COVID-19 related changes in perinatal health care delivery and outcomes among pregnant individuals and newborns

To evaluate whether the COVID-19 pandemic related changes in perinatal care (PNC) delivery resulted in similar care receipt and health outcomes observed before the pandemic. Deliveries between 7/1/2018-10/31/21 at Kaiser Permanente Northern California. Exposure to COVID-19 pandemic-related changes in PNC was categorized by delivery during 1 of 3 time periods: 1) unexposed (T1, 7/1/18-2/29/20); 2) partially exposed (T2, 3/1/20-12/5/20); and 3) fully exposed (T3, 12/6/20-10/31/21). Changes in rates of outcomes in relation to changes in PNC delivery were analyzed using a quasi-experimental interrupted time series design. The cohort was diverse, with 75% of individuals self-reporting race other than non-Hispanic White. There were 75,836 individuals in T1, 34,799 in T2, and 40,829 in T3. Characteristics including age, race/ethnicity, neighborhood deprivation index, parity, and preexisting diabetes did not differ across time periods, while chronic hypertension and obesity increased slightly from T1 to T2-T3. The mean total number of PNC visits did not differ across time periods (T1=9.9, T2=9.7 and T3=9.7), however the percentage of virtual visits increased from 14.2 in T1 to 24.7 in T2-T3 (Fig 1). Number of blood pressure measurements and rate of screening for depression decreased in T2 compared with T1, and increased again in T3, as shown by the adjusted Relative Risk (95%CI) in Fig2a-2b. There were no changes over time periods in rates of gestational diabetes screening, cesarean delivery, severe maternal morbidity, preterm birth, neonatal intensive care unit admission, nor large for gestational age neonate, while small for gestational age slightly decreased in T3 compared with T1-T2. Despite almost doubling the percentage of virtual PNC visits, measures of PNC receipt either decreased temporarily and then increased or did not change across pandemic-associated time periods, while perinatal outcomes did not change. These findings suggest adequate performance of a hybrid in-person/virtual PNC model compared with traditional in-person PNC delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)