Racial and Ethnic and Rural Variations in the Use of Hybrid Prenatal Care in the US
Authors: Hung Peiyin , Yu Jiani , Harrison Sayward E. , Liu Jihong , Promiti Adiba , Odahowski Cassie , Campbell Berry A. , Chatterjee Anirban , Boghossian Nansi S. , Cai Bo , Liang Chen , Li Jixuan , Li Xiaoming ,   National COVID Cohort Collaborative Consortium, Haendel Melissa A. , Chute Christopher G. , Eichman Dave , Walden Anita , Pfaff Emily , Moffit Richard , Gersing Kenneth R. , Rutter Joni L. , Burgoon Penny Wung , Bozzette Samuel , Deacy Mariam , Dillon Christopher , Erwin-Cohen Rebecca , Garbarini Nicole , Gordon Valery , Kurilla Michael G. , Marti Emily Carlson , Michael Sam G. , Portilla Lili M. , Schmitt Clare , Temple-O'Connor Meredith , Pfaff Emily R. , Gabriel Davera , Hong Stephanie S. , Kostka Kristin , Lehmann Harold P. , Moffitt Richard A. , Morris Michele , Palchuk Matvey B. , Tanner Zhang Xiaohan , Zhu Richard L. , Amor Benjamin , Bissell Mark M. , Clark Marshall , Girvin Andrew T. , Lee Adam M. , Miller Robert T. , Walters Kellie M. , Loomba Johanna , (Jerrod) Anzalone Alfred , French Evan , Johnson Steven G. , Olex Amy , Topaloglu Umit , Zhou Andrea , Adams Meredith , Caleb Alexander G. , Bates Benjamin , Beasley Will , Bennett Tellen D. , Boudreau Eilis , Bramante Carolyn T. , Brown Donald E. , Buse John B. , Callahan Tiffany J. , Cato Kenrick , Chapman Scott , Clark Jaylyn , Cottrell Lesley , Crowley Karen , Gagnier Joel , Ge Jin , Awori Hayanga J.W. , Hendricks Brian , Hill Elaine L. , Hillegass William , Housman Dan , Hurley Robert , Yasmine Islam Jessica , Jawa Randeep , Kamaleswaran Rishikesan , Koraishy Farrukh M. , Madlock-Brown Charisse , Mallipattu Sandeep K. , Martin Greg , Mathew Jomol , Mazzotti Diego , Mehta Hemalkumar B. , Murray Kimberly , Northington Lavance , O'Neil Shawn T. , Patel Brijesh , Patel Rena C. , Pincavitch Jami , Prior Fred , Pyarajan Saiju , Pyles Lee , Sadan Ofer , Safdar Nasia , Setoguchi Soko , Sharafeldin Noha , Sharathkumar Anjali , Sokos George , Southerland Andrew M. , Subbian Vignesh , Takemoto Cliff , Ward-Caviness Cavin , Wilcox Adam B. , Wilkins Ken , Williams Andrew E. , Magesh Sruthi , Francis Patricia A. , Graves Alexis , McMurry Julie A. , Bradwell Katie Rebecca , Manna Amin , Beck Gianna , Barros Andrew , Dai Ran , Emmett Mary , Richard Harper Jeremy , Hernandez Wenndy , Li Meng-Hao , Menon Nirup , Saha Amit , Singh Jasvinder A. , Walden Anita Wa 
Published: December 2024

Importance

Understanding whether there are racial and ethnic and residential disparities in prenatal telehealth uptake is necessary for ensuring equitable access and guiding implementation of future hybrid (ie, both telehealth and in-person) prenatal care.

Objective

To assess temporal changes in individuals using hybrid prenatal care before and during the COVID-19 public health emergency (PHE) by race and ethnicity and residence location in the US.

Design, Setting, and Participants

This retrospective cohort study analyzed electronic health record data of prenatal care visits from the National COVID Cohort Collaborative Data Enclave, comprising data from 75 health systems and freestanding institutes in all 50 US states. Data were analyzed on 349 682 nationwide pregnancies among 349 524 people who gave birth from June 1, 2018, through May 31, 2022. Multivariable generalized estimating equations were used to examine variations in receiving hybrid vs only in-person prenatal care. Data phenotyping and analysis occurred from June 13, 2023, to September 27, 2024.

Exposures

Prenatal period overlap (never, partially, or fully overlapping) with the COVID-19 PHE, maternal race and ethnicity, and urban or rural residence.

Main Outcomes and Measures

Hybrid vs in-person–only prenatal care.

Results

Of 349 682 pregnancies (mean [SD] age, 29.4 [5.9] years), 59 837 (17.1%) were in Hispanic or Latino individuals, 14 803 (4.2%) in non-Hispanic Asian individuals, 65 571 (18.8%) in non-Hispanic Black individuals, 162 677 (46.5%) in non-Hispanic White individuals, and 46 794 (13.4%) in non-Hispanic individuals from other racial and ethnic groups. A total of 31 011 participants (8.9%) resided in rural communities. Hybrid prenatal care increased from nearly none before March 2020 to a peak of 8.1% telehealth visits in November 2020, decreasing slightly to 6.2% by March 2022. Among the fully overlapping group, urban residents had nearly 2-fold odds of hybrid prenatal care compared with rural people (adjusted odds ratio [AOR], 1.98; 95% CI, 1.84-2.12). Hispanic or Latino people (AOR, 1.48; 95% CI, 1.41-1.56), non-Hispanic Asian people (AOR, 1.47; 95% CI, 1.35-1.59), and non-Hispanic Black people (AOR, 1.18; 95% CI, 1.12-1.24) were more likely to receive hybrid prenatal care than non-Hispanic White people.

Conclusions and Relevance

In this cohort study, hybrid prenatal care increased substantially during the COVID-19 PHE, but pregnant people living in rural areas had lower levels of hybrid care than urban people, and individuals who belonged to racial and ethnic minority groups were more likely to have hybrid care than White individuals. These findings suggest that strategies that improve equitable access to telehealth for people who live in rural areas and people in some minority racial and ethnic groups may be useful.