A Review of Prenatal Care Delivery to Inform the Michigan Plan for Appropriate Tailored Healthcare in Pregnancy Panel

Abstract

OBJECTIVE: To perform a literature review of key aspects of prenatal care delivery to inform new guidelines. DATA SOURCES: A comprehensive review of Ovid MEDLINE, Elsevier's Scopus, Google Scholar, and ClinicalTrials.gov. METHODS OF STUDY SELECTION: We included studies addressing components of prenatal care delivery (visit frequency, routine pregnancy assessments, and telemedicine) that assessed maternal and neonatal health outcomes, patient experience, or care utilization in pregnant individuals with and without medical conditions. Quality was assessed using the RAND/UCLA Appropriateness Methodology approach. Articles were independently reviewed by at least two members of the study team for inclusion and data abstraction. TABULATION, INTEGRATION, AND RESULTS: Of the 4,105 published abstracts identified, 53 studies met inclusion criteria, totaling 140,150 participants. There were no differences in maternal and neonatal outcomes among patients without medical conditions with reduced visit frequency schedules. For patients at risk of preterm birth, increased visit frequency with enhanced prenatal services was inconsistently associated with improved outcomes. Home monitoring of blood pressure and weight was feasible, but home monitoring of fetal heart tones and fundal height were not assessed. More frequent weight measurement did not lower rates of excessive weight gain. Home monitoring of blood pressure for individuals with medical conditions was feasible, accurate, and associated with lower clinic utilization. There were no differences in health outcomes for patients without medical conditions who received telemedicine visits for routine prenatal care, and patients had decreased care utilization. Telemedicine was a successful strategy for consultations among individuals with medical conditions; resulted in improved outcomes for patients with depression, diabetes, and hypertension; and had inconsistent results for patients with obesity and those at risk of preterm birth. CONCLUSION: Existing evidence for many components of prenatal care delivery, including visit frequency, routine pregnancy assessments, and telemedicine, is limited.

Análise de pacientes encaminhadas para o pré-natal de alto risco

“…A Organização Mundial da Saúde (OMS) estimou que 60% das grávidas em todo o mundo iniciaram o pré-natal antes de 12 semanas de gestação; no entanto, disparidades regionais e de renda foram identificadas. Menos de 50% das gestantes em regiões com recursos limitados receberam atendimento pré-natal precoce versus mais de 80% em regiões com recursos abundantes, e mais de 4 em cada 5 gestantes no grupo de renda mais alta receberam atendimento pré-natal precoce versus 1 em cada 4 gestantes em o grupo de menor renda (Barrera et al, 2021).…”

“…Um pré-natal de alta qualidade pode prevenir ou levar ao reconhecimento e tratamento oportunos de complicações maternas e fetais. As complicações da gravidez e do parto são a principal causa de morbidade e mortalidade em mulheres em idade reprodutiva em todo o mundo (Barrera et al, 2021).…”

“…Para um pré-natal de qualidade, a acessibilidade às unidades especializadas de referência vinculadas ao Sistema Único de Saúde (SUS) deve ser eficiente para atender as necessidades e particularidades das mulheres que desenvolvem gestação de alto risco. O início do pré-natal precoce e rápido referenciamento, quando identificado o risco, permite atender às singularidades das gestantes e prestar o cuidado de saúde com qualidade (Barrera et al, 2021). Porém, ainda é alto o número de gestantes que descobrem a gravidez em estágio mais avançado, iniciando assim o acompanhamento na rede de atenção em saúde tardiamente, após o primeiro trimestre de gestação (Guerra et al, 2019).…”

The transition to parenthood in obstetrics: enhancing prenatal care for 2-generation impact

“…73 Specific recommendations that should be tested and scaled include educating all providers about the history and systems that contribute to the social determinants of health, the early origins of obstetrical research based on the exploitation of the Black female body, how power dynamics impact care, cultural competency and humility, and the new approach of decolonized care that considers individual experiences and socialhistoric systems of oppression as affecting health. 6,7,87 With training in cultural competency and humility, active listening skills, and shared decision-making, providers can be expected to commit to lifelong self-evaluation and critique to readdress new perspectives on the delivery of prenatal care as it evolves. 86 Although many factors contribute to the racial and ethnic disparities in the PTB rate, the problem will not be solved without promoting an antiracist culture and making equitable, respectful, supportive care routine.…”

“…1,4,5 Our vision has aligned with, and could build on, current major efforts to enhance perinatal care individualization through consideration of medical, social, and structural determinants of health. 6,7 Pediatrics enhanced, why not obstetrics? At the molecular, cellular, organ, system, and behavioral levels, neurodevelopment is shaped by ongoing adaptations to the psychosocial environment, with heightened plasticity in children ages 0 to 3 years underscoring the public health benefits of improving early childhood experiences.…”