Department of Research & Evaluation News

A blended prenatal care model that combined virtual and in-person visits was associated with similar birth outcomes compared with traditional in-person care, according to new Kaiser Permanente research.

The study was published November 11, 2026, in Pregnancy.

The study, conducted within Kaiser Permanente Southern California and Kaiser Permanente Northwest, compared pregnant patients who received care through Kaiser Permanente Connected Pregnancy Care with a group of patients who received traditional in-person prenatal care before the COVID-19 pandemic. Researchers found that patients in the blended care group had fewer total prenatal visits and fewer in-person visits, while receiving more virtual care. At the same time, concerning maternal outcomes, including cesarean delivery, postpartum hemorrhage, placenta previa, chorioamnionitis, and maternal hospital stays longer than 2 days, were not significantly different between the groups.

“This study shows that, for carefully selected patients with low-risk pregnancies, some prenatal care can be delivered virtually without compromising major pregnancy outcomes,” said lead author Michael J. Fassett, MD, a retired maternal-fetal medicine specialist and an associate investigator with the Kaiser Permanente Southern California Department of Research & Evaluation. “When patients have the right equipment at home, such as a blood pressure cuff, scale, and handheld ultrasound device called a Doppler, they can participate in their care from home while clinicians continue to monitor when in-person care is needed.”

Study compared more than 41,000 pregnancies

Traditional prenatal care in the United States typically includes 12 to 14 in-person visits throughout pregnancy. The COVID-19 pandemic accelerated the use of telemedicine and prompted development of more flexible care approaches, including Kaiser Permanente Connected Pregnancy Care, a blended model that alternates in-person and virtual visits and includes home monitoring devices.

The retrospective cohort study included 47,577 pregnant patients. Of those, 473 received blended care between July 22, 2022, and Dec. 31, 2024, and 47,104 received traditional in-person care between Jan. 1, 2018, and Dec. 31, 2019.

Patients in the blended care group had an average of 9.4 total prenatal visits, compared with 16.7 visits in the traditional care group. They had fewer in-person visits, 6.2 compared with 15.7, and more virtual visits, 3.2 compared with 1.0. Depression screening was also more frequent in the blended care group, occurring for 84.1% of patients compared with 45.9% in the traditional care group.

Findings support flexible care for low-risk pregnancies

The study found that blended care was associated with lower odds of stillbirth, preterm premature rupture of membranes, which is when the amniotic sac breaks before 37 weeks as well as preterm birth before 37 weeks. However, patients in the blended care group had higher odds of gestational diabetes, intrauterine growth restriction, and non-reassuring fetal heart rate tracings, a heart rate pattern that suggests the baby may not be receiving enough oxygen. The authors said those findings point to the need for careful monitoring and continued attention to remote measurements and nutrition counseling in virtual settings.

The study’s senior author Darios Getahun, MD, PhD, a perinatal epidemiologist with the Department of Research & Evaluation, said the findings add important real-world evidence to a field where more research was needed.

“Blended care does not mean patients are not seen in person,” Dr. Getahun said. “It means visits can be tailored so patients receive both in-person and virtual care, when appropriate. For pregnant patients who face challenges such as transportation, scheduling, or childcare, this approach may reduce unnecessary burdens while maintaining similar outcomes.”

Higher risk patients returned to in-person care

The researchers emphasized that the blended care model was intended for selected patients with singleton, low-risk pregnancies. Patients received home equipment and training for virtual visits, and those who developed higher-risk conditions were returned to in-person care. Dr. Fassett said abnormal home measurements, difficulty finding a fetal heartbeat, elevated blood pressure, or patient preference would all be reasons to bring someone in for face-to-face care.

The authors said future studies should evaluate patient experience, cost-effectiveness, longer-term maternal and child outcomes, and ways to ensure timely completion of screenings in blended care models. They also noted that larger studies could help examine whether outcomes differ by income, insurance type, or other patient characteristics.

The study was supported by the Garfield Memorial Fund.

In addition to Dr. Fassett and Dr. Getahun,  authors include Emily V. West, MD; Chantal C. Avila, MA; Jiaxiao M. Shi, PhD; Vicki Y. Chiu, MS; Joanie W.I. Chung, MA, MPH; and Nehaa Khadka, PhD, from the Kaiser Permanente Southern California Department of Research & Evaluation; Ericka C. Gibson, MD, MPH, from Kaiser Permanente Perinatal Safety and Quality; Linda S. Chong Tim, MSN, CNM, from Kaiser Permanente Hawaii; Christopher J. Jentz, MHSA, and Erica E. Rudolph, MPH, from Kaiser Permanente Quality Data, Analytics and Reporting; David M. Mosen, PhD, MPH, from Kaiser Permanente Center for Health Research; and Jemma C. Nonog, CNM, ARNP, DNP, and Jocelyn W. Audelo, RN, MPH, from Kaiser Foundation Health Plan, National Quality. Dr. Fassett and Dr. Getahun also are affiliated with the Kaiser Permanente Bernard J. Tyson School of Medicine.