FARGO — Fewer women were able to get prenatal clinic visits because of the coronavirus pandemic at a time when complications for pregnancies and childbirths already were rising by double digits, according to a new national study.

The pandemic, which struck the nation with force in March, had a major impact on expectant mothers’ access to prenatal care, according to the study by the Blue Cross Blue Shield Association, with support from Blue Cross Blue Shield of North Dakota.

Among the findings:

  • 1 in 4 women missed a prenatal visit.

  • 48% of women shifted their prenatal appointments to virtual visits.

  • 53% reported they couldn’t have a partner or relative with them in the delivery room because of visitation restrictions.

  • 15% delivered their baby at home.

Dr. Greg Glasner, chief medical officer for Blue Cross Blue Shield of North Dakota and a practicing OB-GYN, said he believes North Dakota’s numbers probably mirrored the national figures, except for the percentage of home births.

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Even before the pandemic struck, pregnancy and childbirth complications rose more than 30% between 2014 and 2018, according to the Health in America study.

Dr. Greg Glasner is chief medical officer, Blue Cross Blue Shield of North Dakota.
Dr. Greg Glasner is chief medical officer, Blue Cross Blue Shield of North Dakota.

Because prenatal visits are important for treating or avoiding complications, that trend will be difficult to improve during the pandemic, although in-person visits have substantially rebounded, Glasner said.

“The COVID impacts were just rolled into this,” he said, referring to COVID-19 access barriers aggravating trends already well established.

One of the primary reasons for the rise in pregnancy and childbirth complications is the obesity epidemic, which increases risks, Glasner said.

“You tend to see more of it as the obesity rate rises,” Glasner said. “People are heavier overall. That leads to more prediabetes, diabetes, hypertension that come from that,” increasing the risk of complications.

Post-delivery depression was also on the rise, the study found. Postpartum depression diagnoses increased almost 30% during the five-year period and was most prevalent among mothers aged 18 to 24.

The increase in postpartum depression might be because of better reporting, although it’s not clear, Glasner said.

“It’s just better reported now,” he said. “There’s better screening for it.”

Electronic medical records have improved health reporting, he added, giving doctors and health systems much better information about their patient and patient populations.

During the pandemic, virtual visits and telephone visits have become widely accepted by patients.

“You can do a lot virtually,” Glasner said. Virtual visits work well for many visits, but women who have complicated pregnancies require more testing and clinical examinations, he said.

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Ideally, women should consult their provider when they decide they are planning a pregnancy, and not wait until they are pregnant, he said.

“I think that would improve these risk factors substantially,” Glasner said. "That is not the norm.”

Millennial women, those born between 1981 and 1996, account for 85% of U.S. pregnancies and have experienced double-digit increases in eight of the top 10 health conditions, including depression, high blood pressure and adult-onset diabetes, all of which lead to higher risk pregnancies and childbirth complications, the report said.

During the recent five-year period in the study, the number of women experiencing both pregnancy and childbirth complications rose 31.5%, and women with complications during pregnancy were twice as likely to have childbirth complications.

“The COVID-19 pandemic is changing the way providers deliver prenatal care,” Glasner said. “Things like drive-up prenatal visits were born out of necessity, but could open the door to new and convenient maternity education and care.”