Perinatal Outcomes Among Patients Using OB Teleflex, A Hybrid Prenatal Telemedicine Program.

Perinatal Outcomes Among Patients Using OB Teleflex, A Hybrid Prenatal Telemedicine Program - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Search Log in Primary site navigation Search Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice J Obstet Gynaecol Can . Author manuscript; available in PMC: 2026 Jun 1. Published in final edited form as: J Obstet Gynaecol Can. 2025 Apr 18;47(6):102911. doi: 10.1016/j.jogc.2025.102911 Show available content in en fr Perinatal Outcomes Among Patients Using OB Teleflex, A Hybrid Prenatal Telemedicine Program Devika LEKSHMI 2 , Sophie NADER 1 , Jennifer ROBERTS-BARRY 2 , Laura E BAECHER LIND 2 , Alysa ST CHARLES 2 , Erika F WERNER 2 , Sebastian Z RAMOS 1 Author information Article notes Copyright and License information 1 Tufts University School of Medicine, Boston, MA 2 Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA ✉ Corresponding author Devika Lekshmi, devika.lekshmi@tuftsmedicine.org Issue date 2025 Jun. PMC Copyright notice PMCID: PMC12167141  NIHMSID: NIHMS2075951  PMID: 40254095 The publisher's version of this article is available at J Obstet Gynaecol Can Abstract Objectives: To assess obstetric outcomes among participants of the OB Teleflex program, in which roughly half of prenatal care was virtual, compared to those who were eligible, but elected traditional prenatal care. Study Design: This retrospective cohort study of patients who delivered between October 1, 2021, and September 30, 2022, compared OB Teleflex participation to routine prenatal care. Low-risk patients with a singleton, viable, non-anomalous fetus, and without hypertension requiring medication, were eligible for OB Teleflex and included in the study. Inverse probability weighting was used to obtain unbiased estimates of program effect on a composite of adverse outcomes that included primary caesarean delivery, neonatal intensive care unit (NICU) admission, preterm birth, insufficient gestational weight gain, and hypertensive disorders of pregnancy. Results: Out of 674 patients that delivered at our center during the study period, 347 were eligible for OB Teleflex and met study criteria. Of the 347 patients eligible for OB Teleflex, 63 (18%) chose to participate in the program. Those who elected OB Teleflex compared to those who did not, differed by race, parity, and history of caesarean deliveries. In both adjusted and unadjusted analysis of the composite of adverse outcomes, there was no difference between OB Teleflex participants and those receiving standard care. Conclusion: Hybrid prenatal telemedicine did not differ from standard prenatal care in the rate of adverse maternal and perinatal outcomes. Programs like OB Teleflex may help to remove barriers from care without worsening birth outcomes. Larger studies are needed to investigate whether hybrid prenatal care can improve outcomes. Keywords: Prenatal Care, Hybrid, Telemedicine, Pregnancy Outcomes Introduction Telemedicine has proven to be a valuable tool in improving access to healthcare and reducing health care disparities outside of obstetrics. 1 , 2 In pediatric care for instance, implementation of telemedicine has advanced the provision of subspecialty care in rural communities by increasing patient satisfaction, minimizing burden for caregivers, and reducing costs associated with travel. 2 Telehealth has also demonstrated notable success in improving outcomes for patients with select conditions including hypertension or Parkinson’s disease. 3 However, obstetrics has been relatively slow in adopting telehealth practices, largely due to the number of screening and diagnostic appointments that necessitate in-person visits. 4 Certain populations stand to benefit from remote care more than others and some telehealth models are less effective at improving outcomes, emphasizing the current novelty of telemedicine in healthcare. 3 , 5 As telehealth becomes more prevalent across all aspects of healthcare, hybrid telemedicine, where there is a combination of in-person and telehealth visits, should be further explored as an alternative to traditional prenatal care. 5 - 7 Prenatal care augmented with specialized telehealth interventions have shown promise in optimizing patient care and improving health outcomes. 5 Telehealth initiatives incorporating text messaging services, online portals, and/or remote monitoring have demonstrated improved breastfeeding rates, vaccination rates, and patient satisfaction. 5 , 8 , 9 Text4Baby, the largest text messaging service for pregnant individuals across the United States, has shown success in promoting smoking cessation. 