Telemedicine For Prenatal Care: A Systematic Review

Nguyen, E.; Engle, G.; Subramanian, S.; Fryer, K.

Objective: To evaluate the effectiveness of telehealth-enhanced prenatal care. Data Sources: We searched for primary literature in PubMed, EMBASE, and Cochrane Library databases. Methods of Study Selection: Studies were included if they were written in English and used telehealth as an adjunct to or substitute for elements of a comprehensive prenatal care system, with pregnant women as the study population. Studies were excluded if they did not involve comprehensive prenatal care, were not in English, or were abstracts only. Two reviewers independently screened studies by titles, abstracts, and full text. Conflicts were resolved by a third reviewer. Remaining conflicts were resolved by a fourth reviewer. Risk of bias was performed independently by two reviewers. Conflicts were resolved by a third reviewer. Tabulation, Integration and Results: The initial search identified 2707 studies, of which 7 met inclusion criteria. One additional study was identified in the grey literature. Studies included 4 non-randomized controlled studies, 1 randomized controlled trial, 2 qualitative studies, and 1 active clinical trial. Telehealth-enhanced prenatal care included remote monitoring and/or virtual visits. Interventions reduced the number of in-person appointments. Patients and providers had high rates of satisfaction with prenatal care delivered via telehealth. Pregnancy outcomes were similar between the intervention and control groups with the exception of one study identifying higher rates of pre-eclampsia and another showing higher rates of gestational diabetes in the telehealth group. Risk of bias assessment revealed moderate bias in all of the non-randomized studies. The randomized controlled trial had low risk of bias. Conclusion: Telemedicine-enhanced prenatal care may decrease the number of in-person prenatal care visits and increase access to care. Future studies should be done to determine neonatal and maternal outcomes of remote care and to study effectiveness of these interventions for women of color and low socioeconomic status.