Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct 1;138(4):603-615.
doi: 10.1097/AOG.0000000000004535.

A Review of Prenatal Care Delivery to Inform the Michigan Plan for Appropriate Tailored Healthcare in Pregnancy Panel

Chloe M Barrera  1 , Allison R Powell, Chloe Ramirez Biermann, Jonathan Y Siden, Buu-Hac Nguyen, Suni Jo Roberts, LaTeesa James, Vineet Chopra, Alex Peahl
Affiliations

A Review of Prenatal Care Delivery to Inform the Michigan Plan for Appropriate Tailored Healthcare in Pregnancy Panel

Chloe M Barrera et al. Obstet Gynecol. .

Abstract

Objective: To perform a literature review of key aspects of prenatal care delivery to inform new guidelines.

Data sources: A comprehensive review of Ovid MEDLINE, Elsevier's Scopus, Google Scholar, and ClinicalTrials.gov.

Methods of study selection: We included studies addressing components of prenatal care delivery (visit frequency, routine pregnancy assessments, and telemedicine) that assessed maternal and neonatal health outcomes, patient experience, or care utilization in pregnant individuals with and without medical conditions. Quality was assessed using the RAND/UCLA Appropriateness Methodology approach. Articles were independently reviewed by at least two members of the study team for inclusion and data abstraction.

Tabulation, integration, and results: Of the 4,105 published abstracts identified, 53 studies met inclusion criteria, totaling 140,150 participants. There were no differences in maternal and neonatal outcomes among patients without medical conditions with reduced visit frequency schedules. For patients at risk of preterm birth, increased visit frequency with enhanced prenatal services was inconsistently associated with improved outcomes. Home monitoring of blood pressure and weight was feasible, but home monitoring of fetal heart tones and fundal height were not assessed. More frequent weight measurement did not lower rates of excessive weight gain. Home monitoring of blood pressure for individuals with medical conditions was feasible, accurate, and associated with lower clinic utilization. There were no differences in health outcomes for patients without medical conditions who received telemedicine visits for routine prenatal care, and patients had decreased care utilization. Telemedicine was a successful strategy for consultations among individuals with medical conditions; resulted in improved outcomes for patients with depression, diabetes, and hypertension; and had inconsistent results for patients with obesity and those at risk of preterm birth.

Conclusion: Existing evidence for many components of prenatal care delivery, including visit frequency, routine pregnancy assessments, and telemedicine, is limited.

PubMed Disclaimer

Conflict of interest statement

Financial Disclosure The authors did not report any potential conflicts of interest.

References

    1. Peahl AF, Smith RD, Moniz MH. Prenatal care redesign: creating flexible maternity care models through virtual care. Am J Obstet Gynecol 2020;223:389.e1–e10. doi: 10.1016/j.ajog.2020.05.029 - DOI
    1. Peahl AF, Howell JD. The evolution of prenatal care delivery guidelines in the United States. Am J Obstet Gynecol 2020;224:339–47. doi: 10.1016/j.ajog.2020.12.016 - DOI
    1. Kilpatrick SJ, Papile L, Macones GA. Guidelines for perinatal care. 8th ed. American Academy of Pediatrics/The American College of Obstetricians and Gynecologists; 2017.
    1. Friedman Peahl A, Heisler M, Essenmacher LK, Dalton VK, Chopra V, Admon LK, et al. A comparison of international prenatal care guidelines for low-risk women to inform high-value care. Am J Obstet Gynecol 2020;222:505–7. doi: 10.1016/j.ajog.2020.01.021 - DOI
    1. Tikkanen R, Gunja MZ, FitzGerald M, Zephyrin L. Maternal mortality and maternity care in the United States compared to 10 other developed countries. Accessed May 11, 2021. https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/mate...

Publication types