9-11 Early data from prenatal care models with reduced visit schedules and telemedicine launched during the COVID-19 pandemic report high patient and provider satisfaction and significant changes in care utilization, but safety data are limited. However, the connection between prenatal visit number, monitoring, telemedicine, and pregnancy outcomes is less clear for patients with additional risk factors. Meta-analysis–level data demonstrate equal maternal and neonatal outcomes and fewer unnecessary interventions when prenatal visits are reduced from 14 to 9 for patients without medical conditions. 6-8 However, supporting evidence for prenatal care delivery is much more limited, as highlighted by a systematic review completed for the MiPATH panel. There is robust evidence supporting many specific prenatal care services (eg, maternal vaccination, detection, and management of anemia). Prenatal care is a crucial preventive care service designed to improve the health of pregnant patients and their infants through (1) medical screening and management of chronic conditions and complications (2) anticipatory guidance on pregnancy, delivery, and the postpartum period and (3) support for SSDHs that affect patients’ ability to access and engage in care. Evidence supporting new prenatal care recommendations Here we summarize the MiPATH panel process, translate key findings into recommendations for maternity care professionals, and address common questions about new recommendations. The resulting Michigan Plan for Appropriate Tailored Healthcare in pregnancy (MiPATH) is a paradigm shift in prenatal care delivery, providing a more individualized and flexible approach to prenatal care that matches recommended services to patients’ medical needs, including chronic conditions and pregnancy complications, as well as social and structural determinants of health (SSDHs), which are nonmedical factors that influence patients’ ability to access and engage in care.
These experiences revealed how prenatal care could be delivered more flexibly both during and beyond the acute public health crisis.Ĭatalyzed by changes in prenatal care delivery launched during the COVID-19 pandemic, the American College of Obstetricians and Gynecologists (ACOG), in collaboration with the University of Michigan, convened a panel to redesign prenatal care delivery recommendations. During the COVID-19 pandemic, maternity care practices across the country rapidly implemented new visit schedules and telemedicine to reduce viral exposure while continuing to deliver necessary prenatal services.
National guidelines recommend a uniform 12- to 14-visit schedule for all patients to deliver evidence-based services, such as laboratory testing, ultrasounds, and blood pressure monitoring. Until the COVID-19 pandemic, prenatal care delivery had remained largely unchanged since 1930. Prenatal care is one of the most common preventive services in the United States-over 98% of the almost 4 million patients who give birth each year receive at least some prenatal care. Zahn is an ob-gyn and vice president of clinical practice at the American College of Obstetricians and Gynecologists in Washington, DC.
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