Remote Monitoring of Hypertension Diseases in Pregnancy: A Pilot Study

Abstract

BackgroundAlthough remote monitoring (RM) has proven its added value in various health care domains, little is known about the remote follow-up of pregnant women diagnosed with a gestational hypertensive disorders (GHD).ObjectiveThe aim of this study was to evaluate the added value of a remote follow-up program for pregnant women diagnosed with GHD.MethodsA 1-year retrospective study was performed in the outpatient clinic of a 2nd level prenatal center where pregnant women with GHD received RM or conventional care (CC). Primary study endpoints include number of prenatal visits and admissions to the prenatal observation ward. Secondary outcomes include gestational outcome, mode of delivery, neonatal outcome, and admission to neonatal intensive care (NIC). Differences in continuous and categorical variables in maternal demographics and characteristics were tested using Unpaired Student’s two sampled t test or Mann-Whitney U test and the chi-square test. Both a univariate and multivariate analysis were performed for analyzing prenatal follow-up and gestational outcomes. All statistical analyses were done at nominal level, Cronbach alpha=.05.ResultsOf the 166 patients diagnosed with GHD, 53 received RM and 113 CC. After excluding 5 patients in the RM group and 15 in the CC group because of the missing data, 48 patients in RM group and 98 in CC group were taken into final analysis. The RM group had more women diagnosed with gestational hypertension, but less with preeclampsia when compared with CC (81.25% vs 42.86% and 14.58% vs 43.87%). Compared with CC, univariate analysis in RM showed less induction, more spontaneous labors, and less maternal and neonatal hospitalizations (48.98% vs 25.00%; 31.63% vs 60.42%; 74.49% vs 56.25%; and 27.55% vs 10.42%). This was also true in multivariate analysis, except for hospitalizations.ConclusionsAn RM follow-up of women with GHD is a promising tool in the prenatal care. It opens the perspectives to reverse the current evolution of antenatal interventions leading to more interventions and as such to ever increasing medicalized antenatal care.

Home blood‐pressure monitoring in a hypertensive pregnant population

“…Our results demonstrate a lower number of visits to antenatal services by hypertensive pregnant women using HBPM, with no increase in adverse outcome for either mother or baby, compared with controls managed traditionally. Although our study was possibly underpowered to assess the adverse maternal, fetal and neonatal outcomes, our findings are supported by previous studies of home monitoring in women with GH. In their pilot study, Lanssens et al .…”

Prenatal Remote Monitoring of Women With Gestational Hypertensive Diseases: Cost Analysis (Preprint)

“…Early hospitalizations and neonatal hospitalizations, with huge potential benefits in terms of social and hospital expenditure restraint. These results are also reported in the previous mentioned study (10).…”

“…The PREMOM study design and data collection method are described in detail elsewhere (10). Briefly, the PREMOM study was a Body Analyzer, and a Withings Pulse O² (Withings, Issy-les-Moulineux, France).…”

“…The slightly higher costs of the medications for the patients of the RM group, when compared to CC group, can be explained by the higher need of medication for those patients. During the RM process, it is easy to make some changes in the antihypertensive treatment because their daily parameters are constantly at hand (10). Women in the CC group will have less medication changes due to the lack of daily follow-up of her bloodpressure.…”

“…Finally, the newborns did have a higher gestational age at delivery (9) and were less likely to be of low birth weight (1,9) or to be admitted to the Neonatal Intensive Care Unit (1, 9, 10) when a RM group was compared to a CC group. In an earlier publication, we reported that RM in pregnant women with gestational hypertensive diseases (GHD) reduces the number of inductions and maternal prenatal admissions (10). However, up to the present, few studies have evaluated the economic impact of RM compared to CC (9,11), and no study is known concerning the cost effectiveness of a RM prenatal follow-up program for women diagnosed with GHD.…”