Telehealth use in antenatal care? Not without women's voices - Authors' reply.

We thank Anna Galle and colleagues for progressing the conversation about quality and equity in antenatal care. Although our analysis of telehealth integrated care addressed the initial 4 months following widespread telehealth integration and analysed data following birth only, this means that women included in the analysis were predominately in the third trimester of pregnancy, a time when most pregnancy complications arise. The fact that women in their final stages of pregnancy received, on average, 40% of consultations via telehealth without an impact on the quality of their pregnancy outcomes remains heartening. To our knowledge, no other evidence exists about the effect of telehealth use on quality outcome measures. With similar programmes implemented worldwide without evidence on safety and quality to guide them, the benefit that this model can provide in ensuring access to quality care during the COVID-19 pandemic has warranted its dissemination before the availability of data across the entirety of a woman's pregnancy. However, such research is underway and will be an important addition to our knowledge of telehealth use beyond the promising short-term findings to date.

The COVID-19 pandemic has led to many health-care changes, many without evidence to guide them. However, it is crucial that the conversation about quality of care is based on evidence that evaluates quality outcome measures, as well as women's voices about personalised care. Galle and colleagues state that “research shows that care quality is compromised by incorporating telehealth into routine maternity care”, yet reference two studies that purely survey the perceptions of health professionals as evidence of this compromise in care.2, 3 Our interrupted times-series analysis aimed to emulate a randomised evaluation of telehealth integrated care (rather than an entirely remote care model), compared with conventional antenatal care. Like most observational studies, this model is hypothesis generating and provides the opportunity to consider building forward better. Traditional in-person antenatal care is imperfect in achieving equity in care, with Ukoha and colleagues stating that telehealth “presents a promising opportunity to address these social determinants of health and their resulting inequities”. We have shown that telehealth can deliver high-quality care without compromising short-term safety. Ongoing high-quality research that encompasses measures of clinical outcomes and the satisfaction of both women and providers with care is needed to keep building forward to achieve personalised and equitable care. Let us not rush back to pre-COVID-19 care models that did not achieve the ideals recommended by WHO for positive antenatal care.

We declare no competing interests.