Patterns of Prenatal Care Delivery and Obstetric Outcomes before and during the COVID-19 Pandemic

 

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Abstract

Objective Health care providers and health systems confronted new challenges to deliver timely, high-quality prenatal care during the coronavirus disease 2019 (COVID-19) pandemic as the pandemic raised concerns that care would be delayed or substantively changed. This study describes trends in prenatal care delivery in 2020 compared with 2018 to 2019 in a large, commercially insured population and investigates changes in obstetric care processes and outcomes.

Study Design This retrospective cohort study uses de-identified administrative claims for commercially insured patients. Patients whose entire pregnancy took place from March 1 to December 31 in years 2018, 2019, and 2020 were included. Trends in prenatal care, including in-person, virtual, and emergency department visits, were evaluated, as were prenatal ultrasounds. The primary outcome was severe maternal morbidity (SMM). Secondary outcomes included preterm birth and stillbirth. To determine whether COVID-19 pandemic-related changes in prenatal care had an impact on maternal outcomes, we compared the outcome rates during the pandemic period in 2020 to equivalent periods in 2018 and 2019.

Results In total, 35,112 patients were included in the study. There was a significant increase in the prevalence of telehealth visits, from 1.1 to 1.2% prior to the pandemic to 17.2% in 2020, as well as a significant decrease in patients who had at least one emergency department visit during 2020. Overall prenatal care and ultrasound utilization were unchanged. The rate of SMM across this period was stable (2.3–2.8%) with a statistically significant decrease in the preterm birth rate in 2020 (7.4%) compared with previous years (8.2–8.6%; p < 0.05) and an unchanged stillbirth rate was observed.

Conclusion At a time when many fields of health care were reshaped during the pandemic, these observations reveal considerable resiliency in both the processes and outcomes of obstetric care.

Key Points

• Overall prenatal care and ultrasound were unchanged from 2018 to 2019 to 2020.

• There was a large increase in the prevalence of telehealth visits in 2020.

• There was no change in the rate of severe maternal morbidity or stillbirth in 2020 compared with 2018 to 2019.

Publication History

Received: 20 June 2022

Accepted: 22 September 2022

Accepted Manuscript online:
13 October 2022

Article published online:
16 January 2023

© 2023. Thieme. All rights reserved.

