July 25 (UPI) -- Using telehealth to supplement or replace in-person maternal care services, such as postpartum depression and diabetes and hypertension monitoring during pregnancy, leads to similar -- and sometimes better -- clinical outcomes and patient satisfaction compared to in-person care.
Knowing this may help lead to strategies to lower unacceptably high maternal complications and deaths in the United States, according to the researchers who analyzed dozens of studies on the subject involving nearly 45,000 women.
That's the gist of a study whose findings were published Monday in Annals of Internal Medicine.
The researchers pointed out that access to "high-quality maternal health care is associated with reduced maternal morbidity and mortality because it facilitates identification of conditions that increase the risk for poor outcomes and enables timely prevention or treatment."
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It's a daunting backdrop: Every 12 hours, a woman dies from complications from pregnancy or giving birth in the United States, according to the the National Institutes of Health.
Nationwide, the number of reported pregnancy-related deaths steadily climbed to 17.3 deaths per 100,000 live births in 2018, up from 7.2 deaths per 100,000 live births in 1987, according to the Centers for Disease Control and Prevention's latest available surveillance data. The CDC said the reasons for the rise are unclear.
Black and American Indian/Alaska Native women are about three times as likely to die from a pregnancy-related cause as compared to white women, the CDC says, and nearly two-thirds of these deaths may be preventable.
Researchers from Oregon Health & Science University conducted a "rapid review" of 28 randomized, controlled trials and 14 observational studies, involving a total of 44,894 women, as a way to explore the pros and cons of telehealth strategies for maternal health care.
The new analysis was performed in response to the recent expansion of telehealth services arising from the COVID-19 pandemic, which made it harder to get in-person care at physician offices -- although pregnancy care could not be deferred as some health screenings and other types of medical visits might have been.
"Telemedicine, including virtual visits and home monitoring, is a promising strategy for tailoring care to patients' individual needs: reducing the burden of missed work, travel, or childcare, while ensuring patients have access to high-quality services," Dr. Alex Peahl, assistant professor of obstetrics and gynecology at the University of Michigan, told UPI in an email.
According to Peahl, who is not a co-author of the analysis, but whose work is cited in it, telemedicine is a "key component" of local and national efforts to redesign prenatal care delivery to fit patients' needs and preferences.
"We recommend 4 prenatal visits be completed in-person for average-risk patients," said Peahl, who is chair of the American College of Obstetricians and Gynecologists and university's Redesigning Prenatal Care Initiative.
"Other visits can be completed in-person or virtually after shared decision making between the patient and provider."
Peahl said that successful telehealth "requires adequate support for patients and providers, including education and preparation for visits, and availability of high-quality equipment, including smart devices and home monitoring tools."
And, she said, "Most importantly, telemedicine must incorporate individuals' preferences in determining the right tailored care plan for them, including the use of telemedicine."
Peahl cited "many instances" in which in-person care is needed, such as when testing to make sure the baby is all right, perhaps using an ultrasound to detect fluid, is required.
But, she said new technology, "including home devices for assessing baby's heart rate or for performing ultrasounds a home, could allow even more care in the future to be safely delivered at home."
For the new analysis, the researchers reviewed studies in which telehealth was used to treat postpartum depression, monitor diabetes or hypertension during pregnancy, or as an alternative to general in-office maternity care for low-risk pregnancies, a news release said.
They found that maternal telehealth interventions supplemented in-person care for most studies of mental health and diabetes during pregnancy. And this primarily resulted in similar, and sometimes better, clinical and patient-reported outcomes versus usual care provided in the doctor's office.
Moreover, according to the review, supplementing in-person maternal mental health care with phone- or web-based platforms or mobile applications resulted in similar or better mental health outcomes versus in-person care.
And a reduced-visit prenatal care schedule, using telehealth to replace in-person general maternity care for low-risk pregnancies, resulted in similar clinical outcomes and higher patient satisfaction versus usual care.
Given the findings, the researchers said telehealth could end up being used to supplement the usual medical care for postpartum depression since "telehealth interventions were more likely to improve mood symptoms in the short term compared to in-person care alone," the release said.
But the scientists acknowledged that such effects may not be sustained.
The study's authors suggested that maternity care may be especially ready for telehealth because of limited evidence supporting traditional approaches to prenatal care that rely on multiple in-person visits.
They said their findings also "highlight an ongoing need to incorporate methods to evaluate and improve health equity, an important element lacking in these telehealth studies" that were reviewed.