9 While comprehensive prenatal telehealth programs are less common in pregnancy, the Mayo Clinic’s novel prenatal care model, OB Nest, supplements onsite visits with virtual appointments, and provides patients home-monitoring devices and access to an online forum for expectant mothers. The Mayo Clinic found improved qualitative outcomes associated with the program including decreased stress and increased patient satisfaction. 10 Prenatal care plays a vital role in preventing health complications during pregnancy by providing screening services and encouraging healthy lifestyle behaviours. Conversely, poor prenatal care utilization has been identified as a potential risk factor for adverse pregnancy outcomes including NICU admission, preterm births, insufficient gestational weight gain, caesarean delivery, and hypertensive disorders of pregnancy. 11 - 15 However, these studies do not investigate the effect of a hybrid approach to prenatal care on these outcomes. While telehealth is increasingly explored as a means to improve patient experience, there is limited research assessing how prenatal care may impact pregnancy when supplemented with remote telehealth. 3 , 16 Thus, we sought to determine if a hybrid program similar to OB Nest could affect pregnancy outcomes in our urban population. Informative and bidirectional communication between patient and provider are proven to be essential for optimizing health outcomes, treatment adherence, trust, and overall care experience. 17 As OB Nest is a program which emphasizes childbirth education and patient-provider communication, we speculated that hybrid prenatal care could be associated with better pregnancy outcomes. Methods Modelled after the OB Nest program’s hybrid approach to prenatal care, we designed the OB Teleflex program ( Figure ). OB Teleflex was offered to all patients who met eligibility criteria after their intake. In this program, in-person visits are limited to those requiring examination or intervention (such as ultrasound, phlebotomy, or Group B strep screening). The remaining 5-6 traditional appointments where physical presence is not required are replaced by telemedicine visits. The OB Teleflex program also includes an additional 2-week postpartum follow-up visit which is unique to OB Teleflex and not part of the OB Nest Program. Figure. OB Teleflex Program Outline. Open in a new tab This figure displays the OB Teleflex program schematic. The top row describes routine visits which occur in-person with an MD Obstetrician. The bottom row consists of telehealth visits which are unique to the OB Teleflex program and are conducted virtually with an OB Nurse Navigator. The OB Nurse Navigator is accessible via text outside of scheduled visits to answer questions, provide support, and coordinate in-person evaluation if needed. Abbreviations: Wks = weeks, US= ultrasound, BP = blood pressure TDAP = tetanus diphtheria and pertussis, GBS = Guillain-Barré syndrome, PA = physician assistant journal This study included individuals who delivered at Tufts Medical Center between October 1st, 2021, and September 30th, 2022, and received prenatal care at our primary academic low-risk practice. English-speaking patients with a singleton, viable, non-anomalous pregnancy, and with regular access to a cellphone or computer, were eligible for participation. Patients transferred to Maternal Fetal Medicine at their initial prenatal visit or those who were taking medication for blood pressure control were not eligible for OB Teleflex and therefore not included in the study. All study participants had lab work and ultrasound testing completed per American College of Obstetricians and Gynecologists (ACOG) guidelines. During visits when no lab or ultrasound testing was required, those in OB Teleflex had a virtual visit with a dedicated OB nurse navigator ( Figure ). The standard of care group had routine in-person prenatal visits with a nurse practitioner or physician. The OB Teleflex group received a blood pressure cuff and fetal doppler for remote monitoring throughout pregnancy, while the routine care group received only blood pressure cuffs if prescribed due to hypertension. In addition, the OB Teleflex group was given their nurse navigator’s contact information to text or call during business hours for further inquiries, personal support, or to coordinate in-person evaluations. The routine care group received the clinic’s phone number which is attended by OB nurses who could answer questions, provide support, and coordinate care. All labor and delivery care management were informed by hospital protocols and applied to both groups. To determine the effect of hybrid prenatal telehealth, our primary end point was a composite of adverse perinatal and maternal outcomes evidenced to be associated with inadequate prenatal care. This composite outcome consisted of one or more of the following: NICU admission, hypertensive disorders of pregnancy, insufficient gestational weight gain, primary caesarean delivery, and spontaneous preterm birth. 