Telehealth expands maternal-fetal medicine access, with Jeffrey Chapa, MD

Shifting demographics and a limited maternal-fetal medicine (MFM) workforce have widened the gap between the number of pregnancies requiring subspecialty input and the availability of specialists to provide it, according to Jeffrey Chapa, MD, National Medical Director, Maternal-Fetal Medicine, Obtelecare, who described telehealth as a means of closing that gap.

A changing obstetrical population

Chapa pointed to delayed childbearing as a defining shift in the patient population over the past 2 decades.

“The obstetrical population has changed drastically over the past 15 to 20 years. We are seeing more women delay childbearing till their late 30s and early 40s. In fact, that is the fastest and probably only growing segment of the obstetrical population,” he said.

That shift has been accompanied by rising rates of comorbid conditions.

“More hypertension, more diabetes, and unfortunately, there is an obesity epidemic right now. So the percentage of the pregnancies that require a maternal-fetal medicine specialist to participate in the care has increased significantly,” Chapa said.

Remote monitoring and fetal surveillance

Chronic maternal medical conditions are particularly well suited to remote management, Chapa said, citing emphasis on remote monitoring at the Society for Maternal-Fetal Medicine meeting in Las Vegas.

“There are several companies that are out there providing solutions for non-stress testing or fetal surveillance, where they can actually do this remotely and have the baby's heart tracing sent electronically for a provider to be able to review and do an assessment of fetal well-being without the patient even coming into the hospital,” he said.

Earlier subspecialty involvement, he added, can shift the clinical trajectory.

“Having access to maternal-fetal medicine early in a pregnancy can often lead to detection of significant issues earlier in the pregnancy, so that we are then allowed to make modifications and changes to the care that can help mitigate those conditions and help maybe prolong the pregnancy and have better outcomes,” Chapa said.

Selecting candidates for hybrid care

Chapa said most patients are suitable for a hybrid model, with defined exceptions.

“There are certain conditions, placenta accreta spectrum, moms with complex medical illness, particularly like critical cardiac disease, those patients probably would be better suited in a setting where there are MFM physicians on site. However, it does not mean that we cannot contribute to their care in some means with telehealth,” he said.