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. 2017 Dec 28;17(1):442.
doi: 10.1186/s12884-017-1605-0.

Blood pressure self-monitoring in pregnancy: examining feasibility in a prospective cohort study

Katherine L Tucker  1 , Kathryn S Taylor  1 , Carole Crawford  1 , James A Hodgkinson  2 , Clare Bankhead  1 , Tricia Carver  1 , Elizabeth Ewers  3 , Margaret Glogowska  1 , Sheila M Greenfield  2 , Lucy Ingram  3 , Lisa Hinton  1 , Khalid S Khan  4 , Louise Locock  5 , Lucy Mackillop  6 , Christine McCourt  7 , Alexander M Pirie  3 , Richard Stevens  1 , Richard J McManus  8
Affiliations

Blood pressure self-monitoring in pregnancy: examining feasibility in a prospective cohort study

Katherine L Tucker et al. BMC Pregnancy Childbirth. .

Abstract

Background: Raised blood pressure (BP) affects approximately 10% of pregnancies worldwide, and a high proportion of affected women develop pre-eclampsia. This study aimed to evaluate the feasibility of self-monitoring of BP in pregnancy in women at higher risk of pre-eclampsia.

Methods: This prospective cohort study of self-monitoring BP in pregnancy was carried out in two hospital trusts in Birmingham and Oxford and thirteen primary care practices in Oxfordshire. Eligible women were those defined by the UK National Institute for Health and Care Excellence (NICE) guidelines as at higher risk of pre-eclampsia. A total of 201 participants were recruited between 12 and 16 weeks of pregnancy and were asked to take two BP readings twice daily three times a week through their pregnancy. Primary outcomes were recruitment, retention and persistence of self-monitoring. Study recruitment and retention were analysed with descriptive statistics. Survival analysis was used to evaluate the persistence of self-monitoring and the performance of self-monitoring in the early detection of gestational hypertension, compared to clinic BP monitoring. Secondary outcomes were the mean clinic and self-monitored BP readings and the performance of self-monitoring in the detection of gestational hypertension and pre-eclampsia compared to clinic BP.

Results: Of 201 women recruited, 161 (80%) remained in the study at 36 weeks or to the end of their pregnancy, 162 (81%) provided any home readings suitable for analysis, 148 (74%) continued to self-monitor at 20 weeks and 107 (66%) at 36 weeks. Self-monitored readings were similar in value to contemporaneous matched clinic readings for both systolic and diastolic BP. Of the 23 who developed gestational hypertension or pre-eclampsia and self-monitored, 9 (39%) had a raised home BP prior to a raised clinic BP.

Conclusions: Self-monitoring of BP in pregnancy is feasible and has potential to be useful in the early detection of gestational hypertensive disorders but maintaining self-monitoring throughout pregnancy requires support and probably enhanced training.

Keywords: Hypertension; Pre-eclampsia; Pregnancy; Self-monitoring.

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Conflict of interest statement

Ethics approval and consent to participate

A favourable ethical review for this study was obtained from South Central – Oxford Research Ethics Committee B (reference; 12 SC 0625, 12/12/2012). Written informed consent was gained from individuals who agreed to take part.

Consent for publication

Not applicable, as this manuscript does not contain identifiable data from any individual person.

Competing interests

We have read and understood the BMC policy on declaration of interests and declare the following interests: RM has received BP monitoring equipment for research studies from Omron and Lloyds Pharmacy. The monitors used in this study were purchased commercially. No author other than those identified has anything to declare.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Participant flow through the study. Note: Women attending clinic for follow up did not necessarily provide useable home BP data
Fig. 2
Fig. 2
Persistence of self-monitoring. Of 162 who self-monitored, 160 started before 20 weeks gestation and, of these, 12 stopped at or before 20 weeks. The graph presents the remaining 148 patients (74% of the 201 total population, and 91% of the 162 who self-monitored). Mean gestation at delivery is indicated by the dotted line (38.2 weeks)
Fig. 3
Fig. 3
Clinic and home blood pressure readings through pregnancy.
Fig. 4
Fig. 4
Time to the first raised blood pressure. a Time to first raised blood pressure excluding the first home reading taken in any monitoring session and using thresholds for hypertension of 140/90mmHg for home and clinic. n=152*, 50 (33%) had a raised clinic BP reading, 43 (28%) has a raised home BP reading. b Sensitivity analysis 1: Time to first raised blood pressure including the first home reading taken in any monitoring session and using thresholds for hypertension of 140/90mmHg for home and clinic. n=151, 49 (32%) has a raised clinic BP reading, 69 (46%) has a raised home BP reading. c Sensitivity analysis 2: Time to first raised blood pressure excluding the first reading taken in any monitoring session and using thresholds for hypertension of 135/85mmHg for home and 140/90mmHg for clinic. n=152*, 50 (33%) has a raised clinic BP reading, 69 (45%) had a raised home BP reading
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