ABSTRACT
Background: COVID-19 pandemic has influenced health care delivery. We conducted an observational study to understand how obstetric medicine (ObM) physicians utilized home blood pressure monitoring (HBPM) to manage hypertension in pregnancy. Method(s): Pregnant participants with risk factors or diagnosis of hypertensive disorders of pregnancy (HDP) were enrolled, May 2020-December 2021, and provided with validated home blood pressure (BP) monitor. ObM physicians completed questionnaires to elicit how home BP readings were interpreted to manage HDP. Result(s): We enrolled 103 people: 44 antepartum patients (33.5 +/- 5 years, gestational age of 24 +/- 5 weeks);59 postpartum patients (35 +/- 6 years, enrolled 6 +/- 4 days post-partum). ObM physicians used range of home BP readings (70%) for management of HDP. Conclusion(s): HBPM to manage HDP is acceptable and can be used to manage hypertension during pregnancy. Further studies are needed to assess the generalizability of our findings and the safety of HBPM reliance alone in management of HDP.Copyright © The Author(s) 2023.
ABSTRACT
Background & Purpose: Home blood pressure monitoring (HBPM) in pregnant women is common, but uncertainty exists on utilization of home blood pressure (BP) readings for management of hypertensive disorders of pregnancy (HDP). We conducted a qualitative improvement study to understand how physicians utilize HBPM for pregnant patients and patient acceptability. Method(s): Pregnant patients with risk factors for HDP were recruited. Participants were provided with a validated home BP monitor (Microlife Watch BP) and monitored their BP two times in the morning/evening and manually entered data into a paper diary. Obstetrical Medicine physicians completed written survey after each clinic visit to understand how they used HBPM. Surveys were sent to all participants to assess acceptability of HBPM. Result(s): In total, 103 women were recruited for the study, of which, 43% were enrolled antepartum (mean age 34+/-5 years;mean gestation 171+/-61 days) and 57% postpartum (mean age 35+/-6 years;mean days postpartum 6+/-4 days). Median compliance with home BP readings was 0.94 (IQR 0.57, 1.00). Obstetrical Medicine physicians relied on the range of HBPM readings (70%) to make clinical decisions for management of HDP. Antepartum, 13% of clinic visits resulted in an increase of antihypertensive medications, and 82% required no change in medication. Post-partum, 44% of visits required a decrease anti-hypertensive medication. 98% of participants found HBPM easy to do, and 51% were able to strictly adhere to their measurement schedule. Barriers to HBPM included newborn care (57%), forgetting to check (39%), and lack of time in the mornings (35%). Conclusion(s): HBPM to manage HDP is acceptable to patients and can be safely used to manage HDP ante-partum and post-partum. In light of the COVID-19 pandemic and increasing demand for virtual healthcare visits, further studies are need to assess the effectiveness of HBPM on management of HDP.