Comparison Between In-Person and Audio-Only Virtual Prenatal Visits and Perinatal Outcomes.
Comparison Between In-Person and Audio-Only Virtual Prenatal Visits and Perinatal Outcomes.
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DOI：
10.1001/jamanetworkopen.2021.5854
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发表时间：
2021-04-01
影响因子：
13.8
通讯作者：
Nelson DB
中科院分区：
文献类型：
--
作者：
Duryea EL;Adhikari EH;Ambia A;Spong C;McIntire D;Nelson DB
在COVID-19大流行期间，仅音频虚拟产前访视是否与弱势人群围产期结局的变化相关？在这项对12607名女性进行的队列研究中，173名女性（2.9%）经历了胎盘脱垂、死产、脐带pH值低于7.0或足月新生儿重症监护室入院，与2019年受影响的195名女性（3.0%）没有显著差异。当按虚拟产前访视次数分层时，该复合结局的发生率也没有显著差异。在这项研究中，在实施仅音频产前虚拟访问后于2020年分娩的妇女没有比2019年分娩的妇女经历更多的不良妊娠结局。确保在美国获得产前护理服务是一项挑战，在COVID-19大流行之前，远程医疗方案的实施受到限制，特别是在脆弱人群中，因为对视频访问技术的监管要求。探讨全音频虚拟产前监护与围产儿结局的关系。这项队列研究比较了2019年5月1日至10月31日期间分娩的女性的围产期结局（n = 6559），仅对2020年5月1日至10月31日期间分娩的孕妇进行了产前访视（n = 6048），在COVID-19大流行期间，基于妊娠并发症，将仅音频虚拟访问整合到产前护理中。得克萨斯州达拉斯的帕克兰卫生和医院系统通过一个高容量的产前诊所系统和公立妇产医院向该县脆弱的产科人口提供护理。包括所有体重超过500 g的婴儿的分娩，无论是活产还是死胎。产前护理包括仅使用音频的产前护理就诊。主要结局是一名足月（≥37周）婴儿的胎盘脱落、死胎、新生儿重症监护室入院和脐带血pH值小于7.0的复合终点。访问数据，产妇的特点，和其他围产期的结果也进行了检查。2019年分娩的6559名女性的平均（SD）年龄为27.8（6.4）岁，2020年分娩的6048名女性的年龄为27.7（6.5）岁（P = .38）。在2020年分娩的女性中，有1090名（18.0%）是非西班牙裔黑人，而2019年为1067名（16.3%）（P = .04）。在2020年的队列中，4067名妇女（67.2%）参加了至少1次，1216名妇女（20.1%）参加了至少3次仅音频的虚拟产前检查。与2019年分娩的妇女相比，2020年分娩的妇女接受产前检查的平均（SD）次数更多（9.8 [3.4] vs 9.4 [3.8]次; P < .001）。在2020年队列中，173名女性（2.9%）经历了复合结局，与2019年的195名女性（3.0%）相比没有显著差异（P = 0.71）。此外，当根据参加的仅音频虚拟访问的数量进行检查时，复合结果的比率没有实质性差异。当在风险适当的模型中使用时，在COVID-19大流行期间，实施仅音频虚拟产前访视与围产期结局的变化以及弱势人群产前访视的增加无关。这项队列研究比较了在2019年接受亲自产前检查的妇女与在2020年COVID-19大流行期间接受仅音频虚拟产前检查的妇女的围产期结局。
Were audio-only virtual prenatal visits during the COVID-19 pandemic associated with a change in perinatal outcomes in a vulnerable population? In this cohort study of 12 607 women, 173 women (2.9%) experienced placental abruption, stillbirth, cord pH less than 7.0, or full-term neonatal intensive care unit admission, which was not significantly different than the 195 women (3.0%) affected in 2019. The rate of this composite outcome also did not differ significantly when stratified by the number of virtual prenatal visits. In this study, women who delivered in 2020 following implementation of audio-only prenatal virtual visits did not experience more adverse pregnancy outcomes than women who delivered in 2019. Ensuring access to prenatal care services in the US is challenging, and implementation of telehealth options was limited before the COVID-19 pandemic, especially in vulnerable populations, given the regulatory requirements for video visit technology. To explore the association of audio-only virtual prenatal care with perinatal outcomes. This cohort study compared perinatal outcomes of women who delivered between May 1 and October 31, 2019 (n = 6559), and received in-person prenatal visits only with those who delivered between May 1 and October 31, 2020 (n = 6048), when audio-only virtual visits were integrated into prenatal care during the COVID-19 pandemic, as feasible based on pregnancy complications. Parkland Health and Hospital System in Dallas, Texas, provides care to the vulnerable obstetric population of the county via a high-volume prenatal clinic system and public maternity hospital. All deliveries of infants weighing more than 500 g, whether live or stillborn, were included. Prenatal care incorporating audio-only prenatal care visits. The primary outcome was a composite of placental abruption, stillbirth, neonatal intensive care unit admission in a full-term (≥37 weeks) infant, and umbilical cord blood pH less than 7.0. Visit data, maternal characteristics, and other perinatal outcomes were also examined. The mean (SD) age of the 6559 women who delivered in 2019 was 27.8 (6.4) years, and the age of the 6048 women who delivered in 2020 was 27.7 (6.5) years (P = .38). Of women delivering in 2020, 1090 (18.0%) were non-Hispanic Black compared with 1067 (16.3%) in 2019 (P = .04). In the 2020 cohort, 4067 women (67.2%) attended at least 1 and 1216 women (20.1%) attended at least 3 audio-only virtual prenatal visits. Women who delivered in 2020 attended a greater mean (SD) number of prenatal visits compared with women who delivered in 2019 (9.8 [3.4] vs 9.4 [3.8] visits; P < .001). In the 2020 cohort, 173 women (2.9%) experienced the composite outcome, which was not significantly different than the 195 women (3.0%) in 2019 (P = .71). In addition, the rate of the composite outcome did not differ substantially when examined according to the number of audio-only virtual visits attended. Implementation of audio-only virtual prenatal visits was not associated with changes in perinatal outcomes and increased prenatal visit attendance in a vulnerable population during the COVID-19 pandemic when used in a risk-appropriate model. This cohort study compares perinatal outcomes among women who received in-person pernatal visits in 2019 vs those who received audio-only virtual prenatal visits during the COVID-19 pandemic in 2020.
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影响因子：
6.3
作者：
Jeganathan S;Prasannan L;Blitz MJ;Vohra N;Rochelson B;Meirowitz N
通讯作者：
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