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Am J Perinatol 2023; 40(13): 1484-1494
DOI: 10.1055/a-1877-7951
Original Article

Impact of the COVID-19 Pandemic on Prenatal Care Utilization at a Public Hospital

Shae M. Boguslawski
1   Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
,
Naima T. Joseph
2   Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Kaitlyn K. Stanhope 
1   Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
,
Angeline J. Ti
3   Department of Family Medicine, Wellstar Atlanta Medical Center, Atlanta, Georgia
,
Franklyn H. Geary
4   Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, Georgia
,
Sheree L. Boulet 
1   Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
› Author Affiliations
Funding This project was supported by grants from the Emory Medical Care Foundation and the National Center for Advancing Translational Sciences of the National Institutes of Health under Award number UL1TR002378. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding for some of the blood pressure cuffs used for patient care during the COVID-19 pandemic was provided through an Immediate Needs Community Health Grant from the Georgia Health Family Alliance.
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Abstract

Objective The aim of the study is to compare rates of prenatal care utilization before and after implementation of a telehealth-supplemented prenatal care model due to the coronavirus disease 2019 (COVID-19) pandemic.

Study Design Using electronic medical record data, we identified two cohorts of pregnant persons that initiated prenatal care prior to and during the COVID-19 pandemic following the implementation of telehealth (from March 1, 2019 through August 31, 2019, and from March 1, 2020, through August 31, 2020, respectively) at Grady Memorial Hospital. We used Pearson's Chi-square and two-tailed t-tests to compare rates of prenatal care utilization, antenatal screening and immunizations, emergency department and obstetric triage visits, and pregnancy complications for the prepandemic versus pandemic-exposed cohorts.

Results We identified 1,758 pregnant patients; 965 entered prenatal care prior to the COVID-19 pandemic and 793 entered during the pandemic. Patients in the pandemic-exposed cohort were more likely to initiate prenatal care in the first trimester (46.1 vs. 39.0%, p = 0.01), be screened for gestational diabetes (74.4 vs. 67.0%, p <0.001), and receive dating and anatomy ultrasounds (17.8 vs. 13.0%, p = 0.006 and 56.9 vs. 47.3%, p <0.001, respectively) compared with patients in the prepandemic cohort. There was no difference in mean number of prenatal care visits between the two groups (6.9 vs. 7.1, p = 0.18). Approximately 41% of patients in the pandemic-exposed cohort had one or more telehealth visits. The proportion of patients with one or more emergency department visits was higher in the pandemic-exposed cohort than the prepandemic cohort (32.8 vs. 12.3%, p < 0.001). Increases in rates of labor induction were also observed among the pandemic-exposed cohort (47.1 vs. 38.2%, p <0.001).

Conclusion Rates of prenatal care utilization were similar before and during the COVID-19 pandemic. However, pregnant persons receiving prenatal care during the pandemic entered care earlier and had higher utilization of certain antenatal screening services than those receiving prenatal care prior to the pandemic.

Key Points

  • Patients initiated prenatal care earlier during the COVID-19 pandemic.

  • Uptake of telehealth services was low.

  • Rates of diabetes screening and ultrasound use increased during the pandemic.

Keywords

COVID-19 - prenatal care - telehealth - antenatal screening

Supplementary Material



Publication History

Received: 20 January 2022

Accepted: 03 June 2022

Accepted Manuscript online:
16 June 2022

Article published online:
16 September 2022

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