11 - 15 By combining relevant outcomes, we aimed to increase statistical power and provide a more robust measure of the overall impact of prenatal care on adverse pregnancy outcomes. The rate of primary caesarean deliveries are reported in comparison to vaginal deliveries, which comprises both spontaneous and assisted vaginal births. Caesarean deliveries were classified as scheduled or unscheduled. Scheduled caesarean deliveries included elective primary, elective repeat, or obstetrically indicated by a contraindication to labor. Unscheduled caesareans were deliveries performed after a trial of labor. Gestational weight gain was calculated using pre-pregnancy BMI and total weight gain, categorized as adequate, insufficient, or excessive according to the Institute of Medicine’s guidelines. 11 Hypertensive disorders of pregnancy included gestational hypertension, preeclampsia without severe features and preeclampsia with severe features as classified by ACOG. 18 Preterm birth was defined by spontaneous labor prior to 37 weeks gestational age. Neonatal Intensive Unit (NICU) admission included any neonates admitted to the unit postpartum. Secondary outcomes of interest abstracted from the electronic medical records (EMR) included length of hospital stay (1-2 days, 3-4 days, or >5 days), birthweight (1500g – 2500g, 2501g – 4000g, or >4000g), and breastfeeding initiation. Pregnancy related complications such as polyhydramnios and gestational mellitus diabetes (GDM) were also collected. Covariates were selected based on literature review and our prior understanding of factors that may have the potential to influence program enrollment or the incidence of the primary outcome. Participants’ demographics were obtained and included self-reported race and ethnicity (Non-Hispanic Black, Non-Hispanic Asian, Non-Hispanic White, Hispanic, or other (classified as more than one race or unknown). Other demographic data collected included age at delivery (<35 or ≥35 years old), distance from facility (miles), and insurance status (public or private). 18 , 19 Clinical information including parity (nulliparous or multiparous), pre-pregnancy BMI (kg/m 2 ), history of GDM in a prior pregnancy, chronic hypertension, history of prior caesarean delivery, and contraindications to vaginal delivery (prior uterine surgery, malpresentation, or placenta previa) were also obtained. 20 - 23 Abstraction was performed by S.N. and D.L. with 10% of charts re-abstracted to ensure accuracy of >95% and any discrepancies were adjudicated by A.S.C. Participants in the OB Teleflex program were compared to those who chose standard prenatal care over the specified study period. Participants' characteristics and outcomes are summarized in Tables 1 and 2 , using proportions for nominal variables and means for continuous variables. Univariate analyses of prognostically important covariates on the composite of adverse outcomes and the individual components are available in Supplementary Table 1 . Table 1: Baseline Measures of OB Teleflex and Standard Prenatal Care Participants Variables OB Teleflex (N=63) Standard Care (N=284) P>∣z∣ Race/Ethnicity, n (%) 0.022 Non-Hispanic White 30 (48%) 138 (49%) Non-Hispanic Asian 6 (10%) 42 (15%) Non-Hispanic Black 17 (27%) 34 (12%) Hispanic 8 (13%) 39 (14%) Other 2 (3%) 31 (11%) Private Insurance, n (%) 42 (71%) 171 (60%) 0.12 Parity, n (%) 0.011 Nulliparous 42 (67%) 139 (49%) Multiparous 21 (33%) 145 (51%) Maternal Age, x ¯ (SD) 31 (6) 31 (4) 0.48 Distance to Facility, x ¯ (SD) 96 (455) 27 (179) 0.055 Previous GDM, n (%) 2 (3%) 14 (5%) 0.75 Pre-pregnancy BMI, x ¯ (SD) 26 (6) 27 (7) 0.19 Chronic Hypertension, n (%) 3 (5%) 7 (2%) 0.39 Prior Caesarean, n (%) 2 (3%) 40 (14%) 0.017 Contraindication to SVD, n (%) 1.00 Prior Uterine Surgery 0 (0%) 1 (5%) Placenta Previa 1 (17%) 4 (18%) Uterine Abnormality 1 (17%) 2 (9%) Breech 4 (67%) 15 (68%) Open in a new tab GDM (Gestational Diabetes Mellitus), BMI (Body Mass Index), VD (Vaginal Delivery) Table 2: Outcomes of OB Teleflex and Standard Prenatal Care Participants Variables OB Teleflex (N=63) Standard Care (N=284) P>∣z∣ Gestational Age, n (%) 0.75 ≥37 weeks 61 (97%) 268 (95%) <37 weeks 2 (3%) 16 (6%) GDM in Index Pregnancy, n (%) 4 (6%) 25 (9%) 0.62 Gestational