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SAFE@HOME - Telemonitoring of blood pressure and symptoms with a digital platform in pregnancy care: a feasibility study (Preprint)


 BACKGROUND
 Pregnant women at risk for hypertensive complications need frequent monitoring in the outpatient clinics. These recurrent visits interfere with daily life and can a burden for both patients and perinatal care resources. Telemonitoring has the potential to complement or replace standard pathways in prenatal care with self-measurements, integrated in a monitoring dashboard for in-hospital obstetric care professionals.
 
 
 OBJECTIVE
 In this feasibility study of a telemonitoring platform in antenatal care, we examined the patient engagement and compliance, accuracy of the alert system and the participants’ experiences.
 
 
 METHODS
 We developed a telemonitoring platform, consisting of an app and secured web portal, wireless blood pressure monitor and an in-app 10-symptom checklist. In this prospective observational study, 14 participating women with low-risk pregnancies were asked to submit blood pressure (BP) measurements and symptom checklists once daily during 15 consecutive weekdays.
Values exceeding the preset threshold values led to alerts on the monitoring dashboard for health care providers and were reviewed daily in our outpatient clinic. Patient engagement was measured by evaluating the number of entered values. The accuracy of the automatic alerts was checked by comparing all the entered values with the threshold values. The usability and patient satisfaction were measured using questionnaires.
 
 
 RESULTS
 Compliance rates for blood pressure and symptom checklist were 93% and 86% respectively during the 15 telemonitoring days. 
No false positive or missing alerts have been found. The telemonitoring system alarmed 7 times for BP thresholds (3.8% of all received BP values), of which 4 alerts for an exceeded upper limit. These 4 alerts came from one participant, who was diagnosed with chronic hypertension and received further evaluation and treatment outside the study protocol. 
Of all 167 returned symptom checklists, 73 reported one or more symptoms (43.7%). In five cases (3.0%), symptoms gave reason for further analysis in the outpatient clinic. Other symptom alarms could be handled with expectant management, e.g. because of normal blood pressure. 
The majority of participants was satisfied with the use and convenience of the app and the automatic blood pressure monitor.
 
 
 CONCLUSIONS
 This feasibility study of a telemonitoring platform for blood pressure and symptom measurements in women with an uncomplicated pregnancy showed that remote monitoring with an app and alert system can be used in antenatal care and holds the promise of improving outpatient care for women at risk of hypertensive pregnancy disorders.
