Virtual Prenatal Care: The Effect of Telemedicine and Home-Ultrasound on Maternal Anxiety and Attachment During Pregnancy in Women With a History of Pregnancy Loss [ID: 1375930

Abstract

INTRODUCTION: We aimed to study the effects of twice-a-week telemedicine visits on maternal anxiety and antenatal attachment in women with a history of previous pregnancy loss by complementing routine prenatal care with home ultrasound. METHODS: This was a randomized controlled trial. Women with history of pregnancy loss (>20 weeks) were recruited and randomized 1:1 in the treatment arms early in their subsequent pregnancy in our high-risk clinic. The control group received routine prenatal high-risk care per protocol, while the study group received additional twice-a-week telemedicine visits with a maternal–fetal medicine specialist, which included a home ultrasound scan (for fetal heart rate, movement, and amniotic fluid) for reassurance. The scan was performed by the patient using a home ultrasound device (Pulsenmore ES) with physician authorization and guidance. Maternal anxiety was evaluated by the validated State-Trait Anxiety Inventory Scale (STAI-S) and maternal attachment was evaluated by the validated Maternal Antenatal Attachment Scale (MAAS-2) at four time points throughout pregnancy. The primary outcome was the STAI-S score at the last prenatal visit. Power analysis required 40 patients to demonstrate a 20% difference in the primary outcome. The study was approved by the local IRB, and all patients signed an informed consent upon randomization. RESULTS: To date, 32 patients completed follow-up, with 16 per arm. There were no differences in demographics or pregnancy outcomes between groups. The study group demonstrated lower anxiety levels at the last prenatal visit (STAI 42.2±4.7 versus 49.6±5.8, P<.001), higher differences between STAI scores at the first versus last visit (−9.9±2.7 versus −7.1±3.1, P=.011), and higher MAAS-2 scores (50.4±3.9 versus 47.2±4.5, P=.039) at last visit. CONCLUSION: Routine prenatal telemedicine visits with home ultrasound can lower maternal anxiety and improve attachment in women with previous pregnancy loss.