Replacing or supplementing in-person maternal care with telehealth generally results in similar, and sometimes better, outcomes compared to in-person care, Oregon Health & Science University researchers found.
The study, published last week in Annals of internal medicinefollows the widespread and rapid implementation of telehealth during the coronavirus pandemic, when doctors suddenly relied on video or phone calls for many types of routine appointments.
“The COVID-19 pandemic and the increased demand for telehealth services we’ve seen over the past several years puts us in a unique position as physicians, where we are now able to reevaluate and reimagine how we deliver care,” said the lead author. Amy Cantor, MD, MPH, associate professor of medical informatics and clinical epidemiology, family medicine, and obstetrics and gynecology at the OHSU School of Medicine. “The results of this study are encouraging because they show that telehealth can improve and expand health care options, especially for underserved communities and those who may face barriers to accessing traditional care.”
The health of mothers and their babies depends on access to high-quality maternal health care. Careful care throughout pregnancy allows providers to identify health conditions that may increase the risk for poor outcomes and provides an opportunity to prevent and treat any complications.
There is little evidence to support the idea that the traditional approach to maternal care—relying only on personal visits—is best. When the COVID-19 pandemic suddenly limited access to in-person care, doctors turned to telehealth services, offering the opportunity to rethink how care can be delivered successfully. Given the disproportionately high rates of maternal morbidity and mortality in the United States, as well as extreme health disparities, researchers are now considering the use of telehealth as a strategy to expand and improve maternal health care delivery.
Cantor’s team conducted a rapid review that included 28 randomized controlled trials and 14 observational studies of nearly 45,000 women. The aim was to understand the effect of telehealth as an adjunct or replacement of in-person maternal health care, compared with in-person care alone, on important health outcomes for pregnant adults and adolescents and their infants.
Researchers found that when care provided by telehealth was used to supplement or replace in-person maternal care services, clinical outcomes and patient satisfaction were similar to in-person care—and sometimes better.
In particular, the study found that telehealth strategies were particularly promising for some health services, such as the treatment of postpartum depression and remote monitoring of conditions such as diabetes and hypertension during pregnancy. And for low-risk pregnancies, telehealth can replace general maternity care.
Despite the study’s promising findings, Cantor said the effect of telehealth on mothers’ access to care remains unclear, highlighting a continuing need to assess and improve health equity. Looking ahead, Cantor said future research should focus on larger studies that examine the effects of telehealth in vulnerable populations, such as those living in rural areas, and evaluate outcomes based on population characteristics in order to better understand the effect of telehealth on health disparities.
Funding for this survey was provided by the Patient-Centered Outcomes Research Institute (PROSPERO: CRD42021276347).