The Coronavirus disease 2019 (COVID-19) pandemic caused significant social, healthcare, and economic devastation in the United States (US), potentially exacerbating the maternal health disparities facing rural women and women of color. Telehealth represented a promising opportunity to reduce disparities in maternal health access, quality, and outcomes, given its substantial range of opportunities, including audiovisual synchronous and asynchronous encounters between patients and providers, remote patient monitoring, facilitating visual communication of evidence-based practice, and supporting clinical decision-making. Yet, multilevel barriers might have hindered some underserved women from fully benefiting from telehealth. Expanded federal and state-level telehealth coverage through the Coronavirus Aid, Relief, and Economic Security (CARES) Act and state policies may have mitigated the detrimental effects of this unprecedented pandemic by reducing gaps in access to telehealth and quality maternity care.

Although self-reported data indicated abrupt increases in telehealth uptake during the pandemic, limited real-world data were available regarding the role of perinatal telehealth uptake on the pandemic’s effects and the role of state-level policy in telehealth adaptation during COVID-19. This longitudinal, real-world data study used recurring national electronic health records (EHR) data from the National COVID Cohort Collaborative (N3C) and integrated statewide population-based data in South Carolina and Florida, which complemented the overrepresentation of urban populations in N3C.