Impact of telehealth implementation on diagnosis of hypertensive disorders of pregnancy

BACKGROUND: COVID-19 caused a rapid integration of telehealth into prenatal care. This raises questions about the ability to screen for hypertensive disorders of pregnancy when caring for patients remotely. OBJECTIVE: This study aimed to assess the effect of telehealth adaptation on the timing and severity of diagnosis of hypertensive disorders of pregnancy. STUDY DESIGN: This was a retrospective study of patients with hypertensive disorders of pregnancy who delivered from April 2019 to October 2019 (before the pandemic) and April 2020 to October 2020 (during the pandemic) at 1 urban tertiary care center. The primary outcome was mean gestational age at diagnosis of a hypertensive disorder of pregnancy. The secondary outcomes included severity of diagnosis, both initially and at the time of delivery. The results were adjusted for baseline characteristic difference at P<.10, using multivariable logistic regression and analysis of covariance, as appropriate. The sample size was calculated based on a previous cohort study of patients who developed preeclampsia, with a mean gestational age at delivery of 36.3 weeks and a standard deviation of 2.8 weeks. A sample size of 124 patients would be needed per group to detect a gestational age difference of 1 week with 80% power and a 95% confidence interval. RESULTS: Overall, 498 patients were included, with 231 from 2019 and 267 from 2020. Of note, 17.1% of patients had preeclampsia with severe features initially, and 29.3% of patients met the criteria at delivery. In 2020, 80.5% of patients used telehealth (vs 0.9% of patients in 2019), doing so for a mean of 29.0% of prenatal appointments. Unadjusted and adjusted analyses showed no significant difference in gestational age at diagnosis or diagnosis severity between cohorts. In the adjusted analysis, cohort year was not significantly associated with severity of initial diagnosis (adjusted odds ratio, 0.86; 95% confidence interval, 0.53–1.39; P=.53) or severity of diagnosis at delivery (adjusted odds ratio, 0.97; 95% confidence interval, 0.64–1.46; P=.87). However, Black race was significantly associated with increased risk of having severe preeclampsia at initial diagnosis (adjusted odds ratio, 1.70; 95% confidence interval, 1.01–2.85; P=.046). In addition, Black race (adjusted odds ratio, 2.62; 95% confidence interval, 1.60–4.28; P<.001), Hispanic ethnicity (adjusted odds ratio for non-Hispanic, 0.40; 95% confidence interval, 0.19–0.82; P=.01), and initial body mass index (adjusted odds ratio, 1.04; 95% confidence interval, 1.01–1.06; P=.005) were significantly associated with a diagnosis of severe preeclampsia at delivery. CONCLUSION: The adaptation of telehealth was not associated with delays in the diagnosis of hypertensive disorders of pregnancy or with increased severity of diagnoses.