Hypertensive disorders of pregnancy affect 10% of pregnancies worldwide, of which almost half develop pre-eclampsia – a syndrome characterised by abnormal placentation leading to pregnancy complications. These include low birth weight babies, premature births, and even life-threatening complications for the mother, such as stroke or organ failure. Worldwide, hypertensive disorders of pregnancy account for 10- 15% of maternal mortality, and pre-eclampsia causes 15% of preterm births and 25% of all neonatal costs. Early detection and prevention is, therefore, important.
Regular blood pressure checks are a key part of the care pathway for pregnant women to enable the identification of high blood pressure to minimise some of the consequences of uncontrolled hypertension and severe pre-eclampsia. However, the COVID-19 pandemic has led to a modification in some antenatal and postnatal services with fewer face-to-face appointments. Pregnant women and particularly those with risk factors for pre-eclampsia, may be concerned about how often they should be checking their blood pressure. Remote or self-monitoring of blood pressure levels has the potential to provide extra blood pressure check which can be useful for clinicians and women to augment the in-person monitoring that occurs at each face-to-face appointment.
Remote monitoring of blood pressure in pregnancy
In 2020, in response to the COVID-19 pandemic, the Royal College of Obstetricians & Gynaecologists published guidelines for self-monitoring of blood pressure in pregnancy to support enhanced monitoring for pregnant women at risk while minimising face-to-face consultations.
There has been an increased recognition of the benefits from self-monitoring of blood pressure. Remote monitoring of blood pressure during pregnancy could improve and hasten the detection of hypertensive disorders including pre-eclampsia and empower women in their own self-care. Thanks to remote patient monitoring technology, mothers-to-be can self-monitor their blood pressure, and communicate the results to their healthcare team remotely using CE marked applications.
There are multiple potential benefits of remote blood pressure monitoring in pregnancy:
- Patient choice – provides women with choice about how their care is delivered depending on their personal situation, be it face-to-face or remotely.
- Reassurance – provides comfort to mums-to-be who may be concerned about their blood pressure levels.
- Empowerment– self-monitoring can give pregnant women a greater understanding of their condition and control over their pregnancy care
- Efficient Care – helps optimise the amount of time a woman spends in a clinic environment or in a hospital bed by being able to remotely monitor them in their community.
- Capacity – by optimising care pathways to include remote blood pressure monitoring in addition to normal antenatal care, clinicians can manage and improve capacity in day assessment units and community midwife visits.
- Prioritisation – by receiving the results in real time, clinicians can quickly identify those women who need more urgent care and deliver the treatment they need as quickly as possible.
Detecting raised blood pressure sooner could lead to earlier diagnosis and treatment to prevent complications. Care teams can use data from the frequent blood pressure readings to make better and more timely treatment decisions. This could lead to improved health outcomes for mothers and their babies, as well as be a cost-effective way for managing the condition, helping to reduce pressures on our healthcare systems.
The role of data analytics in determining patients most at risk
Analysing large volumes of blood pressure data collected via self-monitoring may lead to the development of decision support algorithms, to help clinicians predict those women that are likely to develop severe hypertension and help to minimise and prevent complications by intervening with blood pressure medication earlier.
However, it wasn’t until the pandemic that the use of remote monitoring technology in blood pressure management in pregnancy became more widespread and it will take time to build up the depth and breadth of data required to realise the clinical benefits that AI and data analytics can deliver.
Having access to remote blood pressure monitoring technology has helped to facilitate remote consultations – a change which is likely to continue and could in the future lead to technologies that can detect hypertensive disorders earlier and lead to improvements in maternal and neonatal outcomes.
Remote monitoring and COVID
Remote blood pressure monitoring technology has been invaluable during COVID-19 to help minimise face-to-face contact, whilst providing additional monitoring of pregnant women with, or at risk of, hypertension. It not only allows women to be more engaged with their care, but it also provides them with choices about how their care is delivered. I believe in the near future it will be normal for women to use these technologies to monitor many aspects of health during pregnancy, and to securely share that data with healthcare providers to augment the routinely collected data gathered during pregnancy and help provide enhanced and personalised care for every pregnant woman.
By Dr Lucy Mackillop, consultant obstetric physician at Oxford University Hospitals NHS Foundation Trust, and CMO at Sensyne Health