Hypertension, n (%) 10 (16%) 45 (16%) 1.00 Preeclampsia, n (%) 3 (5%) 16 (6%) 1.00 Polyhydramnios, n (%) 3 (5%) 23 (8%) 0.60 Gestational Weight Gain, n (%) 0.41 Appropriate 22 (35%) 73 (28%) Inadequate 13 (21%) 72 (28%) Excessive 27 (44%) 114 (44%) Caesarean Delivery, n (%) 12 (19%) 99 (35%) 0.015 Indication for Caesarean, n (%) 0.12 Unplanned Caesarean 7 (58%) 59 (60%) Elective Repeat Caesarean 0 (0%) 19 (19%) Elective Primary Caesarean 1 (8%) 2 (2%) Contraindication to Labor 4 (33%) 19 (19%) Breastfeeding Initiation, n (%) 16 (25%) 39 (14%) 0.022 Birthweight Class, n (%) 0.20 1501g-2500g 7 (11%) 20 (7%) 2501g-4000g 52 (83%) 226 (80%) 4000g> 4 (6%) 38 (13%) NICU Admission, n (%) 1 (2%) 26 (9%) 0.039 Length of Stay (days), n (%) 0.016 1-2 Days 21 (33%) 92 (32%) 3-4 Days 42 (67%) 165 (58%) 5+ Days 0 (0%) 27 (10%) Open in a new tab GDM (Gestational Diabetes Mellitus), NICU (Neonatal Intensive Care Unit) To accurately evaluate program effect, we employed the doubly robust estimation method, Inverse Probability Weighted Regression Adjustment (IPWRA). This approach produces unbiased estimates of average treatment effect on the treated (ATT), providing a robust framework for causal inference. Propensity scores were calculated using a multivariate logistic regression to statistically balance OB Teleflex and standard of care groups across baseline measures related to treatment assignment. A patient’s decision to participate in hybrid prenatal telehealth could be attributable to demographic factors, in addition to pre-existing conditions or comorbidities (i.e. chronic hypertension). All cases were weighted by the inverse probability of participating in the program, equal to 1/PS for OB Teleflex and 1/(1–PS) for traditional prenatal care, resulting in pseudo-populations balanced by age, race and ethnicity, insurance, distance from facility, parity, pre-pregnancy BMI, prior caesarean deliveries, chronic hypertension, and history of GDM. Using the estimated inverse-probability weights, non-linear regression models compute treatment-specific predicted outcomes to estimate the average effect of hybrid prenatal telehealth on program participants. Standardized mean differences (SMD) were calculated to assess covariate balance, with an SMD exceeding 0.2 indicating a meaningful imbalance that would necessitate additional adjustments in multivariate analysis ( Supplementary Table 2 ). 24 Overidentification tests were performed to ensure the validity of comparisons between the OB Teleflex and standard of care groups. A two-sided P-value of <0.05 was considered statistically significant and all statistical analyses were performed using STATA (version SE 17.0). Results Out of 674 patients that delivered at our center during the study period, 347 were eligible for the OB Teleflex program and met study criteria. There were 63 (18%) patients that self-elected to participate in OB Teleflex compared to 284 (82%) who elected standard prenatal care. Demographic and baseline characteristics of OB Teleflex and standard prenatal care participants are summarized in Table 1 . The cohort was diverse and consistent with our hospital population, with 15% of the total cohort self-identifying as Non-Hispanic Black, 14% self-identifying as Non-Hispanic Asian and 14% identifying as Hispanic (0.3% Hispanic Asian, 0.8% Hispanic-Black, and 6.6% Hispanic-White). Individuals who elected to participate in the OB Teleflex program were more likely to self-identify as Non-Hispanic Black (27%), more likely to be primiparous (67%), and less likely to have a history of caesarean delivery (3%) when compared to those who elected routine care. Length of stay, NICU admission, breastfeeding initiation, and mode of delivery significantly differed between OB Teleflex and standard of care cohorts. In the univariate analysis of the composite of adverse pregnancy outcomes, participation in OB Teleflex was not associated with a statistically significant reduction in the risk of adverse outcomes compared to standard in-person care (RR:0.85, 95% CI: 0.64, 1.13) ( Supplementary Table 1 ). This finding remained true in the IPWRA multivariate model adjusted for variables confounding treatment selection and the outcome at baseline (RR:0.91, 95% CI: 0.80, 1.04). Unadjusted and adjusted analyses of the individual components of the composite adverse outcome revealed similar results as OB Teleflex did not significantly affect the risk of spontaneous preterm birth, hypertensive disorders of pregnancy, insufficient gestational weight gain, or primary caesarean delivery ( Table 3 ). However, program participation was associated with a reduced relative risk of NICU admissions