The relationship between virtual antenatal care and pregnancy outcomes in a diverse UK inner-city population: a group-based trajectory modeling approach using routine health records - 20/11/25
the
RESILIENT Study Group (Table S1) and The Early Life Cross Linkage in Research, Born in South London (eLIXIR-BiSL) Partnership (Table S2)
Abstract |
Background |
The COVID-19 pandemic resulted in major reconfiguration of maternity services, particularly an increase in virtual antenatal care.
Objective |
We explored associations between virtual antenatal care trajectories and pregnancy outcomes.
Study Design |
Pregnancy and birth outcome data were obtained from a multiethnic and socioeconomically deprived UK inner-city population before and during the pandemic (with and without lockdown). Data were collected using a health record data linkage from the Born in South London cohort. Antenatal care was characterized by the number of outpatient contacts during 6 gestational windows: 0 to 14 +6 , 15 to 20 +6 , 21 to 27 +6 , 28 to 32 +6 , 33 to 36 +6 , and ≥37 weeks' gestation. In each window, the proportion of virtual antenatal care was grouped into quartiles, and group-based trajectory modeling was used to extract virtual antenatal care trajectories. Associations between these trajectories and pregnancy outcomes were explored using adjusted multinominal logistic regression.
Results |
The analysis included 34,114 mother-child dyads (October 2018–July 2023). Group-based trajectory modeling suggested 4 trajectories of virtual antenatal care contacts: low and stable virtual care throughout pregnancy (Trajectory 0; n=27,751 pregnancies, 81.3%), high first trimester virtual care (Trajectory 1; n=832, 2.4%), high second trimester virtual care (Trajectory 2; n=2,410, 7.1%), and high third trimester virtual care (Trajectory 3; n=3,121, 9.2%). Following adjustment, compared with the low and stable group (Trajectory 0), high second trimester virtual care was associated with less gestational hypertension (adjusted relative risk ratio, 0.84; 95% confidence interval, 0.74–0.96) and assisted vaginal birth (0.87 [0.76–1.00]), and more premature births (<37 weeks, 1.21 [1.02–1.44]), labor induction (1.13; 1.02–1.25), breech presentation (1.92; 1.02–3.62), and postpartum hemorrhage (1.14; 1.00–1.30). Similarly, compared to the low and stable group (Trajectory 0), high third trimester virtual care had less gestational hypertension (0.84 [0.73, 0.96]), more premature births (<37 weeks; 1.35; 1.16–1.58) and elective (1.54; 1.38–1.72) or emergency (1.21; 1.01–1.34) cesarean sections, and neonatal intensive care admissions (1.28; 1.09–1.50); fewer third-degree/fourth-degree vaginal tears (0.82; 0.75–0.90); and less early infant skin-to-skin contact (0.82; 0.73–0.92) and breastfeeding (0.90; 0.81–0.99).
Conclusion |
A higher proportion of virtual care contacts in antenatal care in the second or third trimesters was associated with a greater risk of adverse pregnancy outcomes.
Le texte complet de cet article est disponible en PDF.Video |
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Key words : antenatal care, birth outcomes, electronic health records, trajectories, virtual care
Plan
| P.D. and L.A.M. contributed equally to this work. |
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| The authors report no conflict of interest. |
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| This project was funded by the National Institute for Health Research (NIHR) HSDR Programme (reference number NIHR134293 ). The Early Life Cross Linkage in Research, Born in South London (eLIXIR-BiSL) Partnership was developed by an MRC Partnership Grant (MR/P003060/1) and the MRC Longitudinal Population Study Grant (MR/X009742/1). The eLIXIR-BiSL platform is also part-supported by the National Institute for Health Research Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King's College London. The funder ( NIHR ) played no role in study design, data acquisition, analysis, interpretation, or the decision to submit for publication. Abigail Easter, King's College London, is supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust . The views expressed are those of the author[s] and not necessarily those of the NIHR or the Department of Health and Social Care . |
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| Data availability: The data accessed by eLIXIR remain within an NHS firewall and governance is provided by the eLIXIR Oversight Committee which reports to relevant information governance clinical leads. Subject to these conditions, data access is encouraged and those interested should contact the eLIXIR Chief Investigator (Professor Lucilla Poston; Lucilla.poston@kcl.ac.uk ). Access can also be requested through the HDRUK Innovation Gateway ( 3c780d45-ed7b-4101-9c 32-d50512cd9cfe ). |
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| Cite this article as: Dalrymple KV, Tydeman F, Bone JN, et al. The relationship between virtual antenatal care and pregnancy outcomes in a diverse UK inner-city population: a group-based trajectory modeling approach using routine health records. Am J Obstet Gynecol 2025;233:675.e1-36. |
Vol 233 - N° 6
P. 675.e1-675.e36 - décembre 2025 Retour au numéro
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