Home blood pressure monitoring during pregnancy safe, cost effective

(Reuters Health) - For pregnant women with chronic or pregnancy-related hypertension, home blood pressure monitoring could safely reduce their number of required hospital visits, suggests a small study in the UK.

About 10 percent of pregnant women have chronic high blood pressure, gestational high blood pressure or pre-eclampsia - a complication of pregnancy that includes elevated blood pressure - and must keep tabs on their blood pressure throughout pregnancy.

“I saw just how much time and effort women diagnosed with high blood pressure in pregnancy have to spend attending the hospital for monitoring,” said senior study author Dr. Asma Khalil, an obstetrician at St. George’s Hospital at the University of London.

They often have to come to the hospital two or three times a week, spending a couple of hours each time, having their blood pressure and urine monitored, Khalil added.

“I saw how they had to take time off work, arrange childcare, and spend time and money coming to the hospital. I also saw how busy this made the staff at the hospital day unit, and the cost to the health services,” she told Reuters Health in an email.

On top of all of that, just coming to the hospital often stressed women so much that it made their blood pressure higher than it had been at home, Khalil said.

To see if women could monitor themselves at home effectively, and without any added risks to themselves or the pregnancy, the researchers enrolled pregnant patients of the hospital who had been diagnosed with high blood pressure but were otherwise healthy.

A total of 108 women were taught how to measure and track their blood pressure at home using the WatchBP Home monitor. Twenty-nine of these women also opted to use a smartphone app to record their measurements while the rest simply kept written notes.

In addition, women assigned to home monitoring were given written instructions regarding when to go to the hospital based on their blood pressure readings or potential symptoms of pre-eclampsia.

Another 58 women, similar to those in the home-monitoring group, were used as a comparison group drawn from past patients of the hospital who had received normal care.

All the women were followed for five to nine weeks during pregnancy, and the study team analyzed post-delivery records to assess pregnancy outcomes, including preterm birth, cesarean sections, admission to neonatal unit and others. The mothers’ incidence of hypertension-related complications including kidney, liver and heart problems was also assessed.

“There was no difference in the incidence of adverse maternal, fetal or neonatal outcome between women who had home blood pressure monitoring and those who had the traditional blood pressure monitoring,” Khalil said.

Women who self-monitored averaged 0.8 visits to the clinic per week, compared to the traditional-care group’s average of 1.6 visits per week, according to the results in Ultrasound in Obstetrics and Gynecology.

Home blood pressure monitoring in pregnancy reduces hospital blood pressure visits by 50 percent without increasing the risk of complications, so it is likely to be safe and cost saving, Khalil said.

“The app also sends your readings to a computer at the hospital which is monitored by the midwives or doctors there, so they can keep an eye on you too. This saves you a lot of time, money and effort, and puts you in control of your own health,” she said.

The study provides early evidence that self-monitoring might improve the detection and management of high blood pressure in pregnant women but there is not currently enough evidence for this to be recommended as standard practice, said Katherine Tucker and Richard McManus, researchers at the University of Oxford who were not involved in the study.

“This study also shows the potential for self-monitoring to reduce the cost of care through better organized antenatal services, but further research is still needed in this area,” they told Reuters Health in an email.

Self-monitoring of blood pressure during pregnancy is common in some countries, such as Canada, but researchers still don’t understand how effective this is or the best way to use home readings for improved care, they added.

SOURCE: Ultrasound in Obstetrics and Gynecology, online February 22, 2018.