AB1538 BACK TO THE CLINIC? EVALUATING PREGNANCY MANAGEMENT OUTCOMES IN VIRTUAL AND IN-PERSON CARE
Authors: J. Tan, M. De Vera, N. Amiri
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Providing consultations virtually ("telemedicine") has become mainstream in rheumatology, especially due to the COVID-19 pandemic. Telemedicine offers benefits for patients with geographical or mobility limitations. However, it also introduces concerns about privacy, patient satisfaction, and the inability to perform physical examinations. Facing added challenges in pregnancy, patients with rheumatic may experience increased disease activity, elevating the risk of complications for both the mother and child. Regular monitoring is crucial to mitigate these risks. Serving the entire province of British Columbia, Canada, the Pregnancy and Rheumatic Disease (PReDICT) clinic has utilized telemedicine to improve patient access and regular patient monitoring over the course of pregnancy. <h3>Objectives:</h3> Determine whether the use of telemedicine consultations throughout pregnancy associated with poorer pregnancy outcomes, compared to in-person consultations. <h3>Methods:</h3> Between July 2021 and September 2023, patients were monitored at five stages: pre-pregnancy, 1st trimester, 2nd trimester, 3rd trimester, and 6 weeks post-partum. Visits were either in-person or through telemedicine. Patients with ≥50% telemedicine consultations were labeled "majority telemedicine," while those with &lt;50% were labeled "majority in-person." A χ2 test assessed the independence of these groups concerning pregnancy complications. Pregnancy complications observed in this study included preeclampsia, HELLP syndrome, rheumatic disease flare in pregnancy, endometritis, mastitis, proteinuria, gestational diabetes, gestational central hypertension requiring emergency induction, emergency C-section, intrauterine fetal demise (IUFD), neonatal intensive care unit (NICU) admission, fetal heart block, fetal small apical ventricular septal defect, neonatal immune-mediated thrombocytopenia, and fetal macrosomia. <h3>Results:</h3> The study sample comprised 47 pregnant women (average age 33.1 years) with diverse rheumatic diseases (24.4% systemic lupus erythematosus, 11.1% rheumatoid arthritis, 11.1% dermatomyositis, 6.6% undifferentiated connective tissue disease, 33.3% other). Most of the women in this study (91.1%) had never been pregnant before. There was 1 case of 3<sup>rd</sup>-trimester IUFD. The most common complications were maternal rheumatic disease flare (7 instances in 5 patients) and preeclampsia (4 instances). Among 20 "majority telemedicine" patients, 40.0% had complications, and among 27 "majority in-person" patients, 44.4% had complications. The correlation between these variables was insignificant, χ2 = 0.025 (degrees of freedom = 1, N = 47); p =.87. <h3>Conclusion:</h3> The rapid increase of telemedicine in rheumatology has prompted examination of its impacts on pregnancy outcomes for patients with rheumatic diseases. This study found no significant association between telemedicine utilization and pregnancy outcomes among women with rheumatic diseases. These findings suggest the feasibility of telemedicine in managing pregnancies for women with rheumatic diseases, and highlight an opportunity to extend care virtually, especially for those unable to pursue in-person consultations. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>