Remote blood pressure monitoring in women at risk of or with hypertensive disorders of pregnancy: A systematic review and meta‐analysis

BACKGROUND: Remote blood pressure monitoring refers to an organized framework that either allows clinicians to review home-based blood pressure readings and institute management, or provide participants with clear instructions for contacting care teams when blood pressure readings are out of prespecified targets. With widespread uptake of telemonitoring and mobile health in recent years, such models of care have been increasingly described in the literature. OBJECTIVES: This study aimed to review remote blood pressure monitoring in pregnant and postpartum women who are at high-risk for or have an established diagnosis of hypertensive disorders of pregnancy, and its effect on maternal and fetal outcomes, healthcare utilization and psychosocial outcomes. SEARCH STRATEGY: PubMed, Medline, Embase, Cochrane Library, Web of Science and CINAHL databases were searched electronically in June 2024 to their inception. STUDY SELECTION CRITERIA: Included studies compared remote blood pressure monitoring with standard care. Remote blood pressure monitoring was pre-defined as any framework for measuring blood pressure remotely in pregnancy, with organized review by clinicians. Published full-text and study abstracts describing randomized controlled trials and observational studies were included. The study population was pregnant women at high-risk for developing pre-eclampsia or postpartum (<6 weeks) women with an established diagnosis of a hypertensive disorder of pregnancy. Remote blood pressure monitoring undertaken in the antenatal and postnatal periods were analyzed separately. DATA COLLECTION AND ANALYSIS: This systematic review was conducted according to the Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement. Screening of records and data extraction were independently performed. Data were extracted and analyzed using Review Manager software (version 5.4; Cochrane Collaboration, Copenhagen, Denmark). Risk of bias and quality assessment was performed independently using the Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) assessment tool and the Cochrane Risk of Bias 2 (RoB2) tool. MAIN RESULTS: A total of 18 studies with 28 094 patients were included. Antenatal remote blood pressure monitoring reduces antenatal outpatient visits, antenatal hospital admissions for any cause, and antenatal hospital admissions specifically for hypertension. Importantly, there was no increase in adverse maternal and fetal outcomes, including the likelihood of cesarean section deliveries or induction of labor due to hypertension, composite maternal outcome, growth restriction, neonatal intensive care unit admissions, gestational age at delivery and the composite fetal outcome. Psychosocial outcomes were also not significantly different between the remote blood pressure monitoring and usual care groups. Postpartum remote blood pressure monitoring in women with an established hypertensive disorder of pregnancy led to greater compliance with blood pressure follow-up within 10 days, with no increase in unscheduled hypertension-related presentations, postpartum readmissions or outpatient antihypertensive prescription. CONCLUSIONS: Utilizing a model of remote blood pressure monitoring which incorporates organized review and management by clinicians, may reduce antenatal outpatient visits and admissions, without increasing adverse fetal and maternal outcomes, in pregnant women who require frequent monitoring of their blood pressure. In postpartum women with a hypertensive disorder of pregnancy, remote blood pressure monitoring can improve guideline recommended follow-up within 10 days. However, the meta-analysis was hampered by study heterogeneity and a paucity of high-quality evidence. Further randomized controlled trials are needed to confirm the findings of this review and provide recommendations.