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• References

• 1 Spiegelman J, Krenitsky N, Sutton D, Moroz L. Rapid development and implementation of a Covid-19 telehealth clinic for obstetric patients. NEJM Catal 2020; DOI: 10.1056/CAT.20.0170.
  CrossrefPubMedGoogle Scholar
• 2 Betancourt JA, Rosenberg MA, Zevallos A, Brown JR, Mileski M. The impact of COVID-19 on telemedicine utilization across multiple service lines in the United States. Healthcare (Basel) 2020; 8 (04) E380
  CrossrefPubMedGoogle Scholar
• 3 Fryer K, Delgado A, Foti T, Reid CN, Marshall J. Implementation of obstetric telehealth during COVID-19 and beyond. Matern Child Health J 2020; 24 (09) 1104-1110
  CrossrefPubMedGoogle Scholar
• 4 Aziz A, Zork N, Aubey JJ. et al. Telehealth for high-risk pregnancies in the setting of the COVID-19 pandemic. Am J Perinatol 2020; 37 (08) 800-808
  Article in Thieme ConnectPubMedGoogle Scholar
• 5 ACOG. COVID-19 FAQs for obstetrician-gynecologists, obstetrics. Accessed October 31, 2022 at: https://www.acog.org/clinical-information/physician-faqs/covid-19-faqs-for-ob-gyns-obstetrics.
  PubMedGoogle Scholar
• 6 Moynihan R, Sanders S, Michaleff ZA. et al. Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review. BMJ Open 2021; 11 (03) e045343
  CrossrefPubMedGoogle Scholar
• 7 Venkatesh AK, Janke AT, Shu-Xia L. et al. Emergency department utilization for emergency conditions during COVID-19. Ann Emerg Med 2021; 78 (01) 84-91
  CrossrefPubMedGoogle Scholar
• 8 Son M, Gallagher K, Lo JY. et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy outcomes in a U.S. population. Obstet Gynecol 2021; 138 (04) 542-551
  CrossrefPubMedGoogle Scholar
• 9 Simon E, Cottenet J, Mariet AS. et al. Impact of the COVID-19 pandemic on preterm birth and stillbirth: a nationwide, population-based retrospective cohort study. Am J Obstet Gynecol 2021; 225 (03) 347-348
  CrossrefPubMedGoogle Scholar
• 10 Rolnik DL, Matheson A, Liu Y. et al. Impact of COVID-19 pandemic restrictions on pregnancy duration and outcome in Melbourne, Australia. Ultrasound Obstet Gynecol 2021; 58 (05) 677-687
  CrossrefPubMedGoogle Scholar
• 11 Hawco S, Rolnik DL, Woolner A. et al. The impact of mitigation measures on perinatal outcomes during the first nine months of the COVID-19 pandemic: a systematic review with meta-analysis. Eur J Obstet Gynecol Reprod Biol 2022; 274: 117-127
  CrossrefPubMedGoogle Scholar
• 12 Been JV, Burgos Ochoa L, Bertens LCM, Schoenmakers S, Steegers EAP, Reiss IKM. Impact of COVID-19 mitigation measures on the incidence of preterm birth: a national quasi-experimental study. Lancet Public Health 2020; 5 (11) e604-e611
  CrossrefPubMedGoogle Scholar
• 13 Leonard SA, Kennedy CJ, Carmichael SL, Lyell DJ, Main EK. An expanded obstetric comorbidity scoring system for predicting severe maternal morbidity. Obstet Gynecol 2020; 136 (03) 440-449
  CrossrefPubMedGoogle Scholar
• 14 Weiner JP, Bandeian S, Hatef E, Lans D, Liu A, Lemke KW. In-person and telehealth ambulatory contacts and costs in a large US insured cohort before and during the COVID-19 pandemic. JAMA Netw Open 2021; 4 (03) e212618
  CrossrefPubMedGoogle Scholar
• 15 Patel SY, Mehrotra A, Huskamp HA, Uscher-Pines L, Ganguli I, Barnett ML. Trends in outpatient care delivery and telemedicine during the COVID-19 pandemic in the US. JAMA Intern Med 2021; 181 (03) 388-391
  CrossrefPubMedGoogle Scholar
• 16 Zachrison KS, Yan Z, Schwamm LH. Changes in virtual and in-person health care utilization in a large health system during the COVID-19 pandemic. JAMA Netw Open 2021; 4 (10) e2129973
  CrossrefPubMedGoogle Scholar
• 17 Zork NM, Aubey J, Yates H. Conversion and optimization of telehealth in obstetric care during the COVID-19 pandemic. Semin Perinatol 2020; 44 (06) 151300
  CrossrefPubMedGoogle Scholar
• 18 Almuslim H, AlDossary S. Models of incorporating telehealth into obstetric care during the COVID-19 pandemic, its benefits and barriers: a scoping review. Telemed J E Health 2022; 28 (01) 24-38
  CrossrefPubMedGoogle Scholar
• 19 Madden N, Emeruwa UN, Friedman AM. et al. Telehealth uptake into prenatal care and provider attitudes during the COVID-19 pandemic in New York City: a quantitative and qualitative analysis. Am J Perinatol 2020; 37 (10) 1005-1014
  Article in Thieme ConnectPubMedGoogle Scholar
