Hypertensive disorders with onset during pregnancies are among the leading causes of maternal and infant mortality and morbidity in the U.S. and can have far-reaching consequences for the long-term health of the mother and child.
In Dr. Jerome Adams’ recent Call to Action to recognize and address hypertension control as a public health priority, the former Surgeon General referenced the success of health care providers who have promoted shared management of hypertension through self-measured blood pressure monitoring (SMBP), empowering patients through blood pressure (BP) management and goal setting.
It’s not an unusual recommendation— SMBP is well accepted in primary care for managing hypertension — but its use in pregnancy has not been routine. That’s beginning to change for several reasons.
Research shows efficacy
First, the research backs it up. Recent studies show the efficacy of SMBP for identifying and controlling hypertensive complications in the prenatal and postpartum period, notably Penn Medicine’s Heart Safe Motherhood program, which resulted in 0% readmission rates for hypertension in the postpartum period with the addition of text-based monitoring.
Pandemic as a motivator
The second major factor is the pandemic. Covid-19 motivated providers to implement virtual solutions like SMBP, with the need to deliver care remotely outweighing previous barriers to adoption. Even as clinics and hospitals start to reopen for routine, in-office care, patients are still anxious about attending appointments in person, especially pregnant mothers, who are more prone to anxiety even in the most normal times.
SMBP carries a double benefit — it provides a means to adhere to ACOG’s new guidelines for increased BP monitoring during the prenatal and postpartum period, and it enables care management from the comfort and safety of a patient’s home.
The pregnant population is ideally suited for SMBP. Women of childbearing age are comfortable with using technology to supplement their care — in fact, many expect and want it. They’re already using apps and wearable devices to monitor their menstrual cycles, regulate weight and fitness, track their diet, etc. — they often expect to use digital tools to navigate pregnancy too. As a health event that uniquely involves another person, the stakes are also much higher in pregnancy — a pregnant woman is that much more likely to engage with tools to manage her health.
Importance of education
With women educated to take their own BP, remote monitoring can be started early in pregnancy and continued through the postpartum period. Adding in a digital educational layer safely and conveniently fills the care gap that many women experience, eliminating the outdated OB paper packet by providing a resource that is constantly accessible and up-to-date — and reducing the risk of mothers consulting “Dr. Google.”
This can also safely reduce the number of visits women make to the OB’s office, as a study out of George Washington University shows. The usual schedule in pregnancy is an office visit every 4 weeks with more frequent visits as the due date nears. But empowering women to be part of their health care between or in place of these visits is possible and important. Women can take their own BP and learn to follow their BP trends — even recognizing when BP begins to rise. Adding in technology so that providers can monitor their patients in real-time adds a dimension that is a critical part of improving health outcomes.
Of course, SMBP is not a solution in and of itself — social and economic risk factors are a primary culprit in poor outcomes, and without addressing systemic problems, no technology can successfully resolve the troubling rates of hypertensive disorders in pregnancy.
However, as part of a holistic approach to care that enables patient empowerment and enhances provider, payer, care team, and community support for those suffering from hypertensive disorders and their effects, it is an essential tool and should be promoted as such.
Lauren Demosthenes is an obstetrician-gynecologist.
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