when compared to standard of care (RR:0.93, 95% CI: 0.88, 0.99). Table 3: Results of IPWRA Estimator of OB Teleflex Effect on Composite Adverse Prenatal Outcome and Its Individual Components Intervention Adverse Outcomes Multivariate Analysis ATT 95% CI p-value OB Teleflex Participation Composite of Combined Outcomes 0.91 0.80, 1.04 0.159 NICU Admission 0.93 0.88, 0.99 0.018 Primary Caesarean Delivery 0.96 0.79, 1.15 0.638 Spontaneous Preterm Birth 1.03 0.98, 1.08 0.217 Hypertensive Disorders of Pregnancy 1.08 0.97, 1.20 0.183 Insufficient Gestational Weight Gain 0.75 0.84, 1.12 0.696 Open in a new tab Multivariate analysis of the IPWRA (inverse probability of regression adjustment) cohort adjusted for race and ethnicity, insurance, pre-pregnancy BMI, maternal age, parity, distance to facility, history of GDM, history of caesarean delivery, and chronic hypertension. RR (Relative Risk), CI (Confidence Interval), SVD (Spontaneous Vaginal Delivery), GDM (Gestational Diabetes Mellitus) Discussion Patients who selected our hybrid telehealth model differed by race and ethnicity, parity, and other baseline characteristics than those who selected routine in-person prenatal care. Participants’ race differed between OB Teleflex and standard prenatal care cohorts, with more Non-Hispanic Black individuals self-electing OB Teleflex services. Secondary outcomes including mode of delivery among all comers, breastfeeding initiation, NICU admission, and length of stay differed between the groups. Lastly, we identified comparable birth outcomes across OB Teleflex and standard care groups when assessing a composite of NICU admissions, spontaneous preterm birth, primary caesarean delivery, insufficient gestational weight gain, and hypertensive disorders of pregnancy. When solely examining NICU admissions, participation in hybrid telehealth conferred a reduced risk in comparison to the standard of care group. At minimum, this suggests that hybrid prenatal care can achieve similar outcomes to routine prenatal care, and as others have suggested, may reduce barriers to care for some. 4 , 6 It is well established that patient-provider interactions are instrumental in determining the quality-of-care pregnant patients receive, and may ultimately influence their birth outcomes. 17 , 24 Observational studies examining delivery outcomes of women who received antenatal and intrapartum care versus those who did not, have shown significantly lower rates of maternal and perinatal mortality, demonstrating the benefits of prenatal care provision. 7 Inadequate prenatal care utilization has been associated with adverse outcomes in pregnancy including hypertensive disorders of pregnancy or insufficient gestational weight gain, potentially due to untimely screening or the lack of counselling on healthy lifestyle habits. 11 However, evidence of an association between adverse perinatal outcomes and alternative prenatal care models is lacking. Alternative prenatal care programs are typically adopted to improve accessibility and continuity of care using approaches like virtual or remote monitoring and are oftentimes accompanied by fewer in-person visits. Programs which target pregnancy-related health behaviors such as vaccination uptake, smoking cessation, and breastfeeding initiation, are a few examples of non-traditional care models that have shown promise in improving some obstetric outcomes. 5 , 8 , 9 We found similar rates of preterm birth, primary caesarean delivery, gestational weight gain, and hypertensive disorders of pregnancy among participants in our hybrid prenatal telehealth program, OB Teleflex compared to those receiving standard of care. Our findings suggest patients can have similar pregnancy outcomes using a hybrid telemedicine program which may portend more convenience by requiring fewer in-person prenatal visits when compared to standard in person prenatal care. Furthermore, our study reaffirms the idea that that flexible, patient-centered care can serve as an optional model for prenatal care that prioritizes patients' desire for convenience. Our examination of the study population's preferences provides valuable insights into the appeal of alternative prenatal care among pregnant individuals. Participants in our hybrid telehealth program lived further away on average and were more likely to be nulliparous. Previous studies assessing patient preferences for prenatal care delivery, saw that patients preferred less visits overall and most desired continued contact with their provider in-between prenatal visits. 