Inequities in Adequacy of Prenatal Care and Shifts in Rural/Urban Differences Early in the COVID-19 Pandemic.

Background: Adequate prenatal care is vital for positive maternal, fetal, and child health outcomes; however, differences in prenatal care utilization exist, particularly among rural populations. The COVID-19 pandemic accelerated the adoption of telehealth in prenatal care, but its impact on the adequacy of care remains unclear.

Methods: Using Pregnancy Risk Assessment Monitoring System (PRAMS) data, this study examined prenatal care adequacy during the early-pandemic year (2020) and pre-pandemic years (2016-2019) and investigated rural-urban inequities. Logistic regression models assessed the association between the pandemic year and prenatal care adequacy, and considered barriers to virtual care as a covariate.

Results: The sample consisted of 163,758 respondents in 2016-2019 and 42,314 respondents in 2020. Overall, the study participants were 12% less likely to receive adequate prenatal visits during the early-pandemic year (2020) compared with 2016-2019 (adjusted odds ratio [aOR] = 0.88; 95% confidence interval [CI] [0.86, 0.91]). Respondents in rural areas had lower odds of receiving adequate prenatal care compared with those in urban areas during both pre-pandemic years (aOR = 0.90; 95% CI [0.88, 0.93]) and the early-pandemic year (aOR = 0.94; 95% CI [0.88, 0.99]). However, after adjusting for barriers to virtual care, the difference between rural and urban areas in the early-pandemic year became nonsignificant (aOR = 0.93; 95% CI [0.78, 1.11]). Barriers to virtual care, including lack of phones, data, computers, internet access, and private space, were significantly associated with inadequate prenatal care.

Conclusion: During the early-pandemic year, PRAMS respondents experienced reduced adequacy of prenatal care. Although rural-urban inequities persisted, our results suggest that existing barriers to virtual care explained these inequities. Telehealth interventions that minimize these barriers could potentially enhance health care utilization among pregnant people.