Revolutionizing prenatal care: new guidelines to transform 100-year model

This story was originally published on August 6, 2021 and was updated on April 18, 2025.

For nearly a century, being pregnant usually meant seeing a doctor at least a dozen times before the baby was born.

But after COVID hit and office visits were limited due to exposure risks in 2020, that practice shifted out of necessity – and now, those changes may be here to stay.

Michigan Medicine's redesign of prenatal care delivery during the pandemic, which included a flexible approach involving fewer in-person visits for uncomplicated pregnancies and use of telemedicine, is serving as a national model.

The American College of Obstetricians and Gynecologists, which collaborated with Michigan Medicine teams, is recommending significant changes to the way prenatal care is delivered in the United States, according to newly released clinical guidance.

"Prenatal care delivery hasn't changed since World War II, and it doesn't always line up with what many patients both want and need during their pregnancy journey," said Alex Peahl, M.D., MS.c., an obstetrician-gynecologist at University of Michigan Health Von Voigtlander Women's Hospital and head of the Michigan Plan for Appropriate, Tailored Healthcare in Pregnancy, also known as MiPATH, that guided the new recommendations.

"The COVID era has taught us that for many of our pregnant patients, we can offer a more flexible approach that maintains high-quality care for moms and their babies."

A uniform 12–14 in-person visit recommendation for all pregnancies has remained unchanged since 1930. Although many prenatal services, such as vaccinations and imaging, are evidence-based, Peahl said, the field lacked robust data on how to provide these services.

The new guidelines, which stem from a collaboration between ACOG and the University of Michigan through MiPATH, recommend individualizing care, incorporating telemedicine, and considering both medical conditions and social and structural determinants that may impact outcomes in routine care delivery.

More than a dozen clinicians and researchers who represented expertise across maternity care, pediatrics, telemedicine, and health equity joined a national panel to consider the new recommendations.

"Maternal and fetal experts and patient representatives from across the country recognized that prenatal care guidelines were long overdue for reconsideration," Peahl said.

"We came together to revisit several aspects of prenatal care delivery, including tailored care based on medical conditions and social and structural determinants of health. Alternative approaches to prenatal care during the COVID-19 pandemic helped us develop recommendations focused on 'right sizing' prenatal care for each individual."

For those with uncomplicated pregnancies, this could mean choosing fewer, more widely spaced prenatal visits (down from 12-14 to eight to 10), which is more in line with peer countries, with better maternity outcomes than the United States, Peahl said. These visits would be supplemented with home monitoring devices, telemedicine, and other sources of social support like classes and peer groups.

"These guidelines place a strong emphasis on shared decision-making and help maternity care providers to match individuals' needs to services delivered, making sure each patient gets the right services from the right professional in the right way," Peahl said.

Tailoring options for prenatal care delivery

The guidance acknowledges that the new care model might not be appropriate for all and some patients with higher-than-average risks may still need a more frequent prenatal visit schedule and more intense monitoring. 

This includes pregnant individuals with chronic hypertension, preexisting diabetes, or those with a history of pregnancy-related complications.

Peahl notes that the pandemic also reinforced the significant negative effects of adverse social and structural determinants of health impacting health care access and outcomes, particularly for pregnant people. 

Prenatal care delivery hasn't changed since World War II, and it doesn't always line up with what many patients both want and need during their pregnancy journey." Alex Peahl, M.D., MS.c. 

These individuals may need more frequent contact with support services, such as social work, but not necessarily prenatal visits, to address concerns like housing insecurity, social isolation, and inadequate health care coverage.

The recommendations include concrete guidance on when to screen for such determinants of health and how findings may influence other aspects of prenatal care delivery.

"We recognize the significant influence of nonmedical conditions on maternity care access and outcomes," she said.

"Recommendations include an early risk assessment of medical and obstetric risk factors, as well as social and structural determinants of health to help individuals get connected to needed services as early as possible.”

Addressing social needs, she adds, helps maternity care professionals deliver prenatal care in the context of patients’ lives and communities, promoting a positive experience, autonomy, and trust building between patients and their pregnancy teams.

In collecting data backing new guidelines, Peahl and colleagues published three systematic reviews that found evidence supporting many components of tailored prenatal care delivery, including targeted visit schedules and telemedicine.

They didn't find any differences in maternal and neonatal outcomes among average-risk patients who received the traditional 12 to 14 in-person visits and patients receiving targeted visit schedules or telemedicine. 

Additionally, they found an overall positive experience for patients and maternity care professionals participating in these new care models.

Researchers also found high-quality evidence for the accuracy and feasibility of home monitoring of blood pressure. 

This Michigan Medicine-led work created the foundation for legislation in Michigan that will require health insurance coverage of blood pressure monitors for pregnant and postpartum women starting this year.

However, while telemedicine has been shown to improve access to care, reduce travel burden, and the need for childcare or time off from work, some institutions may not have the infrastructure to accommodate telemedicine appointments, guidelines state.

Future research will be needed to assess the impact of this new approach on care delivery and pregnancy outcomes, Peahl says.

New policies should also be explored to address barriers, including cost, geographic challenges, and inadequate obstetric billing and payment systems to ensure that tailored prenatal care can be implemented optimally.

"The data our teams collected and analyzed provide an important foundation for redesigning more flexible, high-value, evidence-based prenatal care delivery plans and strategizing ways to fill key gaps in care," Peahl said.

"Through these efforts we are confident that prenatal care can be redesigned to be more effective, efficient, and equitable for pregnant individuals nationwide."

Guidelines cited: "Tailored prenatal care delivery for pregnant individuals. Clinical Consensus No. 8. American College of Obstetricians and Gynecologists," Obstet Gynecol.