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Cited by 121Telemedicine and Telehealth ImplementationCOVID-19 Impact on ReproductionMaternal and Neonatal Healthcare

Widespread implementation of a low-cost telehealth service in the delivery of antenatal care during the COVID-19 pandemic: an interrupted time-series analysis

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Palmer, Kirsten R, Tanner, Michael, Davies-Tuck, Miranda, Rindt, Andrea, Papacostas, Kerrie, Giles, Michelle L, Brown, Kate, Diamandis, Helen +7 more·2021·The Lancet
DOI 10.1016/s0140-6736(21)00668-1PMC PMC8248925
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Abstract

Background Little evidence is available on the use of telehealth for antenatal care. In response to the COVID-19 pandemic, we developed and implemented a new antenatal care schedule integrating telehealth across all models of pregnancy care. To inform this clinical initiative, we aimed to assess the effectiveness and safety of telehealth in antenatal care.Methods We analysed routinely collected health data on all women giving birth at Monash Health, a large health service in Victoria (Australia), using an interrupted time-series design. We assessed the impact of telehealth integration into antenatal care from March 23, 2020, across low-risk and high-risk care models. Allowing a 1-month implementation period from March 23, 2020, we compared the first 3 months of telehealth integrated care delivered between April 20 and July 26, 2020, with conventional care delivered between Jan 1, 2018, and March 22, 2020. The primary outcomes were detection and outcomes of fetal growth restriction, pre-eclampsia, and gestational diabetes. Secondary outcomes were stillbirth, neonatal intensive care unit admission, and preterm birth (birth before 37 weeks' gestation).Findings Between Jan 1, 2018, and March 22, 2020, 20 031 women gave birth at Monash Health during the conventional care period and 2292 women gave birth during the telehealth integrated care period. Of 20 154 antenatal consultations provided in the integrated care period, 10 731 (53%) were delivered via telehealth. Overall, compared with the conventional care period, no significant differences were identified in the integrated care period with regard to the number of babies with fetal growth restriction (birthweight below the 3rd percentile; 2% in the integrated care period vs 2% in the conventional care period, p=0·72, for low-risk care models; 5% in the integrated care period vs 5% in the conventional care period, p=0·50 for high-risk care models), number of stillbirths (1% vs 1%, p=0·79; 2% vs 2%, p=0·70), or pregnancies complicated by pre-eclampsia (3% vs 3%, p=0·70; 9% vs 7%, p=0·15), or gestational diabetes (22% vs 22%, p=0·89; 30% vs 26%, p=0·06). Interrupted time-series analysis showed a significant reduction in preterm birth among women in high-risk models (-0·68% change in incidence per week [95% CI -1·37 to -0·002]; p=0·049), but no significant differences were identified in other outcome measures for low-risk or high-risk care models after telehealth integration compared with conventional care.Interpretation Telehealth integrated antenatal care enabled the reduction of in-person consultations by 50% without compromising pregnancy outcomes. This care model can help to minimise in-person interactions during the COVID-19 pandemic, but should also be considered in post-pandemic health-care models.Funding None.

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  • Telehealth is now in widespread use in maternal healthcare, and many parents are likely to have encountered some form of digital service delivery or mode of bereavement support, including online support groups.

    “Telehealth is now in widespread use in maternal healthcare, and many parents are likely to have encountered some form of digital service delivery or mode of bereavement support, including online support groups (Palmer 2021).”

    From Support for parents and families after stillbirth and neonatal death (2024) · cites this paper as Palmer 2021

    The Introduction and Discussion (page numbers unavailable) document substantial telehealth use for antenatal consultations in one Australian health-care network during the COVID-19 pandemic. They do not establish widespread use across maternal healthcare or that many parents encountered digital bereavement support or online support groups. (LLM, conf=0.87)

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  1. [27]WHO WHO recommendations on antenatal care for a positive pregnancy experience: summary 2018 World Health Organization Geneva, Switzerland http://apps.who.int/iris/bitstream/handle/10665/259947/WHO-RHR-18.02-eng.pdf;jsessionid=8113365FD531F62F7E18F3585CC01880?sequence=1 28079998

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Authors
Palmer, K. R., Tanner, M., Davies-Tuck, M., Rindt, A., Papacostas, K., Giles, M. L., Brown, K., Diamandis, H., Fradkin, R., Stewart, A. E., Rolnik, D. L., Stripp, A., Wallace, E. M., Mol, B. W., & Hodges, R. J.
Affiliations
  • Monash Health (AU)
  • Monash University (AU)
  • Hudson Institute of Medical Research (AU)
Corresponding author
Palmer, Kirsten R
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2021-07
Volume
398
Issue
10294
Pages
41-52
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(21)00668-1
PMC
PMC8248925
OpenAlex
W3173477219
Cited by
121
References
34
Citations by year
2026: 14 · 2025: 21 · 2024: 22 · 2023: 29 · 2022: 25 · 2021: 10
FWCI
18.63
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Funders
  • Medical Research Council
  • National Health and Medical Research Council (1176437)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Medicine › Obstetrics and Gynecology › COVID-19 Impact on Reproduction
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
Keywords
telemedicine, prenatal care, COVID-19 pandemic, fetal growth restriction, preeclampsia, gestational diabetes mellitus, stillbirth, preterm birth, neonatal intensive care admission, telehealth implementation, maternal outcomes, Victoria, Australia, New South Wales
MeSH terms
COVID-19, Adult, Female, Humans, Pregnancy, Pregnancy Complications, Prenatal Care, Retrospective Studies, Victoria, Telemedicine, Interrupted Time Series Analysis

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