Patterns of antepartum care in Ontario before and during a time of COVID-19 and virtual care: a population-based study

Background — The COVID-19 pandemic resulted in changes to the way health care was delivered, including expansion of virtual care. We aimed to understand differences in antepartum care delivery prior to and during the pandemic.

Methods — We conducted a population-based retrospective cohort study of people 15–50 years with an in-hospital birth at 20+ weeks’ gestation in Ontario, Canada, across two time periods: December 1, 2020–November 30, 2022 (pandemic), and December 1, 2017–November 30, 2019 (pre-pandemic). Outcomes were total number and timing of antepartum visits, ultrasounds, and acute care encounters. Outcomes were compared between cohorts, and between those who did and did not receive virtual care during the pandemic. Regression modeling was used to examine associations between pregnancy during the pandemic and rates of outcomes.

Results — A total of 228,551 pandemic and 218,126 pre-pandemic births were included. Median number of antepartum visits was 10 (6–13) in the pandemic period and 9 (4–12) pre-pandemic (standardized difference (StD): 0.32), corresponding to a relative rate of 1.21 (95% CI [1.20, 1.21]). Significantly more individuals in the pandemic had >11 visits, with no differences in acute care encounters and only a small increase in health care costs (<10%). Those in the pandemic cohort were more likely to have their initial visit during the first trimester (79.3% vs. 66.5%, StD: 0.29). Those receiving virtual care were more likely to live in an urban area and be more materially advantaged.

Interpretation — Pregnancy during the pandemic was associated with in an increased rate of ambulatory antepartum visits and increased care in the first trimester.