• 20 Peahl AF, Powell A, Berlin H. et al. Patient and provider perspectives of a new prenatal care model introduced in response to the coronavirus disease 2019 pandemic. Am J Obstet Gynecol 2021; 224 (04) 384.e1-384.e11
  CrossrefPubMedGoogle Scholar
• 21 Palmer KR, Tanner M, Davies-Tuck M. et al. Widespread implementation of a low-cost telehealth service in the delivery of antenatal care during the COVID-19 pandemic: an interrupted time-series analysis. Lancet 2021; 398 (10294): 41-52
  CrossrefPubMedGoogle Scholar
• 22 Metz TD, Clifton RG, Hughes BL. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Disease severity and perinatal outcomes of pregnant patients with coronavirus disease 2019 (COVID-19). Obstet Gynecol 2021; 137 (04) 571-580
  CrossrefPubMedGoogle Scholar
• 23 Villar J, Ariff S, Gunier RB. et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: the INTERCOVID multinational cohort study. JAMA Pediatr 2021; 175 (08) 817-826
  CrossrefPubMedGoogle Scholar
• 24 Papageorghiou AT, Deruelle P, Gunier RB. et al. Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study. Am J Obstet Gynecol 2021; 225 (03) 289.e1-289.e17
  CrossrefPubMedGoogle Scholar
• 25 DeSisto CLWB, Wallace B, Simeone RM. et al. Risk for stillbirth among women with and without COVID-19 at delivery hospitalization - United States, March 2020-September 2021. MMWR Morb Mortal Wkly Rep 2021; 70 (47) 1640-1645
  CrossrefPubMedGoogle Scholar
• 26 Karasek D, Baer RJ, McLemore MR. et al. The association of COVID-19 infection in pregnancy with preterm birth: a retrospective cohort study in California. Lancet Reg Health Am 2021; 2: 100027
  PubMedGoogle Scholar
• 27 Caniglia EC, Magosi LE, Zash R. et al. Modest reduction in adverse birth outcomes following the COVID-19 lockdown. Am J Obstet Gynecol 2021; 224 (06) 615.e1-615.e12
  CrossrefPubMedGoogle Scholar
• 28 Oakley LL, Ortqvist AK, Kinge J. et al. Preterm birth after the introduction of COVID-19 mitigation measures in Norway, Sweden, and Denmark: a registry-based difference-in-differences study. Am J Obstet Gynecol 2022; 226 (04) 550.e1-550.e22
  CrossrefPubMedGoogle Scholar
• 29 Khalil A, von Dadelszen P, Draycott T, Ugwumadu A, O'Brien P, Magee L. Change in the incidence of stillbirth and preterm delivery during the COVID-19 pandemic. JAMA 2020; 324 (07) 705-706
  CrossrefPubMedGoogle Scholar
• 30 Harvey EM, McNeer E, McDonald MF. et al. Association of preterm birth rate with COVID-19 statewide stay-at-home orders in Tennessee. JAMA Pediatr 2021; 175 (06) 635-637
  CrossrefPubMedGoogle Scholar
• 31 Lauder J, Sciscione A, Biggio J, Osmundson S. Society for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org. Society for maternal-fetal medicine consult series #50: the role of activity restriction in obstetric management: (Replaces Consult Number 33, August 2014). Am J Obstet Gynecol 2020; 223 (02) B2-B10
  CrossrefPubMedGoogle Scholar
• 32 Berghella V, Boelig R, Roman A, Burd J, Anderson K. Decreased incidence of preterm birth during coronavirus disease 2019 pandemic. Am J Obstet Gynecol MFM 2020; 2 (04) 100258
  CrossrefPubMedGoogle Scholar
• 33 Barrera CM, Powell AR, Biermann CR. et al. A review of prenatal care delivery to inform the michigan plan for appropriate tailored healthcare in pregnancy panel. Obstet Gynecol 2021; 138 (04) 603-615
  CrossrefPubMedGoogle Scholar
• 34 Peahl AF, Gourevitch RA, Luo EM. et al. Right-sizing prenatal care to meet patients' needs and improve maternity care value. Obstet Gynecol 2020; 135 (05) 1027-1037
  CrossrefPubMedGoogle Scholar
• 35 Peahl AF, Zahn CM, Turrentine M. et al. The Michigan plan for appropriate tailored healthcare in pregnancy prenatal care recommendations. Obstet Gynecol 2021; 138 (04) 593-602
  CrossrefPubMedGoogle Scholar
• 36 Osarhiemen OA, Robinson MA, Zhao Z. et al. Assessing access to obstetrical care via telehealth in the era of COVID-19. Am J Obstet Gynecol 2022; 226 (03) 429-432
  CrossrefPubMedGoogle Scholar
• 37 Onwuzurike C, Meadows AR, Nour NM. Examining inequities associated with changes in obstetric and gynecologic care delivery during the coronavirus disease 2019 (COVID-19) pandemic. Obstet Gynecol 2020; 136 (01) 37-41
  CrossrefPubMedGoogle Scholar

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