Project Summary

A rapid review summarizes, on a short timeline, the results of a group of studies on a specific treatment, program, or type of care. PCORI funds rapid reviews to quickly understand the evidence base on a topic. The results of these reviews may inform future PCORI-funded research or support decision making.

What was the review about?

Among high income countries, the United States has one of the highest complication rates during pregnancy and childbirth. Problems include high blood pressure, preterm birth, and maternal and infant death. Also, women and infants who are Black, Latina, and Asian are more likely to have problems during pregnancy and worse health outcomes.

High quality maternity care improves health outcomes for women and infants. Maternity care refers to care throughout pregnancy, during labor and birth, and after birth. Improving access to maternity care can improve health outcomes.

Telehealth is a way to provide care remotely using phone, video, or other devices. During the COVID-19 pandemic, use of telehealth expanded. Questions remain about the use of telehealth for maternity care.

In this rapid review, the research team wanted to learn about the benefits and harms of telehealth approaches that add to or replace in-person maternity care.

What did the studies in the review focus on?

The research team summarized 42 studies, which included 44,894 women who were pregnant or recently gave birth. Among these, 14 studies included more than 25% of women who were Black, Asian, Pacific Islander, South Asian, Native American, multiple races, or Hispanic.

The purpose of telehealth was to add to in-person care in 26 studies and replace it in 16 studies. The telehealth technology used was mobile or web apps in 10 studies, phone in 9 studies, virtual visits in 6 studies, and more than one type in 17 studies. Studies focused on different types of care. For example, 12 were on mental health and 11 were on general maternity care.

The research team assessed the risk of bias, which is the chance that aspects of each study’s design or conduct could lead to the wrong conclusions. They determined 33 were low to moderate risk and 9 were high risk.

What were the results?

For some types of care, telehealth to replace usual care had similar or better health outcomes and patient satisfaction compared with in-person care. For example, for general maternity care, compared with usual care, women who had pregnancy visits using only telehealth on a reduced visit schedule had similar health outcomes, such as diabetes during pregnancy or preterm births. Women also had higher satisfaction with telehealth visits than with in-person care.

Compared with usual care, adding telehealth to in-person visits for mental health care had similar or better mental health outcomes. However, for most types of care studied, adding telehealth visits didn’t improve health outcomes compared with usual care. For example, adding telehealth to in-person visits had similar breastfeeding rates compared with usual care.

Areas with little or no research. Only three studies looked at the effects of telehealth on monitoring high blood pressure during or after pregnancy. Few studies addressed harms of telehealth, such as treatment delays.

Most studies didn’t include enough people from different backgrounds to assess differences in outcomes by race or ethnicity.

What were the limits of the rapid review?

Because the purpose and type of telehealth varied, the research team couldn’t combine statistical data across studies. Instead, the team completed a narrative review which summarizes the study results in text and tables.

Rapid Review Methods At a Glance

Design ElementDescription
Data sources and searchesDatabases (MEDLINE, the Cochrane Library, CINAHL, and Embase) for relevant English-language studies published between January 2015 to April 2022
Studies included in review

42 studies, including 28 randomized controlled trials and 14 observational studies. Researchers determined 34 were low or medium risk of bias and 9 were high risk of bias. Clinical areas included:

  • 12 studies in mental health care
  • 11 studies in general maternity care
  • 7 studies in diabetes care in pregnancy
  • 4 studies in breastfeeding
  • 3 studies in high blood pressure during or after pregnancy
  • 2 studies in smoking cessation
  • 2 studies in weight gain during pregnancy
  • 1 study in asthma
Population44,894 women who were pregnant or recently gave birth
Interventions/ Comparators
  • Telehealth intervention including via mobile or web applications, phone, virtual visits, or multimodal types of technologies

  • Usual in-person care as recommended by the American College of Obstetricians and Gynecologists (ACOG) or as described by study
Outcomes  Timeframe Length of follow-up for collecting data on primary outcomes. View Glossary Maternal health including depression, anxiety, preeclampsia, and hypertension; obstetric including cesarean delivery and preterm birth; patient-reported satisfaction; utilization; adverse events including any harms, such as missed diagnosis or treatment delay

View Rapid Review Report

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*The content included in this document does not necessarily represent the views of PCORI, its Board of Governors, or Methodology Committee. This work is made available under a Creative Commons Attribution-NonCommerical-NoDerivatives 4.0 International License (CC-BY-NC-ND 4.0 International). More information

More on This Rapid Review


View Annals of Internal Medicine Journal Article

© 2022 American College of Physicians.

Used with permission. Access to this article is for personal reading only, and unauthorized reproduction or distribution of this article is prohibited.

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PCORI Rapid Reviews


Learn more about the other PCORI-commissioned rapid reviews here.

Journal Citations

Project Information

Amy Cantor, MD
Pacific Northwest Evidence-based Practice Center at Oregon Health & Science University
$129,988

Key Dates

November 2021
2021
2022

Tags

Has Results
Project Status
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: February 13, 2024