Abstract
Objective 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.
Study Design 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 t-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.
Results 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%,
p = 0.01), be screened for gestational diabetes (74.4 vs. 67.0%, p <0.001), and receive dating and anatomy ultrasounds (17.8 vs. 13.0%, p = 0.006 and 56.9 vs. 47.3%, p <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, p = 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%, p < 0.001). Increases in rates of labor induction were also observed among the pandemic-exposed
cohort (47.1 vs. 38.2%, p <0.001).
Conclusion 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.
Key Points
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Patients initiated prenatal care earlier during the COVID-19 pandemic.
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Uptake of telehealth services was low.
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Rates of diabetes screening and ultrasound use increased during the pandemic.
Keywords
COVID-19 - prenatal care - telehealth - antenatal screening
