Study: Replacing usual maternal care with telehealth produces similar outcomes

Patients who received maternal care through telehealth had similar, and occasionally better, outcomes than those who received in-person care only, according to a study published in Annals of Internal Medicine.

Maternal mortality, morbidity and near misses “are unacceptably high” in the United States, “despite exceedingly high costs,” Amy G. Cantor, MD, MPH, a family physician who specializes in primary care for women at the Pacific Northwest Evidence-based Practice Center in Portland, Oregon, and colleagues wrote. The numbers only worsened during the pandemic, with maternal mortality rates increasing by 33%, and outcomes being worse for those in underrepresented populations.

Given that the field of maternity care is “ripe for innovation,” the researchers wrote that these findings suggest telehealth may be able to improve practices and outcomes.

Cantor and colleagues conducted a rapid review of 28 randomized controlled trials and 14 observational studies including 44,894 women. They analyzed telehealth strategies that were used as alternatives to in-person visits for prenatal care, diabetes or hypertension monitoring during pregnancy and postpartum depression during the COVID-19 pandemic.

The review addressed four key questions:

• Do maternal telehealth strategies produce similar outcomes?

• Do maternal telehealth strategies produce equal access to care or health disparities?

• What gaps exist in current research?

• What are the harms of telehealth strategies for maternal health?

Overall, telehealth strategies resulted in similar obstetric and patient satisfaction outcomes as in-person care, according to Cantor and colleagues. The researchers found that supplementing in-person care with telehealth led to similar or better mental health outcomes. In addition, using telehealth to reduce in-person prenatal visits for low-risk pregnancies was associated with similar clinical outcomes as in-person care and higher patient satisfaction.

However, the researchers were unable to analyze equal access to care. Though few harms were reported, most studies did not assess health disparities and “there was no evidence to inform how outcomes differed” in underrepresented populations, Cantor and colleagues wrote.

Along with health disparities, other clinical areas that lack evidence and present gaps in research include obstetric outcomes for gestational weight gain, smoking cessation, gestational hypertension and prenatal mental health interventions. More gaps that “can be used by stakeholders to inform priorities for future research” consist of obstetric and utilization outcomes for breastfeeding and adverse effects of telehealth interventions, the researchers wrote.

Cantor and colleagues additionally found that there was a difference when it came to whether the interventions supplemented or replaced usual care. Most of the studies in the review “evaluated bidirectional telehealth interventions that supplemented in-person care,” which resulted in mostly similar outcomes, the researchers wrote. However, with strategies that replaced it entirely, utilization of care was better, they added.

In all, the study “suggests telehealth strategies could help achieve prenatal care goals,” the researchers wrote.

“These findings also highlight an ongoing need to incorporate methods to evaluate and improve health equity, an important element lacking in these telehealth studies,” they wrote. “Future research should focus on larger studies with broader inclusion criteria, examine effects of telehealth interventions in rural populations, and evaluate outcomes based on population characteristics to inform the effect of telehealth on health disparities and health equity and potential harms of telehealth interventions.”