“…There was a trend towards the prolongation of pregnancy and reduced cesarean section rate when using CVD results in clinical management. It was concluded that adjunctive cardiovascular dynamics monitoring may have a role in the evaluation and management of hypertension during pregnancy 15 …”
“…There was a trend towards the prolongation of pregnancy and reduced cesarean section rate when using CVD results in clinical management. It was concluded that adjunctive cardiovascular dynamics monitoring may have a role in the evaluation and management of hypertension during pregnancy 15 …”
“…Of the 1794 unique records, we retained 91 for full-text review. Ultimately, we included 6 studies in the effectiveness review [ 34 – 39 ], 7 studies (reported in 8 articles) in the values and preferences review [ 40 – 49 ], and 1 study in the cost review [ 50 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Overall, 6 studies met the inclusion criteria for the effectiveness review [ 34 – 39 ]. Table 1 presents descriptive data for the 1 RCT and 5 observational studies.…”
Section: Resultsmentioning
confidence: 99%
“…N = 33 Multi-cohort (prospective cohort for SMBP), retrospective cohort for provider) Non-probability facility-based Daily twice-a-day self-monitoring using a BP kit recorded on paper; trained how to measure BP, interpret readings and when to contact provider – otherwise, received routine antenatal care. Historical group of women with chronic hypertension who received routine care at prenatal visits Fukushima et al, 2002 [ 34 ] United States: Los Angeles Pregnant women with pregnancy-induced hypertension. Women in the self-monitoring group were identified to be at most-risk by hypertension severity.…”
Section: Resultsmentioning
confidence: 99%
“…These studies were also judged to have low risk of bias. Three additional observational studies were not included in the GRADE Evidence Profile because they reported the same outcomes as the RCT [ 34 , 35 , 39 ].…”
Background
The World Health Organization (WHO) recommends self-monitoring of blood pressure (SMBP) for hypertension management. In addition, during the COVID-19 response, WHO guidance also recommends SMBP supported by health workers although more evidence is needed on whether SMBP of pregnant individuals with hypertension (gestational hypertension, chronic hypertension, or pre-eclampsia) may assist in early detection of pre-eclampsia, increase end-user autonomy and empowerment, and reduce health system burden. To expand the evidence base for WHO guideline on self-care interventions, we conducted a systematic review of SMBP during pregnancy on maternal and neonatal outcomes.
Methods
We searched for publications that compared SMBP with clinic-based monitoring during antenatal care. We included studies measuring any of the following outcomes: maternal mortality, pre-eclampsia, long-term risk and complications, autonomy, HELLP syndrome, C-section, antenatal hospital admission, adverse pregnancy outcomes, device-related issues, follow-up care with appropriate management, mental health and well-being, social harms, stillbirth or perinatal death, birthweight/size for gestational age, and Apgar score. After abstract screening and full-text review, we extracted data using standardized forms and summarized findings. We also reviewed studies assessing values and preferences as well as costs of SMBP.
Results
We identified 6 studies meeting inclusion criteria for the effectiveness of SMBP, 6 studies on values and preferences, and 1 study on costs. All were from high-income countries. Overall, when comparing SMBP with clinic-monitoring, there was no difference in the risks for most of the outcomes for which data were available, though there was some evidence of increased risk of C-section among pregnant women with chronic hypertension. Most end-users and providers supported SMBP, motivated by ease of use, convenience, self-empowerment and reduced anxiety. One study found SMBP would lower health sector costs.
Conclusion
Limited evidence suggests that SMBP during pregnancy is feasible and acceptable, and generally associated with maternal and neonatal health outcomes similar to clinic-based monitoring. However, more research is needed in resource-limited settings.
Systematic review registration
PROSPERO CRD42021233839.
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