Schedule of Visits and Televisits for Routine Antenatal Care: A Systematic Review

Abstract

Background. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine plan a new evidence-based joint consensus statement to address the preferred visit schedule and the use of televisits for routine antenatal care. This systematic review will support the consensus statement. Methods. We searched PubMed®, Cochrane databases, Embase®, CINAHL®, ClinicalTrials.gov, PsycINFO®, and SocINDEX from inception through February 12, 2022. We included comparative studies from high-income countries that evaluated the frequency of scheduled routine antenatal visits or the inclusion of routine televisits, and qualitative studies addressing these two topics. We evaluated strength of evidence for 15 outcomes prioritized by stakeholders. Results. Ten studies evaluated scheduled number of routine visits and seven studies evaluated televisits. Nine qualitative studies also addressed these topics. Studies evaluated a wide range of reduced and traditional visit schedules and approaches to incorporating televisits. In comparisons of fewer to standard number of scheduled antenatal visits, moderate strength evidence did not find differences for gestational age at birth (4 studies), being small for gestational age (3 studies), Apgar score (5 studies), or neonatal intensive care unit (NICU) admissions (5 studies). Low strength evidence did not find differences in maternal anxiety (3 studies), preterm births (3 studies), and low birth weight (4 studies). Qualitative studies suggest that providers believe fewer routine visits may be more convenient for patients and may free up clinic time to provide additional care for patients with high-risk pregnancies, but both patients and providers had concerns about potential lesser care with fewer visits. In comparisons of hybrid (televisits and in-person) versus in-person only visits, low strength evidence did not find differences in preterm births (4 studies) or NICU admissions (3 studies), but did suggest greater satisfaction with hybrid visits (2 studies). Qualitative studies suggested patients and providers were open to reduced schedules and televisits for routine antenatal care, but importantly, patients and providers had concerns about quality of care, and providers and clinic leadership had suggestions on how to best implement practice changes. Conclusion. The evidence base is relatively sparse, with insufficient evidence for numerous prioritized outcomes. Studies were heterogeneous in the care models employed. Where there was sufficient evidence to make conclusions, studies did not find significant differences in harms to mother or baby between alternative models, but evidence suggested greater satisfaction with care with hybrid visits. Qualitative evidence suggests diverse barriers and facilitators to uptake of reduced visit schedules or televisits for routine antenatal care. Given the shortcomings of the evidence base, considerations other than proof of differences in outcomes may need to be considered regarding implications for clinical practice. New studies are needed to evaluate prioritized outcomes and potential differential effects among different populations or settings.

Changes to Prenatal Care Visit Frequency and Telehealth

“…Given the limited conclusions from our prior systematic review of the benefits and harms of reduced care schedules and televisits, 7 the qualitative evidence provides helpful insights into the perspectives, preferences, and experiences of pregnant individuals, their health care professionals, and, in some cases, the clinic leadership with respect to implementing these changes in routine antenatal care. These findings will be important to consider as more research on alternative care schedules and televisits emerges and consensus on these methods of delivery evolves.…”

Reduced Compared With Traditional Schedules for Routine Antenatal Visits

“…3,[8][9][10] Qualitative studies suggest that patients and health care professionals are open to a reduced number of scheduled routine antenatal visits but have concerns about quality of care and patient access. 11,12 However, the actual effect of reducing the number of routine antenatal visits has not been adequately summarized.…”

“…This article is based on an AHRQ Comparative Effectiveness Review, which also addressed incorporation of televisits into routine antenatal care and qualitative research on routine antenatal schedules and televisits. 11,14…”

Frequency Of pRenatal CAre viSiTs (FORCAST): study protocol to develop a core outcome set for prenatal care schedules

“…The copyright holder for this preprint this version posted April 19, 2023. ; https://doi.org/10.1101/2023.04.17.23288705 doi: medRxiv preprint noted inconsistencies in which outcomes are routinely collected and reported [6][7][8][9]. There is a need for consistent reporting of maternal and infant outcomes in future clinical trials that compare the traditional 12 to 14 in-office visit approach with new models of prenatal care schedules that incorporate different frequency of visits and use of telemedicine.…”

“…Two systematic reviews were recently commissioned for evaluating the effect of varying the frequency of prenatal care visit schedule recommendations on maternal and infant outcomes [5,9]. To identify any additional outcome measures published in the literature, we will supplement these systematic reviews with an electronic investigation with no date or language boundary using the databases of MEDLINE via the PubMed interface, Web of Science, Embase (Excerpta Medica Database), and CENTRAL (Cochrane Central Register of Controlled Trials) to identify outcome measures in systematic reviews that reported on the effect of different frequency of prenatal visit recommendations on maternal and infant outcomes.…”