detection and outcomes of fetal growth restriction, pre-eclampsia and gestational diabetes, as well as stillbirth. Results: The outcomes of 2,977 births during the telehealth integrated period were compared to 20,031 births prior to its implementation. Following telehealth integration, 10,928 of the 20,517 (53.3%) antenatal consultations provided were delivered via telehealth. No significant change during integrated compared to conventional care periods in the rate of fetal growth restriction <3rd centile (2.9% vs 2.6%), stillbirth (1% vs 1%), or pregnancies complicated by pre-eclampsia (4.2% vs 3.9%) or gestational diabetes (23.6% vs 22.9%) was seen. A reduction in preterm birth among women in high-risk models (ITS-0.71 (-1.4 to-0.036);p = 0.04), but no change in other outcome measures were observed for low or high-risk care models. Discussion: Telehealth integrated into antenatal care was able to reduce in-person consultations by 50% without compromising pregnancy outcomes.