ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2025
The roles of COVID-19 pandemic exposure and telehealth in prenatal care access for rural and racial minority communities in the United States: A retrospective cohort study.
Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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Who cites it
1 citing paper in PubMed.
- The roles of COVID-19 pandemic exposure and telehealth in prenatal care access for rural and racial minority communities in the United States: A retrospective cohort study.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
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9 authors.
Funding
Abstract
purposeTo examine how COVID-19 public health emergency (PHE) exposure during pregnancy and telehealth use were associated with rural-urban and racial/ethnic differences in prenatal care initiation timing and frequency.
methodsThis retrospective cohort study of 349,682 pregnancies to birthing individuals who received both prenatal and intrapartum care at the 75 health systems in the United States contributing to the National Clinical Cohort Collaborative (N3C) from 6/1/2018 through 5/31/2022. Outcomes included prenatal care initiation timing and the number of prenatal care visits. Prenatal periods were categorized into 3 PHE exposure groups: (1) never, (2) partially, and (3) fully exposed to the PHE. The full-exposure group was further categorized into telehealth users and those with exclusively in-person care.
findingsThe full-exposure group with telehealth uptake had the earliest prenatal care initiation (median: 9 weeks [interquartile range: 7-13]) and the most visits (19 visits [12-20]). In contrast, the full-exposure group without telehealth use initiated care the latest (11 weeks [8-21]) and had the fewest visits (13 visits [6-22]). Rural-urban disparities persisted; however, telehealth users in both groups had earlier initiation and more visits. Racial and ethnic disparities in timeliness to initiation were most pronounced among the full-exposure group with telehealth (Black-White: adjusted hazard ratio [aHR]: 0.76, 95% CI, 0.70-0.83; Hispanic-White: aHR: 0.62, 95% CI, 0.58-0.68), compared to the full-exposure group with exclusively in-person care (Black-White: 0.95 [0.93-0.94]; Hispanic-White: 0.80 [0.80-0.81]).
conclusionsPrenatal telehealth care improved early initiation but also exacerbated racial/ethnic disparities in the timeliness of prenatal care access. However, rural-urban disparities persisted.
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