Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Am J Perinatol. 2023 Oct;40(13):1484-1494. doi: 10.1055/a-1877-7951. Epub 2022 Jun 16.
The aim of the study is to compare rates of prenatal care utilization before and after implementation of a telehealth-supplemented prenatal care model due to the coronavirus disease 2019 (COVID-19) pandemic.
Using electronic medical record data, we identified two cohorts of pregnant persons that initiated prenatal care prior to and during the COVID-19 pandemic following the implementation of telehealth (from March 1, 2019 through August 31, 2019, and from March 1, 2020, through August 31, 2020, respectively) at Grady Memorial Hospital. We used Pearson's Chi-square and two-tailed -tests to compare rates of prenatal care utilization, antenatal screening and immunizations, emergency department and obstetric triage visits, and pregnancy complications for the prepandemic versus pandemic-exposed cohorts.
We identified 1,758 pregnant patients; 965 entered prenatal care prior to the COVID-19 pandemic and 793 entered during the pandemic. Patients in the pandemic-exposed cohort were more likely to initiate prenatal care in the first trimester (46.1 vs. 39.0%, = 0.01), be screened for gestational diabetes (74.4 vs. 67.0%, <0.001), and receive dating and anatomy ultrasounds (17.8 vs. 13.0%, = 0.006 and 56.9 vs. 47.3%, <0.001, respectively) compared with patients in the prepandemic cohort. There was no difference in mean number of prenatal care visits between the two groups (6.9 vs. 7.1, = 0.18). Approximately 41% of patients in the pandemic-exposed cohort had one or more telehealth visits. The proportion of patients with one or more emergency department visits was higher in the pandemic-exposed cohort than the prepandemic cohort (32.8 vs. 12.3%, < 0.001). Increases in rates of labor induction were also observed among the pandemic-exposed cohort (47.1 vs. 38.2%, <0.001).
Rates of prenatal care utilization were similar before and during the COVID-19 pandemic. However, pregnant persons receiving prenatal care during the pandemic entered care earlier and had higher utilization of certain antenatal screening services than those receiving prenatal care prior to the pandemic.
· Patients initiated prenatal care earlier during the COVID-19 pandemic.. · Uptake of telehealth services was low.. · Rates of diabetes screening and ultrasound use increased during the pandemic..
本研究旨在比较因 2019 年冠状病毒病（COVID-19）大流行而实施远程医疗补充产前保健模式前后的产前保健利用率。
使用电子病历数据，我们在佐治亚纪念医院分别确定了两个在 COVID-19 大流行之前（2019 年 3 月 1 日至 8 月 31 日）和之后（2020 年 3 月 1 日至 8 月 31 日）开始产前保健的孕妇队列，这两个队列都是在远程医疗实施之后。我们使用 Pearson's Chi-square 和双侧 t 检验比较了产前保健利用率、产前筛查和免疫接种、急诊和产科分诊就诊以及妊娠并发症的发生率，比较了大流行前和大流行暴露队列。
我们确定了 1758 名孕妇；965 名孕妇在 COVID-19 大流行前开始产前保健，793 名孕妇在大流行期间开始产前保健。暴露于大流行的队列中，有更多的患者在孕早期开始产前保健（46.1%比 39.0%，=0.01），接受妊娠期糖尿病筛查（74.4%比 67.0%，<0.001），接受孕龄和解剖超声检查（17.8%比 13.0%，=0.006 和 56.9%比 47.3%，<0.001，分别）与大流行前的队列相比。两组的产前保健就诊次数平均没有差异（6.9 次比 7.1 次，=0.18）。暴露于大流行的队列中约有 41%的患者进行了一次或多次远程医疗就诊。暴露于大流行的队列中，急诊就诊的患者比例高于大流行前的队列（32.8%比 12.3%，<0.001）。也观察到暴露于大流行的队列中分娩诱导率增加（47.1%比 38.2%，<0.001）。
在 COVID-19 大流行前后，产前保健利用率相似。然而，在大流行期间接受产前保健的孕妇比在大流行前接受产前保健的孕妇更早开始保健，并且某些产前筛查服务的利用率更高。
· 患者在 COVID-19 大流行期间更早开始产前保健。· 远程医疗服务的采用率较低。· 糖尿病筛查和超声使用率在大流行期间增加。