25 , 26 As the current recommendation of 12-14 in-person prenatal visits proves impractical or inaccessible for some, patients are increasingly receptive towards novel forms of prenatal care. 6 , 26 Some even identifying remote monitoring as an instant solution to transportation challenges and timely access to care as one of the greatest advantages of telemedicine. 1 Patient preferences should be considered when creating alternative care models, as interventions emphasizing patient-provider communication and continuity of care have shown promise in improving health outcomes. 16 , 26 The utilization of antepartum and postpartum services by various subpopulations should be explored to determine which aspects of hybrid prenatal care incentivize participant engagement. Notably, a greater proportion of Non-Hispanic Black women self-elected our hybrid prenatal telehealth program over standard of care. Given this population faces significant barriers to care and is more likely to endure adverse birth outcomes, this finding necessitates further investigation into how a hybrid approach to prenatal care, may help to address existing disparities in maternal healthcare by improving care administration. 1 , 27 Ancillary studies should focus on surveying patients about their experiences with the OB Teleflex program, to evaluate overall satisfaction and cost-effectiveness of this program, especially within this population. While the underlying factors contributing to inequities in birth outcomes are multifaceted, interventions like OB Teleflex, that highlight patient-provider communication and continuity of care, may have the potential to improve outcomes and mitigate disparities in reproductive health. Our study has several strengths. The study cohort is diverse making our findings more generalizable to other urban clinics. Our EMR is comprehensive, and all race and ethnicity information are obtained from self-reported data. Collecting self-reported race and ethnicity data for our study upholds the fundamental human right to accurately define one’s ancestral heritage, thereby respecting patients’ identities and fostering inclusivity in research. 28 Additionally, to reduce potential selection bias and account for unmeasured confounding, we used inverse probability weighting with regression adjustment to improve the robustness of effect estimates of OB Teleflex participation. Finally, our intervention, OB Teleflex, is an innovative and pragmatic way to reduce in-person visits for patients who may have barriers to care, while still providing the education and support that are vital in pregnancy. Our study findings should be taken in the context of some limitations. There is a possibility of recruitment bias in our study, as not all potential participants may have had a delivery record that could be linked to their prenatal encounters on the EMR. Additionally, OB Teleflex utilization was assessed in a binary manner, potentially overlooking nuances in participant engagement with various components of the program. For instance, factors such as time spent with the nurse navigator, or the extent of education and support received were not comprehensively measured. Further research is warranted to delve deeper into these components and identify which key factors drive participant benefit. Information regarding patient’s socioeconomic background, their mental health status, and access to transportation were not readily available in the EMR and could not be controlled for. Our analyses on birth outcomes of primiparous patients in OB Teleflex was limited by a small sample size. A larger study focusing on the implications of hybrid telehealth in exclusively multiparous or primiparous populations are needed to determine the benefits of alternative prenatal care models in this subpopulation as they encounter prenatal care for the first time. Our study sample size and EMR availability greatly limited our analysis of perinatal survival and neonatal outcomes. Future studies with larger cohorts are needed to confirm these findings. Our findings underscore the potential significance of hybrid prenatal telehealth in obstetrics. Participation in OB Teleflex, which we consider to be a more convenient model of prenatal care for patients compared to standard in-person care, did not lead to worse birth outcomes. With its commitment to accessible and patient-centered care, innovative programs like OB Teleflex have the potential to redefine traditional prenatal care by mitigating persistent barriers without compromising quality of care and outcomes. Supplementary Material 1 Univariate Analyses of Covariates on Individual and Combined Adverse Outcomes ( Supplementary Table 1 ) Univariate Analyses of prognostically important covariates on composite of combined