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Telehealth Strategies for the Delivery of Maternal Health Care

BACKGROUND
Telehealth strategies to supplement or replace in-person maternity care may affect maternal health outcomes.


PURPOSE
To conduct a rapid review of the effectiveness and harms of telehealth strategies for maternal health care given the recent expansion of telehealth arising from the COVID-19 pandemic, and to produce an evidence map.


DATA SOURCES
Systematic searches of MEDLINE, the Cochrane Library, CINAHL, Embase, and Scopus for English-language studies (January 2015 to April 2022).


STUDY SELECTION
Randomized controlled trials (RCTs) and observational studies of maternal care telehealth strategies versus usual care.


DATA EXTRACTION
Dual data extraction and risk-of-bias assessment of studies, with disagreements resolved through consensus.


DATA SYNTHESIS
28 RCTs and 14 observational studies (n = 44 894) were included. Maternal telehealth interventions supplemented in-person care for most studies of mental health and diabetes during pregnancy, primarily resulting in similar, and sometimes better, clinical and patient-reported outcomes versus usual care. Supplementing in-person mental health care with phone- or web-based platforms or mobile applications resulted in similar or better mental health outcomes versus in-person care. A reduced-visit prenatal care schedule using telehealth to replace in-person general maternity care for low-risk pregnancies resulted in similar clinical outcomes and higher patient satisfaction versus usual care. Overall, telehealth strategies were heterogeneous and resulted in similar obstetric and patient satisfaction outcomes. Few studies addressed disparities, health equity, or harms.


LIMITATIONS
Interventions varied, and evidence was inadequate for some clinical outcomes.


CONCLUSION
Replacing or supplementing in-person maternal care with telehealth generally results in similar, and sometimes better, clinical outcomes and patient satisfaction compared with in-person care. The effect on access to care, health equity, and harms is unclear.


PRIMARY FUNDING SOURCE
Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42021276347).