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Changes in prenatal testing during the COVID-19 pandemic
Sara C Handley1,2,3, Rachel Ledyard1, Lisbet S Lundsberg4
1Divison of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Insights
Prenatal testing timing was largely maintained during the COVID-19 pandemic, with slight delays in some second-trimester screenings. Despite healthcare disruptions, essential prenatal screening remained a priority for expectant mothers and healthcare providers.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic significantly impacted healthcare systems globally.
- Prenatal care delivery faced unprecedented challenges, necessitating an evaluation of its continuity and timing.
Purpose of the Study:
- To assess changes in the timing of routine prenatal testing during the COVID-19 pandemic.
- To compare prenatal testing schedules between pre-pandemic and early pandemic periods.
Main Methods:
- A retrospective observational cohort study utilized claims and electronic health record data.
- Data from Highmark, Penn Medicine, and Yale New Haven were analyzed for pre-pandemic (2018-2019) and early pandemic (2020) periods.
- Primary outcomes included second-trimester fetal anatomy ultrasounds and gestational diabetes screening; first-trimester ultrasounds were a secondary outcome.
Main Results:
- Mean gestational age for second-trimester anatomy ultrasounds slightly increased across all datasets during the pandemic.
- A decrease in early (<20 weeks) anatomy ultrasounds was observed, but not at later gestations.
- No consistent changes in gestational diabetes screening timing were found.
- Significant reductions in first-trimester ultrasounds occurred at academic institutions.
Conclusions:
- While some prenatal tests were performed later during the pandemic, overall timing remained appropriate.
- Prenatal screening continued to be a priority, demonstrating resilience in care despite healthcare system disruptions.
Objective:
The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare delivery, including prenatal care. The study objective was to assess if timing of routine prenatal testing changed during the COVID-19 pandemic.
Methods:
Retrospective observational cohort study using claims data from a regional insurer (Highmark) and electronic health record data from two academic health systems (Penn Medicine and Yale New Haven) to compare prenatal testing timing in the pre-pandemic (03/10/2018-12/31/2018 and 03/10/2019-12/31/2019) and early COVID-19 pandemic (03/10/2020-12/31/2020) periods. Primary outcomes were second trimester fetal anatomy ultrasounds and gestational diabetes (GDM) testing. A secondary analysis examined first trimester ultrasounds.
Results:
The three datasets included 31,474 pregnant patients. Mean gestational age for second trimester anatomy ultrasounds increased from the pre-pandemic to COVID-19 period (Highmark 19.4 vs. 19.6 weeks; Penn: 20.1 vs. 20.4 weeks; Yale: 18.8 vs. 19.2 weeks, all p < 0.001). There was a detectable decrease in the proportion of patients who completed the anatomy survey <20 weeks' gestation across datasets, which did not persist at <23 weeks' gestation. There were no consistent changes in timing of GDM screening. There were significant reductions in the proportion of patients with first trimester ultrasounds in the academic institutions (Penn: 57.7% vs. 40.6% and Yale: 78.7% vs. 65.5%, both p < 0.001) but not Highmark. Findings were similar with multivariable adjustment.
Conclusion:
While some prenatal testing happened later in pregnancy during the pandemic, pregnant patients continued to receive appropriately timed testing. Despite disruptions in care delivery, prenatal screening remained a priority for patients and providers during the COVID-19 pandemic.
