Prenatal remote blood pressure monitoring: Impacts on blood pressure measurement and health outcomes

Introduction: Remote monitoring technology can help patients and healthcare providers to track blood pressure measurements during pregnancy to manage hypertension, but limited evidence from widespread community use is available. Methods: Among pregnant patients in 2022-2023 with hypertensive disorders of pregnancy, in a setting offering home blood pressure monitoring with blood pressure data collected either via weekly nurse telephone calls or digital remote upload of blood pressures with nurse calls only as-needed, we compared participant characteristics, monitoring process, and clinical outcomes between remote monitoring participants and non-remote monitoring participants using propensity weighting to account for differences between participant groups. Results: < 0.05) fewer synchronous nurse phone calls (6.4 with remote monitoring vs. 12.6 without remote monitoring), more weeks with blood pressure readings shared with clinicians (measures on 12.7 weeks with remote monitoring vs. 8.3 weeks without remote monitoring,) and more weeks with severe hypertension captured (events on 1.08 weeks with remote monitoring vs. 0.22 weeks without remote monitoring). While the number of medication adjustments was not significantly different between monitoring types, the gestational age at first adjustment was 1.96 weeks earlier (95% confidence interval [CI] 0.22-3.69) in patients with remote monitoring. Emergency department visits and hospitalizations did not differ statistically significantly between monitoring groups, nor did severe maternal morbidity or cesarean or stillbirth outcomes. Conclusions: Remote blood pressure monitoring uptake and feasibility was high and was associated with higher capture of clinically actionable values, earlier medication adjustment, improved resource utilization, and similar perinatal outcomes compared with a telephone-based care model for hypertensive disorders of pregnancy.