The relationship between virtual antenatal care and pregnancy outcomes in a diverse UK inner-city population: a group-based trajectory modeling approach using routine health records.

IF 8.4 1区 医学 Q1 OBSTETRICS & GYNECOLOGY
Kathryn V Dalrymple, Florence Tydeman, Jeffrey N Bone, Lucilla Poston, Tisha Dasgupta, Alice McGreevy, Milly G Wilson, Abigail Easter, Asma Khalil, Sara L White, Sergio A Silverio, Lisa Long, Daghni Rajasingam, Hiten D Mistry, Peter von Dadelszen, Laura A Magee
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Abstract

Background: The COVID-19 pandemic resulted in major reconfiguration of maternity services, particularly an increase in virtual antenatal care.

Objective: We explored associations between virtual antenatal care trajectories and pregnancy outcomes.

Study design: Pregnancy and birth outcome data were obtained from a multiethnic and socioeconomically deprived UK inner-city population before and during the pandemic (with and without lockdown). Data were collected using a health record data linkage from the Born in South London cohort. Antenatal care was characterized by the number of outpatient contacts during 6 gestational windows: 0 to 14+6, 15 to 20+6, 21 to 27+6, 28 to 32+6, 33 to 36+6, and ≥37 weeks' gestation. In each window, the proportion of virtual antenatal care was grouped into quartiles, and group-based trajectory modeling was used to extract virtual antenatal care trajectories. Associations between these trajectories and pregnancy outcomes were explored using adjusted multinominal logistic regression.

Results: The analysis included 34,114 mother-child dyads (October 2018-July 2023). Group-based trajectory modeling suggested 4 trajectories of virtual antenatal care contacts: low and stable virtual care throughout pregnancy (Trajectory 0; n=27,751 pregnancies, 81.3%), high first trimester virtual care (Trajectory 1; n=832, 2.4%), high second trimester virtual care (Trajectory 2; n=2,410, 7.1%), and high third trimester virtual care (Trajectory 3; n=3,121, 9.2%). Following adjustment, compared with the low and stable group (Trajectory 0), high second trimester virtual care was associated with less gestational hypertension (adjusted relative risk ratio, 0.84; 95% confidence interval, 0.74-0.96) and assisted vaginal birth (0.87 [0.76-1.00]), and more premature births (<37 weeks, 1.21 [1.02-1.44]), labor induction (1.13; 1.02-1.25), breech presentation (1.92; 1.02-3.62), and postpartum hemorrhage (1.14; 1.00-1.30). Similarly, compared to the low and stable group (Trajectory 0), high third trimester virtual care had less gestational hypertension (0.84 [0.73, 0.96]), more premature births (<37 weeks; 1.35; 1.16-1.58) and elective (1.54; 1.38-1.72) or emergency (1.21; 1.01-1.34) cesarean sections, and neonatal intensive care admissions (1.28; 1.09-1.50); fewer third-degree/fourth-degree vaginal tears (0.82; 0.75-0.90); and less early infant skin-to-skin contact (0.82; 0.73-0.92) and breastfeeding (0.90; 0.81-0.99).

Conclusion: A higher proportion of virtual care contacts in antenatal care in the second or third trimesters was associated with a greater risk of adverse pregnancy outcomes.

虚拟产前保健和怀孕结果在不同的英国城市人口的关系使用常规健康记录的基于组的轨迹建模方法
背景:2019冠状病毒病大流行导致孕产妇服务的重大重组,特别是虚拟产前保健的增加。我们探讨了虚拟产前护理轨迹与妊娠结局之间的关系。方法:在大流行之前和期间(有和没有封锁),从多种族和社会经济贫困的英国市中心人口中获得妊娠和分娩结果数据。数据收集使用健康记录数据链接从出生在伦敦南部,(eLIXIR-BiSL)队列。产前保健的特征是六个妊娠期窗口的门诊接触次数:0-14+6、15-20+6、21-27+6、28-32+6、33-36+6和≥37周妊娠。在每个窗口中,将虚拟产前护理的比例分成四分位数,并使用基于组的轨迹建模来提取虚拟产前护理轨迹。这些轨迹与妊娠结局之间的关联使用调整多项逻辑回归进行了探讨。结果:共纳入34114对母子对(2018.10 - 2017.07)。基于群体的轨迹建模显示了虚拟产前护理接触的四种轨迹:整个妊娠期间的低水平和稳定的虚拟护理(轨迹-0;N = 27751例妊娠,占81.3%);高早期妊娠虚拟护理(轨迹-1;n = 832, 2.4%);妊娠晚期虚拟护理(轨迹-2;n = 2410, 7.1%);和高妊娠晚期虚拟护理(轨迹-3;9.2%, n = 3121)。调整后,与低和稳定组(轨迹-0)相比,高的妊娠中期虚拟护理与妊娠高血压(调整相对风险比0.84,95%可信区间[0.74-0.96])和辅助阴道分娩(0.87[0.76-1.00])以及更多的早产(rd /4度阴道撕裂(0.82,0.75-0.90)相关;婴儿早期皮肤接触(0.82,0.73-0.92)和母乳喂养(0.90,0.81-0.99)较少。结论:在妊娠中期或晚期的产前护理中,虚拟护理接触者的比例越高,不良妊娠结局的风险越大。
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来源期刊
CiteScore
15.90
自引率
7.10%
发文量
2237
审稿时长
47 days
期刊介绍: The American Journal of Obstetrics and Gynecology, known as "The Gray Journal," covers the entire spectrum of Obstetrics and Gynecology. It aims to publish original research (clinical and translational), reviews, opinions, video clips, podcasts, and interviews that contribute to understanding health and disease and have the potential to impact the practice of women's healthcare. Focus Areas: Diagnosis, Treatment, Prediction, and Prevention: The journal focuses on research related to the diagnosis, treatment, prediction, and prevention of obstetrical and gynecological disorders. Biology of Reproduction: AJOG publishes work on the biology of reproduction, including studies on reproductive physiology and mechanisms of obstetrical and gynecological diseases. Content Types: Original Research: Clinical and translational research articles. Reviews: Comprehensive reviews providing insights into various aspects of obstetrics and gynecology. Opinions: Perspectives and opinions on important topics in the field. Multimedia Content: Video clips, podcasts, and interviews. Peer Review Process: All submissions undergo a rigorous peer review process to ensure quality and relevance to the field of obstetrics and gynecology.
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