Abstract
Background The SARS-CoV-2 (COVID-19) pandemic resulted in major shifts in service delivery for patient care not involving COVID-19 illness. The preexisting telehealth infrastructure in Mississippi allowed the state to rapidly expand the scope of telehealth programs. Little research has been done to examine the use of telehealth during the COVID-19 pandemic and its impact on the delivery of care during pregnancy and outcomes associated with pregnancy. The objectives of this study are to (1) describe prenatal care practices during the height of the first wave of the COVID-19 pandemic, compared to the immediate prepandemic time period, and (2) explore maternal and birth outcomes during these time periods. Methods This study was conducted as a retrospective historical cohort study from medical records at one Maternal Care Level IV (Regional Perinatal Health Care Center) in Mississippi and its affiliated centers. The participant cohort was inclusive of women who received prenatal care prior to a single birth delivery between May 1, 2020, and January 31, 2021. The pandemic cohort was defined through the timeframe of the included participants' end-term prenatal care, with reference to the beginning of the COVID-19 pandemic. The prepandemic cohort received a majority of their prenatal care prior to the COVID-19 pandemic. Results There were 1,894 women included. Among them, 620 (32.77%) completed the majority of their end-term pregnancy in the pre-COVID-19 time period and 1,272 (67.23%) completed the end-term pregnancy during the pandemic. The odds ratio for patients from the pandemic cohort of scheduling telehealth visits compared to not scheduling telehealth visits is 8.19 (95% CI: 3.98, 16.86) times the odds ratio for patients from the prepandemic cohort. The pandemic exposure as well as infant's gestational age and very low birth weight (VLBW) show significant effects on the infant's living status in the univariate logistic regression. However, after controlling for the infant's gestational age and VLBW, we did not detect a significant effect of pandemic exposure. Conclusion This study demonstrated a very small reliance of telehealth for the medical supervision of pregnant women during the COVID-19 pandemic. This is likely because of the essential physical examinations that occur in women who are considered to be at high risk for poor maternal and birth outcomes. Additional studies on the impact of COVID-19 infection on maternal and infant outcomes are also needed as there may be important risk factors not yet identified for poor maternal or birth outcomes.
Highlights
In 2019, Mississippi had 36,634 live births with 19,884 (54.3%) among white women, 15,732 (42.9%) among black women, and 1,018 (2.8%) among women of other races [1].e most recently published pregnancy-related mortality ratio was 33.2 deaths per 100,000 live births. is rate is 1.9 times higher than the average US ratio of 17.3 deaths per 100,000 live births for the same time period [2]
Little research has been done to examine the use of telehealth during the COVID-19 pandemic and its impact on the delivery of care during pregnancy and outcomes associated with pregnancy. e objectives of this study are to (1) describe prenatal care practices during the height of the first wave of the COVID-19 pandemic, compared to the immediate prepandemic time period, and (2) explore maternal and birth outcomes during these time periods
620 (32.77%) completed the majority of their end-term pregnancy in the pre-COVID-19 time period and 1,272 (67.23%) completed the end-term pregnancy during the pandemic. e odds ratio for patients from the pandemic cohort of scheduling telehealth visits compared to not scheduling telehealth visits is 8.19 times the odds ratio for patients from the prepandemic cohort. e pandemic exposure as well as infant’s gestational age and very low birth weight (VLBW) show significant effects on the infant’s living status in the univariate logistic regression
Summary
In 2019, Mississippi had 36,634 live births with 19,884 (54.3%) among white women, 15,732 (42.9%) among black women, and 1,018 (2.8%) among women of other races [1]. Care is rendered for fetal conditions, such as genetic disorders and malformations, as well as maternal conditions including hypertensive disorders of pregnancy, obesity, heart disease, diabetes, history of preterm labor, advanced maternal age, or communicable diseases Any of these conditions can impact the health of the mother or child, and specialized maternal and fetal care is administered at UMMC. E Mississippi State Department of Health Perinatal High Risk Management/Infant Services System (PHRM/ISS) is a case management program intended to ensure healthy pregnancy outcomes for women with risk factors that could impact pregnancy, delivery, and newborn development and care and their infants. Given the upshift in the use of telehealth for PHRM/ISS case management services during the COVID-19 pandemic, it is of interest to explore the use of in-person and telehealth services for the supervision of pregnant women during the same time period. Little research has been done to examine the use of telehealth during the COVID-19 pandemic and its impact on patient outcomes. e objectives of this study are to (1) describe prenatal care practices during the height of the COVID-19 pandemic, compared to the immediate prepandemic time period, and (2) explore maternal and birth outcomes during these time periods
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