adverse outcomes and its individual components including, primary caesarean delivery, NICU admission, spontaneous preterm birth, hypertensive disorders of pregnancy, and insufficient gestational weight gain. RR = Relative Risk, CI= Confidence Interval, GDM = Gestational Diabetes Mellitus, BMI = Body Mass Index NIHMS2075951-supplement-1.pdf (130.1KB, pdf) 2 Standardized Mean Differences of Participants' Characteristics Before and After IPWRA ( Supplementary Table 2 ) Standardized mean difference of covariates between OB Teleflex and standard of care, for all participants, before (raw) and after (weighted) IPW adjusted for race and ethnicity, insurance, pre-pregnancy BMI, maternal age, parity, distance to facility, history of GDM, history of caesarean delivery, and chronic hypertension. GDM = Gestational Diabetes Mellitus, BMI = Body Mass Index NIHMS2075951-supplement-2.pdf (116.2KB, pdf) Key Points. The OB Teleflex program streamlines in-person prenatal visits to those requiring physical examination or intervention, supplementing care with telemedicine visits led by an OB nurse navigator. In our hybrid prenatal care program, OB Teleflex, the rate of adverse maternal and perinatal outcomes including NICU admissions, primary caesarean deliveries, spontaneous preterm birth, insufficient gestational weight gain, and hypertensive disorders of pregnancy, did not differ from standard prenatal care. Clinical Application. Alternative prenatal care models may be implemented to improve care accessibility by providing patients with convenient and flexible care options, such as hybrid telehealth, to supplement some in-person visits. Supplying patients with remote monitoring devices such as blood pressure cuffs and fetal dopplers and delivering continuous antenatal and postpartum care with a dedicated nurse navigator, may drive patient engagement and foster patient-provider communication. Acknowledgements The project described was supported by data provided and accessed via the National Center for Advancing Translational Sciences, National Institutes of Health, Award Number UM1TR004398. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Disclosures Dr. Ramos is supported by the NIH/Office of Research on Women’s Health Building Interdisciplinary Research Careers in Women’s Health (Grant number: 3K12AR084217-08S1). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The remaining authors declare they have nothing to disclose. Footnotes Ethics This study was approved and determined to be exempt by the Tufts Health Sciences Institutional Review Board (STUDY00003104). This manuscript was presented during the Society for Maternal-Fetal Medicine 43rd Annual Pregnancy Meeting as a poster in February 2024. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. References [1]. George SM, Hamilton A, Baker R. Pre-experience Perceptions About Telemedicine Among African Americans and Latinos in South Central Los Angeles. Telemed J E Health 2009;15:525–30. 10.1089/tmj.2008.0152. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] [2]. Marcin JP, Shaikh U, Steinhorn RH. Addressing health disparities in rural communities using telehealth. Pediatr Res 2016;79:169–76. 10.1038/pr.2015.192. [ DOI ] [ PubMed ] [ Google Scholar ] [3]. 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Supplementary Materials 1 Univariate Analyses of Covariates on Individual and Combined Adverse Outcomes ( Supplementary Table 1 ) Univariate Analyses of prognostically important covariates on composite of combined adverse outcomes and its individual components including, primary caesarean delivery, NICU admission, spontaneous preterm birth, hypertensive disorders of pregnancy, and insufficient gestational weight gain. RR = Relative Risk, CI= Confidence Interval, GDM = Gestational Diabetes Mellitus, BMI = Body Mass Index NIHMS2075951-supplement-1.pdf (130.1KB, pdf) 2 Standardized Mean Differences of Participants' Characteristics Before and After IPWRA ( Supplementary Table 2 ) Standardized mean difference of covariates between OB Teleflex and standard of care, for all participants, before (raw) and after (weighted) IPW adjusted for race and ethnicity, insurance, pre-pregnancy BMI, maternal age, parity, distance to facility, history of GDM, history of caesarean delivery, and chronic hypertension. GDM = Gestational Diabetes Mellitus, BMI = Body Mass Index NIHMS2075951-supplement-2.pdf (116.2KB, pdf) ACTIONS View on publisher site PDF (453.3 KB) Cite Collections Permalink RESOURCES Similar articles Cited by other articles Links to NCBI Databases Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top

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