Telehealth in antenatal care: recent insights and advances

Abstract

Background: For decades, antenatal care in high-resource settings has involved 12-14 face-to-face visits across pregnancy. The COVID-19 pandemic forced many care providers to rapidly embrace telehealth to reduce face-to-face visits. Here we review recent advances in telehealth used to provide antenatal care.

Main body: We conducted a narrative review examining the impact of telehealth on obstetric care. Two broad types of telehealth are used in antenatal care. The first is real-time telehealth, where consultations are done virtually instead of face-to-face. The second is remote monitoring, where in-clinic physical examinations are replaced with at-home alternatives. These can include blood pressure monitoring, fetal heart rate monitoring, and emerging technologies such as tele-ultrasound. Large cohort studies conducted during the pandemic era have shown that telehealth appears not to have increased adverse clinical outcomes for mothers or babies. However, further studies may be required to confidently conclude rare outcomes are unchanged, such as maternal mortality, serious morbidity, or stillbirth. Health economic studies suggest telehealth has the potential to reduce the financial cost of care provision. Telehealth in antenatal care seems to be acceptable to both pregnant women and healthcare providers.

Conclusion: Adoption of telehealth technologies may improve the antenatal care experience for women and reduce healthcare expenditure without adversely impacting health outcomes for the mother or baby. More studies are warranted to confirm telehealth does not alter the risk of rare outcomes such as maternal or neonatal mortality.

Keywords: Ambulatory blood pressure monitoring; Antenatal care; Consumer satisfaction; Cost-effectiveness; Maternal outcomes; Neonatal outcomes; Obstetrics; Pregnancy; Telehealth.

Fig. 1

Schedule of antenatal visits for low-risk antenatal telehealth models. Schedule of face-to-face and telehealth visits for three antenatal telehealth models for low-risk pregnancies (Peahl et al. [17], in green; Palmer et al. [20], in red; Fryer et al. [18], in orange), compared with the standard antenatal care schedule (in blue)

Fig. 2

Schedule of antenatal visits for high-risk pregnancy telehealth models. Schedule of face-to-face and telehealth visits for two antenatal telehealth models for high-risk pregnancies (Palmer et al. [20], in red; Aziz et al. [15], in yellow), compared with the standard antenatal care schedule (in blue)

Fig. 3

Summary of the main remote monitoring technologies currently used in antenatal care

Fig. 4

Self-recorded tele-ultrasound (adapted from Hadar et al. [40])