Comparison Between In-Person and Audio-Only Virtual Prenatal Visits and Perinatal Outcomes

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, AND PARTICIPANTSThis 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 audioonly 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 AND MEASURESThe primary outcome was a composite of placental abruption, stillbirth, neonatal intensive care unit admission in a full-term (Ն37 weeks) infant, and umbilical cord blood pH less than 7.0. Visit data, maternal characteristics, and other perinatal outcomes were also examined.

Psychological Distress and Behavioural Changes in Pregnant and Postpartum Individuals During the COVID-19 Pandemic

“…A modified prenatal schedule that includes a combination of in person and virtual appointments could relieve some patient anxiety and has been found to be effective. 26 …”

The impact of mitigation measures on perinatal outcomes during the first nine months of the COVID-19 pandemic: A systematic review with meta-analysis

“… [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] .…”

Schedule of Visits and Televisits for Routine Antenatal Care: A Systematic Review

“…Overall, seven studies (in 9 publications) compared televisits (or hybrid visits) with in-person visits for routine antenatal care. [55][56][57][58][59][60][61][62][63] These included two RCTs, 55,56 four NRCSs, [57][58][59][60][61][62] and one survey. 63 The studies mostly compared groups of patients who either had a hybrid schedule, including both televisits and in-person visits, with those who had in-person visits only.…”

“…Three of the studies were conducted during the COVID-19 pandemic. 57,58,63 Three studies were funded by nonindustry sources (Butler Tobah 2019, Pflugeisen 2017), one was unfunded , and the other three did not report information on funding source. Pflugeisen 2016 and Pflugeisen 2017 both evaluated a "Virtual Visit" program, but the patients did not appear to overlap.…”