Table 2. Prenatal Visits, Care Processes, and Health Outcomes of Individuals Who Delivered a Singleton Live Birth or Stillbirth by Exposure to a Multimodal Prenatal Health Care Model During the COVID-19 Pandemic at Kaiser Permanente Northern California, 2018-2021.
| Visit, process, or care outcome | Patients, No. (%) (N = 151 464) | Standardized mean difference | |||
|---|---|---|---|---|---|
| Unexposed (T1) (n = 75 836) | Partially exposed (T2) (n = 34 799) | Fully exposed (T3) (n = 40 829) | T2 vs T1 | T3 vs T1 | |
| Prenatal visits per individual, mean (SD) | |||||
| Total | 9.41 (4.8) | 9.17 (4.5) | 9.15 (4.5) | −0.052 | −0.056 |
| In-office | 8.36 (4.2) | 7.25 (3.6) | 7.20 (3.5) | −0.285 | −0.299 |
| Telemedicine | |||||
| Any | 1.04 (1.3) | 1.92 (1.9) | 1.95 (1.9) | 0.543 | 0.563 |
| Video | 0.01 (0.1) | 0.39 (0.8) | 0.75 (1.1) | 0.657 | 0.954 |
| Telephone | 1.04 (1.3) | 1.53 (1.7) | 1.19 (1.5) | 0.332 | 0.114 |
| Prenatal telemedicine visits/total visits | 79 214 (11.1) | 66 726 (20.9) | 79 518 (21.3) | 0.618 | 0.649 |
| Prenatal in-office visits/total visits | 634 280 (88.9) | 252 258 (79.1) | 294 147 (78.7) | −0.618 | −0.649 |
| Prenatal care process | |||||
| Blood pressure measurements per individual, mean (SD) | 18.50 (11.4) | 17.22 (11.0) | 17.58 (11.3) | −0.114 | −0.081 |
| Gestational diabetes screeninga | 69 612 (91.8) | 32 153 (92.4) | 37 624 (92.2) | 0.022 | 0.013 |
| Depression screeningb | 66 379 (87.5) | 29 906 (85.9) | 35 787 (87.7) | −0.047 | 0.004 |
| Primary prenatal maternal outcomes | |||||
| Preeclampsia and eclampsia | 4982 (6.6) | 2547 (7.3) | 3056 (7.5) | 0.029 | 0.036 |
| Severe maternal morbidityc | 2714 (3.6) | 1312 (3.8) | 1720 (4.2) | 0.010 | 0.033 |
| Cesarean delivery | |||||
| Yes | 18 568 (24.5) | 8911 (25.6) | 10 377 (25.4) | 0.026 | 0.022 |
| No | 53 227 (70.2) | 24 151 (69.4) | 28 436 (69.6) | −0.017 | −0.012 |
| Missing | 4041 (5.3) | 1737 (5.0) | 2016 (4.9) | −0.015 | −0.018 |
| Preterm birth | 6055 (8.0) | 2798 (8.0) | 3331 (8.2) | 0.002 | 0.006 |
| Spontaneous | 3321 (4.4) | 1427 (4.1) | 1705 (4.2) | −0.014 | −0.01 |
| Medically indicated | 2734 (3.6) | 1371 (3.9) | 1626 (4.0) | 0.018 | 0.020 |
| Primary newborn outcome: neonatal intensive care unit admission | |||||
| Yes | 7014 (9.2) | 2905 (8.3) | 3516 (8.6) | −0.032 | −0.022 |
| No | 64 699 (85.3) | 30 144 (86.6) | 35 265 (86.4) | 0.038 | 0.03 |
| Missing | 4123 (5.4) | 1750 (5.0) | 2048 (5.0) | −0.018 | −0.019 |
| Secondary prenatal maternal outcomes | |||||
| Gestational hypertension | 6140 (8.1) | 3200 (9.2) | 4164 (10.2) | 0.039 | 0.073 |
| Gestational diabetes | |||||
| Yes | 7566 (10.0) | 3280 (9.4) | 3814 (9.3) | −0.019 | −0.022 |
| No | 64 804 (85.5) | 30 036 (86.3) | 35 254 (86.3) | 0.025 | 0.026 |
| Missing | 3466 (4.6) | 1483 (4.3) | 1761 (4.3) | −0.015 | −0.012 |
| Diagnosed depression | 13 615 (18.0) | 7205 (20.7) | 9463 (23.2) | 0.070 | 0.130 |
| Moderate to severe depressiond | 7487 (9.9) | 3106 (8.9) | 3778 (9.3) | −0.032 | −0.021 |
| Venous thromboembolism | 270 (0.4) | 119 (0.3) | 136 (0.3) | −0.002 | −0.004 |
| Secondary newborn outcomes | |||||
| Transient tachypnea | 270 (0.4) | 102 (0.3) | 222 (0.5) | −0.011 | 0.028 |
| 5-min Apgar score <7 | |||||
| Yes | 851 (1.1) | 368 (1.1) | 531 (1.3) | −0.006 | 0.016 |
| No | 70 850 (93.4) | 32 678 (93.9) | 38 234 (93.6) | 0.020 | 0.009 |
| Missing | 4135 (5.5) | 1753 (5.0) | 2064 (5.1) | −0.019 | −0.018 |
| Birth weight small for gestational age | |||||
| Yes | 6997 (9.2) | 3273 (9.4) | 3698 (9.1) | 0.006 | −0.006 |
| No | 64 692 (85.3) | 29 759 (85.5) | 35 064 (85.9) | 0.006 | 0.016 |
| Missing | 4147 (5.5) | 1767 (5.1) | 2067 (5.1) | −0.017 | −0.018 |
| Birth weight large for gestational age | |||||
| Yes | 8447 (11.1) | 3898 (11.2) | 4680 (11.5) | 0.002 | 0.010 |
| No | 63 242 (83.4) | 29 134 (83.7) | 34 082 (83.5) | 0.009 | 0.002 |
| Missing | 4147 (5.5) | 1767 (5.1) | 2067 (5.1) | −0.017 | −0.018 |
Abbreviations: T1, birth delivery between July 1, 2018, and February 29, 2020; T2, birth delivery between March 1, 2020, and December 5, 2020; T3, birth delivery between December 6, 2020, and October 31, 2021.
Screening was done by 50-g, 1-hour oral glucose challenge.
Screening was done with the Patient Health Questionnaire–9.
Severe maternal morbidity includes at least 1 of the following morbidities occurring at any time during pregnancy: acute myocardial infarction, aneurysm, acute kidney failure, acute respiratory distress syndrome, amniotic fluid embolism, cardiac arrest or ventricular fibrillation, conversion of cardiac rhythm, disseminated intravascular coagulation, eclampsia, heart failure or arrest during surgery or procedure, puerperal cerebrovascular disorders, pulmonary edema or acute heart failure, severe anesthesia complications, sepsis, shock, sickle cell disease with crisis, air and thrombotic embolism, blood products transfusion, hysterectomy, temporary tracheostomy, or ventilation.9,10,11
Defined as a Patient Health Questionnaire–9 screening score greater than or equal to 10.15