HumanInsight Impact of a hybrid model of prenatal care on the diagnosis of fetal growth restriction
Am J Perinatol. 2022 Jun 16. doi: 10.1055/a-1877-8478. Online ahead of print.
OBJECTIVE: Fetal growth restriction (FGR) is associated with poor neonatal outcomes and stillbirth, and screening via fundal height or ultrasound is routinely performed. During the COVID-19 pandemic, we developed a hybrid model of prenatal care which decreased the frequency of in-person visits and incorporated telemedicine visits. We sought to determine if prenatal FGR diagnoses decreased with this hybrid model compared to routine prenatal care.
STUDY DESIGN: This was a retrospective cohort study of singleton non-anomalous neonates with birthweights <10%ile at term. The "routine care" group were those born April-July 2019 with in-person prenatal care, and the "hybrid care" group were those born April-July 2020 with both in-person and telemedicine prenatal care at a collaborative academic practice. The primary outcome was the rate of diagnosis of small for gestational age (SGA) as defined as infant birthweight <10%ile without a prenatal diagnosis of FGR. The secondary outcome was timing of diagnosis of FGR.
RESULTS: 1,345 and 1,296 women gave birth in the routine and hybrid groups, respectively. The number of in-person prenatal care visits decreased from 15,024 in the routine period to 7,727 in the hybrid period; 3,265 telemedicine visits occurred during the hybrid period. The total number of prenatal patients remained relatively stable at 3,993 and 3,753 between periods. Third trimester ultrasounds decreased from 2,929 to 2,014 between periods. Birthweights <10%ile occurred in 115 (8.6%) births during the routine period and 79 (6.1%) births during the hybrid period. 44/115 (38.3%) cases were prenatally diagnosed with FGR in the routine vs 28/79 (35.4%) in the hybrid group (p=0.76). Median gestational age at diagnosis did not vary between groups (36 vs 37 weeks, p=0.44).
CONCLUSIONS: A hybrid prenatal care model did not alter the detection of FGR. Future efforts should further explore the benefits of incorporating telemedicine into prenatal care.
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