The impact of COVID-19 on preconception care and utilization of prenatal care

The COVID-19 pandemic has resulted in a rapid shift in the delivery of prenatal care services to telehealth modalities due to the inaccessibility of traditional care services and high exposure risks of in-person healthcare visits. Prior to the pandemic obstetricians utilized telehealth with specific populations. Studies during this time suggest that care delivered via telehealth is associated with positive outcomes specifically the management of gestational diabetes cigarette smoking cessation and breastfeeding initiation. Although telehealth has the potential to improve access for patients who face transportation and childcare barriers telehealth may also exacerbate health inequities. African Americans are less likely to utilize telehealth than their white counterparts and if utilized the audio/telephone is the preferred modality. The COVID-19 pandemic has disproportionately affected communities of color who already experience elevated risks of adverse perinatal outcomes. In addition to the disproportionate burden of adverse birth outcomes such as low birth weight and preterm birth experienced by African Americans and the ongoing Black maternal mortality crisis it is critical to ensure consistent high-quality uninterrupted prenatal care for African American women. As such the overall goal of the proposed research is to examine the association between receipt of preconception care and utilization of prenatal care services during the COVID-19 pandemic. We will specifically 1)examine whether there is a difference in the initiation utilization and preferred mode of delivery of prenatal care by receipt of preconception care; 2) examine the roles of race/ethnicity in the associations between receipt of preconception care and timing of initiation of prenatal care prenatal care utilization and preferred mode of delivery of prenatal care during the COVID-19 pandemic and 3) determine if there are differences in contributing factors influencing utilization of telehealth for prenatal care by race/ ethnicity during the COVID-19 pandemic. To achieve this goal we will conduct a secondary data analysis of data from the COVID-19 Supplement of the Pregnancy Risk Assessment and Monitoring Survey (PRAMS). This work is imperative in our quest to eliminate health inequities and prepare for a more patient-centered resource efficient approach to prenatal care post-COVID-19 pandemic.