Background

Little evidence is available on the use of telehealth for antenatal care. In response to the COVID-19 pandemic, we developed and implemented a new antenatal care schedule integrating telehealth across all models of pregnancy care. To inform this clinical initiative, we aimed to assess the effectiveness and safety of telehealth in antenatal care.

Methods

We analysed routinely collected health data on all women giving birth at Monash Health, a large health service in Victoria (Australia), using an interrupted time-series design. We assessed the impact of telehealth integration into antenatal care from March 23, 2020, across low-risk and high-risk care models. Allowing a 1-month implementation period from March 23, 2020, we compared the first 3 months of telehealth integrated care delivered between April 20 and July 26, 2020, with conventional care delivered between Jan 1, 2018, and March 22, 2020. The primary outcomes were detection and outcomes of fetal growth restriction, pre-eclampsia, and gestational diabetes. Secondary outcomes were stillbirth, neonatal intensive care unit admission, and preterm birth (birth before 37 weeks' gestation).

Findings

Between Jan 1, 2018, and March 22, 2020, 20 031 women gave birth at Monash Health during the conventional care period and 2292 women gave birth during the telehealth integrated care period. Of 20 154 antenatal consultations provided in the integrated care period, 10 731 (53%) were delivered via telehealth. Overall, compared with the conventional care period, no significant differences were identified in the integrated care period with regard to the number of babies with fetal growth restriction (birthweight below the 3rd percentile; 2% in the integrated care period vs 2% in the conventional care period, p=0·72, for low-risk care models; 5% in the integrated care period vs 5% in the conventional care period, p=0·50 for high-risk care models), number of stillbirths (1% vs 1%, p=0·79; 2% vs 2%, p=0·70), or pregnancies complicated by pre-eclampsia (3% vs 3%, p=0·70; 9% vs 7%, p=0·15), or gestational diabetes (22% vs 22%, p=0·89; 30% vs 26%, p=0·06). Interrupted time-series analysis showed a significant reduction in preterm birth among women in high-risk models (–0·68% change in incidence per week [95% CI −1·37 to −0·002]; p=0·049), but no significant differences were identified in other outcome measures for low-risk or high-risk care models after telehealth integration compared with conventional care.

Interpretation

Telehealth integrated antenatal care enabled the reduction of in-person consultations by 50% without compromising pregnancy outcomes. This care model can help to minimise in-person interactions during the COVID-19 pandemic, but should also be considered in post-pandemic health-care models.

Funding

None.

中文翻译：

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在 COVID-19 大流行期间广泛实施低成本远程医疗服务以提供产前护理：中断的时间序列分析

背景

关于使用远程医疗进行产前保健的证据很少。为应对 COVID-19 大流行，我们制定并实施了新的产前保健计划，将远程医疗整合到所有孕期保健模式中。为了告知这一临床计划，我们旨在评估远程医疗在产前保健中的有效性和安全性。

方法

我们使用间断时间序列设计分析了在 Monash Health（澳大利亚维多利亚州的一家大型医疗服务机构）中所有分娩妇女的常规收集的健康数据。我们评估了远程医疗从 2020 年 3 月 23 日起在低风险和高风险护理模式中融入产前护理的影响。从 2020 年 3 月 23 日起有 1 个月的实施期，我们将 2020 年 4 月 20 日至 7 月 26 日期间提供的前 3 个月远程医疗综合护理与 2018 年 1 月 1 日至 2020 年 3 月 22 日期间提供的常规护理进行了比较。主要结局是胎儿生长受限、先兆子痫和妊娠糖尿病的检测和结局。次要结局是死产、新生儿重症监护病房入院和早产（妊娠 37 周前出生）。

发现

2018 年 1 月 1 日至 2020 年 3 月 22 日期间，20031 名妇女在常规护理期间在 Monash Health 分娩，2292 名妇女在远程医疗综合护理期间分娩。在综合护理期间提供的 20 154 次产前咨询中，10 731 次（53%）是通过远程医疗提供的。总体而言，与传统护理期相比，综合护理期在胎儿生长受限的婴儿数量（出生体重低于第 3 个百分位数；综合护理期为2%，传统护理期为2%）方面没有显着差异。护理期，对于低风险护理模式，p=0·72；综合护理期间为5%，而传统护理期间为5%，高风险护理模式为 p=0·50），死产数量（1 %对比1%，p=0·79；2%对2%，p=0·70），或妊娠合并先兆子痫（3%对3%，p=0·70；9%对7%，p=0·15）或妊娠糖尿病（ 22%对22%，p=0·89；30%对26%，p=0·06）。中断时间序列分析显示，在高风险模型中，女性早产显着减少（每周发生率变化为 –0·68% [95% CI -1·37 至 -0·002]；p=0·049 )，但与传统护理相比，远程医疗整合后低风险或高风险护理模式的其他结果测量没有显着差异。

解释

远程医疗综合产前保健使面对面咨询减少了 50%，而不会影响怀孕结果。这种护理模式有助于在 COVID-19 大流行期间最大限度地减少面对面的互动，但也应在大流行后的医疗保健模式中加以考虑。

资金

没有任何。