Replacing or supplementing in-person maternal care with telehealth generally produces similar, and sometimes better, outcomes than in-person care, researchers at Oregon Health & Science University found.
The study, published last week in Annals of Internal Medicinefollows the widespread, rapid deployment 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 few years puts us in a unique position as clinicians where we’re now in a position to reassess and rethink how we deliver care,” said 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 of poor outcomes and provides an opportunity to prevent and treat any complications.
There is little evidence to support the idea that a 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, providing an opportunity to rethink how care can be successfully delivered. Given the disproportionately high rates of maternal morbidity and mortality in the United States, as well as extreme health care 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 objective was to understand the effect of telehealth as an adjunct or substitute for in-person care for the mother, compared with in-person care alone, on important health outcomes for pregnant adults and adolescents and their infants.
Researchers have found that when telehealth care is used to supplement or replace in-person maternal care services, clinical outcomes and patient satisfaction are similar to in-person care—and sometimes better.
In particular, the study found that telehealth strategies hold particular promise for certain 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 some of the general in-person maternity care.
Despite the study’s promising findings, Cantor said the effect of telehealth on mothers’ access to care remains unclear, highlighting the continued need to evaluate and improve health equity. Looking ahead, Cantor said future research should focus on larger studies that examine the effects of telehealth on vulnerable populations, such as those living in rural areas, and evaluate outcomes based on population characteristics, for to better understand the effect of telehealth on health disparities.
Funding for it study was provided by the Institute for Patient-Oriented Outcomes Research (PROSPERO: CRD42021276347).