Prenatal telehealth visits increase early in COVID-19 pandemic

Key takeaways :

• Prenatal telehealth use increased from 1.3% in 2018 to 17.3% during the first year of COVID-19.
• Higher telehealth use among Medicaid participants could be explained by state-level policy changes.

Early in the COVID-19 pandemic, prenatal telehealth visits increased substantially with higher telehealth rates particularly among patients with Medicaid, according to a cross-sectional study published in JAMA Network Open.

“The COVID-19 pandemic has affected prenatal care practice, with an increase in the adoption of alternative care models,” Mahip Acharya, PhD, senior data analyst at the Institute for Digital Health and Innovation at the University of Arkansas for Medical Sciences, Little Rock, and colleagues wrote. “Telehealth visits are useful for quick patient follow-ups but are of limited value when laboratory tests or ultrasonography are required.”

In this cross-sectional study, researchers used a U.S. health insurance claims database to identify 45,203 deliveries (mean age, 31.5 years) from September 2018 to October 2021. Researchers classified pregnancies as high risk if the maternal age at delivery was older than 35 years or if certain clinical characteristics were observed. Prenatal telehealth visits were identified, and researchers assessed trends in prenatal telehealth utilization during the prior 40 weeks for all deliveries.

Of all pregnancies, 12.3% had gestational diabetes and 58.6% were high-risk. During 40-week pregnancy by month of delivery, prenatal telehealth use was 1.3% in September 2018, 1.1% in January 2020, 17.3% in November 2020 and 9.9% in October 2021. Monthly telehealth utilization rates for all pregnancies were 0.1% in September 2018, 0.1% in January 2020, 2.8% in April 2020 and 0.5% in October 2021.

Participants with higher-risk pregnancies had slightly higher telehealth use for both episodic and monthly visits.

Incidence rate ratios for all deliveries during COVID-19 were 1.38 for participants with anxiety and 1.77 for participants with depression. Participants who received Medicaid experienced 165% higher prenatal telehealth rates for deliveries during compared with before the pandemic.

Prior to the pandemic, researchers observed no statistically significance in telehealth use between patients on Medicaid compared with patients with commercial insurance during the pre-pandemic period. Researchers also noted that telehealth use for both low- and high-risk pregnancies also was not statistically significant during the pre-pandemic period.

“Higher telehealth rates among patients with Medicaid are likely explained by state-level policy changes in telehealth coverage and reimbursement. Higher telehealth utilization among pregnant patients with anxiety and depression aligns with overall telehealth use patterns during the pandemic,” the researchers wrote. “Alternative prenatal care models have been proposed that incorporate virtual visits for mental health screening.”