The impact of the COVID-19 pandemic on the rate of participants with insufficient prenatal care

Abstract

Insufficient prenatal care (PNC) is associated with increased maternal and neonatal morbidity and mortality. Given the lockdown restrictions during the COVID-19 pandemic, we hypothesized the rate of participants with insufficient PNC increased during the pandemic. This was a retrospective cohort study of a prospectively collected, population based perinatal database from a large academic center from 2011-2022. All pregnancies with complete PNC data were included. The Adequacy of Prenatal Care Utilization Index (APNCU index) was used, which incorporates gestational age (GA) that PNC was initiated, GA at delivery, and the number of prenatal visits (PNVs) compared to ACOG recommendations. Insufficient PNC is defined as PNC begun after the 4th month of gestation or less than 50% of recommended PNVs. Maternal comorbidities, PNC, and obstetrical outcomes were compared between pregnancies with PNC started before and after March 15, 2020 (the date of the first CDC recommendations). The primary outcome was insufficient PNC. Logistic regression was used to evaluate the association of receiving PNC during the COVID-19 pandemic with insufficient PNC. 46,794 pregnancies were included. 20.4% of participants with PNC during the pandemic had insufficient PNC, lower than the 23.5% before the pandemic (p< 0.001). This trend was consistent even with stratification for race or ethnicity (Figure 1). On logistic regression, PNC initiated after March 15, 2020 was independently associated with a lower rate of insufficient PNC (aOR 0.879, 95% CI 0.816 – 0.947) after adjusting for covariates that may increase the number of PNV (Table 1). Initiation of PNC during the COVID-19 pandemic was independently associated with an improved rate of sufficient PNC visits. Possible explanations include decreased occupational stressors, increased health concerns given the societal focus on health, boredom, and the advent of telemedicine. Limitations include the retrospective design, no information on if visits were in-person or virtual, and the possible unaccounted for confounding.View Large Image Figure ViewerDownload Hi-res image Download (PPT)