Telehealth may adapt well to pregnancy and postpartum care, study finds

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New research suggests that telehealth can be used effectively to complement or replace in-person maternal care services, such as treating postpartum depression and monitoring diabetes and hypertension during pregnancy. Photo by BillionPhotos.com/Shutterstock

July 25 (UPI) — Using telehealth to complement or replace in-person maternal care services, such as postpartum depression and monitoring diabetes and hypertension during pregnancy, leads to similar – and sometimes better – clinical outcomes. and patient satisfaction with in-person care.

Knowing this can help develop strategies to reduce unacceptable maternal complications and deaths in the United States, according to researchers who analyzed dozens of studies on the subject involving nearly 45,000 women.

It is the essence of a study whose findings were published Monday in the 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 the identification of conditions that increase the risk of poor outcomes and enables prevention. or timely treatment”.

It’s a daunting backdrop: every 12 hours, a woman dies from pregnancy or childbirth in the United States, according national institutes of health.

Nationally, the number of reported pregnancy-related deaths has steadily increased to 17.3 deaths per 100,000 live births in 2018, from 7.2 deaths per 100,000 live births in 1987, according to the Centers for Disease. Control and Prevention. latest surveillance data available. The CDC said the reasons for the rise are unclear.

Black and Native American/Alaska Native women are about three times more likely to die from pregnancy-related causes than white women, according to the CDC, and nearly two-thirds of those deaths could be preventable.

Researchers at Oregon Health & Science University conducted a “rapid review” of 28 randomized controlled trials and 14 observational studies, involving a total of 44,894 women, to explore the benefits and harms of telehealth strategies for maternal health care.

The new analysis was carried out in response to the recent expansion of telehealth services resulting from the COVID-19 pandemic, which has made it more difficult to obtain in-person care in doctors’ offices – although pregnancy care cannot be postponed because certain health examinations and other types of medical visits could have been.

“Telemedicine, including virtual visits and home monitoring, is a promising strategy for tailoring care to individual patient needs: reducing the burden of missed work, travel or childcare, while ensuring patients access to high quality services,” said 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 the delivery of prenatal care to meet the needs and to patient preferences.

“We recommend that 4 in-person prenatal visits be done for patients at average risk,” said Peahl, who is president of the American College of Obstetricians and Gynecologists and the university’s Redesigning Prenatal Care Initiative.

“Other visits can be done in person or virtually after shared decision-making between patient and provider.”

Peahl said successful telehealth “requires adequate support for patients and providers, including education and preparation for visits, and the availability of high-quality equipment, including smart devices and home monitoring.

And, she said, “more importantly, telemedicine must integrate individuals’ preferences to determine the right care plan for them, including the use of telemedicine.”

Peahl cited “many cases” where in-person care is needed, such as when testing to make sure the baby is okay, perhaps using an ultrasound to detect fluid.

But, she said, new technologies, “including home devices to assess the baby’s heart rate or to perform ultrasound scans at home, could allow even more safe care to be offered in the future. home”.

For the new analysis, the researchers looked at 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 pregnancies at low risk, according to a press release.

They found that maternal telehealth interventions complemented in-person care for most studies of mental health and diabetes in pregnancy. And it has mostly resulted in similar, and sometimes better, clinical and patient-reported outcomes compared to usual care provided in the doctor’s office.

Additionally, according to the review, supplementing in-person maternal mental health care with phone or web-based platforms or mobile apps resulted in similar or better mental health outcomes compared to in-person care.

And a reduced-visit antenatal care schedule, using telehealth to replace general in-person maternity care for low-risk pregnancies, resulted in similar clinical outcomes and greater patient satisfaction compared to usual care.

Given the findings, the researchers said telehealth could end up being used to supplement usual medical care for postpartum depression, as “telehealth interventions were more likely to improve mood symptoms in the short term.” term compared to in-person care alone,” the statement read.

But scientists have acknowledged that such effects may not be long-lasting.

The study authors suggested that maternity care may be particularly ready for telehealth due to limited evidence supporting traditional approaches to prenatal care that rely on multiple in-person visits.

They said their findings “also highlight a continued need to incorporate methods to assess and improve health equity, an important element that is missing in these telehealth studies” that were reviewed.

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