Effect of telehealth-integrated antenatal care on pregnancy outcomes in Australia: an interrupted time-series analysis

Background During the COVID-19 pandemic, rapid integration of telehealth into antenatal care occurred to support ongoing maternity care. A programme of this scale had not been previously implemented. We evaluated whether telehealth-integrated antenatal care in an Australian public health system could achieve pregnancy outcomes comparable to those of conventional care to assess its safety and efficacy. Methods Routinely collected data for individuals who gave birth at Monash Health (Melbourne, VIC, Australia) during a conventional care period (Jan 1, 2018, to March 22, 2020) and telehealth-integrated period (April 20, 2020, to April 25, 2021) were analysed. We included all births that occurred at 20 weeks' gestation or later or with a birthweight of at least 400 g (if duration of gestation was unknown). We excluded multiple births, births for which private antenatal care was received, and births to individuals transferred from other hospitals or who had no antenatal care. Baseline demographics, telehealth uptake, and pregnancy complications (related to pre-eclampsia, fetal growth restriction [FGR], gestational diabetes, stillbirth, neonatal intensive care [NICU] admission, and preterm birth [<37 weeks' gestation]) were compared using comparative statistics and an interrupted time-series analysis. Results were stratified by care stream, with high-risk models consisting of obstetric specialist-led care, and all other streams categorised as low-risk models. The impact of the integrated period on outcomes was also assessed with stratification by parity. Findings 17 873 births occurred in the conventional period and 8131 in the integrated period. Compared with the conventional period, women giving birth during the integrated period were slightly older (3063 years vs 3088 years) and had slightly higher BMI (2552 kg/m2 vs 2614 kg/m2), and more Australian-born women gave birth during the integrated period (3737% vs 3979%). There were no significant differences in smoking status or parity between the two groups. 107 (008%) of 129 514 antenatal consultations in the conventional period and 34 444 (4594%) of 74 982 in the integrated period were delivered by telehealth. No significant differences between the conventional and integrated periods were seen in median gestational age at pre-eclampsia diagnosis (low-risk models 374 weeks in the conventional period vs 371 weeks in the integrated period, difference -03 weeks [-07 to 01]; high-risk models 355 weeks vs 363 weeks, difference 03 weeks [-03 to 11]), incidence of FGR below the 3rd birthweight percentile (low-risk models 162% vs 174%, difference 012 percentage points [-026 to 050]; high-risk 404% vs 413%, difference 0089 percentage points [-108 to 126]), and incidence of preterm birth (low-risk models 499% vs 501%, difference 002% [-062 to 066]; high-risk models 1576% vs 1443%, difference -133% [-342 to 077]). Parity did not affect these findings. Interrupted time-series analysis showed a significant reduction in induction of labour for singletons with suspected FGR among women in low-risk models during the integrated period (-004% change per week [95% CI -007 to -001], p=00040), and NICU admission declined after telehealth integration (low-risk models -002% change per week [-003 to -0003], p=0018; high-risk models -010% change per week, -019 to -0001; p=0047). No significant differences in stillbirth rates were observed. The proportion of women diagnosed with gestational diabetes was significantly higher in the integrated period compared with the conventional period for both low-risk care models (2228% vs 2513%, difference 285 percentage points [160 to 411]) and high -risk care models (2870% vs 3402%, difference 532 percentage points [257 to 807]). However overall, when compared with the conventional period, there was no significant difference in proportion of women with gestational diabetes requiring insulin therapy (low-risk models 808% vs 773%, difference -035 percentage points [-113 vs 044]; high-risk models 1481% vs 1571%, difference 089 percentage points [-123 to 302]), or proportion of women with gestational diabetes who gave birth to a baby with macrosomia in the integrated period (low-risk models 316% vs 233%, difference -083 percentage points [-177 to 012]; high-risk models 558% vs 481%, difference -077 percentage points [-306 to 152]).

Automated summary

This article compared the pregnancy outcomes of antenatal care integrated with telehealth and conventional care in an Australian public health system. It found that women giving birth during the integrated period were older and had higher BMI, with more Australian-born. The uptake of telehealth increased significantly. There were no significant differences in many pregnancy complication indicators between the two periods, except for a higher diagnosis rate of gestational diabetes in the integrated period. The induction rate of singleton pregnancies with suspected FGR in the low-risk model decreased and NICU admission rate declined.