Effect of Telehealth Adaptation on the Diagnosis of Hypertensive Disorders of Pregnancy [ID: 1358276]

Abstract

INTRODUCTION:COVID-19 caused a rapid integration of telehealth into prenatal care. This study aims to assess the effect of telehealth adaptation on timing and severity of the diagnosis of hypertensive disorders of pregnancy (HDP).METHODS:This is an IRB-approved retrospective cohort study of patients with HDP who delivered from April to October of 2019 (pre-pandemic) and 2020 (pandemic) at one urban tertiary care center. The primary outcome was mean gestational age at diagnosis of HDP. Secondary outcomes included initial and final severity of diagnosis before delivery. Results were adjusted for baseline characteristics different at P<.10, using multivariable logistic regression and ANCOVA as appropriate.RESULTS:Four hundred ninety-eight patients were included, with 231 from 2019 and 267 from 2020. 17.1% had preeclampsia with severe features initially, and 29.3% met these criteria by delivery. In 2020, 80.5% of patients used telehealth (versus 0.9% in 2019), doing so for a mean of 29% of prenatal appointments. Unadjusted and adjusted analyses showed no significant difference in gestational age at diagnosis or diagnosis severity between cohorts. In the adjusted analysis, Black race was significantly associated with initial diagnosis severity (odds ratio [OR] 1.7 [1.0–2.8], P=.046); telehealth use as represented by cohort year was not (0.9 [0.5–1.3], P=.54). Black race (OR 2.6 [1.6–4.3], P<.001), non-Hispanic ethnicity (OR 0.4 [0.2–0.8], P=.04), and body mass index (OR 1.04 [1.0–1.1], P=.005) were significantly associated with final diagnosis severity; telehealth use was not (OR 1.0 [0.6–1.4], P=.87).CONCLUSION:The adaptation of telehealth is not associated with a change in timing or severity of diagnosis of HDP.