JMIR Publications

ABSTRACT

Background:

The COVID-19 pandemic significantly impacted primary healthcare-seeking behaviour of the general population. The extent to which healthcare-seeking behaviour of pregnant women in general practitioner (GP) care was affected, remains largely unknown. The unique healthcare needs of pregnant women necessitate regular monitoring and care to ensure the well-being of expectant mothers, foetuses, and neonates, as timely interventions and screenings can profoundly influence the long-term health outcomes. Understanding how pandemic-related changes have influenced pregnant women’s primary healthcare-seeking behaviour is essential for developing targeted interventions and informing policy decisions to improve health outcomes for expectant mothers, foetuses, and neonates’ health outcomes, both during public health emergencies and in routine healthcare settings.

Objective:

This study aims to examine the impact of different COVID-19 pandemic phases on healthcare-seeking behaviour among pregnant women in Dutch GP practices throughout 2020 and 2021. By analysing clinical Electronic Health Record (EHR) GP data, we aim to evaluate the healthcare consumption, occurrence of pregnancy-relevant symptoms and diagnoses, and types of contact (i.e., regular consultations, phone consultations, home visits, digital consultations) during different pandemic phases.

Methods:

Using a retrospective cohort design, EHRs of selected pregnant women from three Dutch GP networks, between 2019 and 2021 were analysed, comparing six pandemic phases divided into 13 sub-phases, to a pre-pandemic phase. Contact rates were analysed by interrupted time-series analyses, pregnancy-relevant symptoms and diagnoses by comparing frequency of pregnancy-relevant International Classification of Primary Care (ICPC) code registrations, and type of contact by descriptive statistics.

Results:

In total 10,985 pregnant women were included, yielding 39,023 patient-GP contacts. Contact rates fluctuated significantly across pandemic phases, with sharpest declines at the onset (P<.001) and end (P≤.013) of the pandemic. Pregnancy-relevant symptoms and diagnosis in the category related to pregnancy showed the highest variability across the pandemic phases, such as an increase in the frequency of healthcare consumption concerning gestational diabetes mellitus (GDM, P≤.022) and nausea or vomiting of pregnancy (P≤.034). Contacts for symptoms and diagnosis like digestive or urinary tract problems did not fluctuate across the pandemic phases. The number of physical contacts decreased, while telephone contacts increased.

Conclusions:

By analysing EHR data from over 10,000 pregnant women, this study highlights the pandemic’s impact on pregnant women's GP healthcare-seeking behaviour. There was a shift towards telehealth. Given the increase in GDM and its the potential long-term effects, enhanced public health strategies within GP practices are needed, ensuring continuous access to prenatal care, and striving for improved outcomes of expectant mothers, their foetuses, and neonates during times of pandemics and in routine healthcare settings.