PhD student The University of Manitoba Winnipeg, Canada
Background: Disruptions in healthcare services due to COVID-19 could have impacted vulnerable groups, including pregnant women. Limited evidence exists on the pandemic’s role in limiting access and use of prenatal care services and the quality of care for pregnant women.
Objectives: To investigate the impact of the pandemic restrictions on in-person prenatal care visits (PNCV) and the quality of prenatal care.
Methods: Using the mother-infant linked administrative health databases in Manitoba, Canada, we conducted a province-wide population-based cohort study among independent pregnancies. We examined the quarterly rates of PNCV before (October 2016-March 2020) and during (April 2021-March 2022) the pandemic (average number of visits per quarter). Quality of prenatal care was categorized using the Revised Graduated Prenatal Care Utilization Index (R–GINDEX) into: inadequate ( < 50% recommended visits), intermediate (50%-80% recommended visits), adequate (>80% recommended visits), intensive (high-risk), and no care. Interrupted time series analyses were conducted to assess the immediate and lagged changes in PNCV and quality of care after the implementation of pandemic restrictions in the second quarter of 2020.
Results: Amongst 70,931 pregnancies, we observed no significant mean difference in the overall numbers of PNCV during the pandemic compared to pre-pandemic (8.2 vs. 8.6,p=0.0837). Prenatal care utilization was 3.4% inadequate and 34.7% adequate before the pandemic and 4.8% and 26.6% during the pandemic, respectively. Restrictions were associated with an abrupt decline in adequate and intermediate care during the first trimester by 11.3% (p < 0.001) and 11.98%, respectively, followed by non-significant change throughout the pandemic (β3=-0.25, p=0.694 and β3=-0.96, p=0.192, respectively). Moreover, restrictions were associated with an increased rate of inadequate care during the first (β2=1.52, p=0.007) and second trimesters (β2=0.78, p=0.208), and not among third trimesters (β2=-0.44, p=0.094). During the pandemic, we found no significant differences in the rates of intensive prenatal care during the first (p=0.478), second (p=0.614), and third (p=0.608) trimesters compared to pre-pandemic period.
Conclusions: Our findings suggest a decline in adequacy levels of prenatal care services after COVID-19 restrictions were enacted, with higher impact on pregnancies during their first and second trimesters. Although the overall adequacy of care decreased, there were no changes to the rates of intensive visits. This study will further investigate the impact of the pandemic on virtual PNCV and assess the association between the quality of prenatal care and adverse maternal and neonatal outcomes.
.jpg "Laila Aboulatta, PharmD photo")
