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
Bibliographic record
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: , 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.018 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".