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 Element | Description |
|---|---|
| Data sources and searches | Databases (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:
|
| Population | 44,894 women who were pregnant or recently gave birth |
| Interventions/ Comparators |
|
| Outcomes | 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 |
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© 2022 American College of Physicians.
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