Telehealth integrated antenatal care may reduce the volume of in-person consultations without impacting the detection of pregnancy complications

1. There was no significant difference with regard to diagnosis and treatment of pre-eclampsia, fetal growth restriction, and gestational diabetes between the telehealth integrated care and conventional models.

2. A significant reduction in the incidence of pre-term births among women in high-risk pregnancies was seen (-0.68% change per week).

Evidence Rating Level: 3 (Average)

Study Rundown: COVID-19 has changed the way healthcare systems function, with telehealth comprising a significant portion of modern clinical encounters. Regular antenatal care is a key component to a successful pregnancy. However, in light of the COVID-19 pandemic, antenatal care was shifted to a virtual format in many parts of the world. This time-series analysis aimed to assess the safety and effectiveness of telehealth integrated antenatal care for low- and high-risk pregnancies compared to conventional antenatal care in the Australian state of Victoria. Co-primary outcomes included diagnosis and treatment of pre-eclampsia, fetal growth restriction, and gestational diabetes, while secondary outcomes included stillbirth, admission to the neonatal intensive care unit (NICU), and preterm birth (<37 weeks’ gestation). Findings from this study suggest no significant differences between conventional care and telehealth with regard to number of fetal growth restrictions, stillbirths, and pre-eclampsia-related pregnancies, reinforcing the utility of a newly incorporated telehealth integrated schedule for antenatal care. While this study was well designed, it compared results from a 27-month conventional care regimen to a newly established (3-month-old) telehealth schedule. A longer assessment of the telehealth integrated care model may help to increase the study’s overall validity.

Click to read the study in The Lancet

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

In-depth [case-control study]: This study compared the first three months of telehealth integrated care with two years of conventional care at Monash Health (a large health service in Victoria). Between Jan 1, 2018, and Mar 22, 2020, 20 031 deliveries occurred via conventional care, compared with 2292 deliveries, via telehealth, from April 20 to Jul 26, 2020.

Telehealth comprised the majority (n=10 731, 53%) of antenatal consultations provided during the 3-month integrated care period. No significant differences were observed with regard to co-primary outcomes of pre-eclampsia (3% in telehealth vs. 3% in conventional care, p=0.70, for low-risk pregnancies; 9% in telehealth vs. 7% in conventional care, p=0.15, for high-risk pregnancies), fetal growth restriction (2% in telehealth vs. 2% in conventional care, p=0.72, for low-risk pregnancies; 5% in telehealth vs. 5% in conventional care, p=0.50, for high-risk pregnancies), and gestational diabetes (22% in telehealth vs. 22% in conventional care, p=0.89, for low-risk pregnancies; 30% in telehealth vs. 26% in conventional care, p=0.06, for high-risk pregnancies). A similar pattern was seen with regard to the secondary outcomes of stillbirths (1% in telehealth vs. 1% in conventional care, p=0.79, for low-risk pregnancies; 2% in telehealth vs. 2% in conventional care, p=0.70, for high-risk pregnancies) and number of pre-term births (4% in telehealth vs. 6% in conventional care, p=0.10, for low-risk pregnancies; 29% in telehealth vs. 27% in conventional care, p=0.34, for high-risk pregnancies). Findings from this study suggest that telehealth can be successfully implemented to minimize the number of in-person antenatal care visits during the COVID-19 pandemic without adversely affecting the detection and management of pregnancy complications.

Image: PD

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