Hans van den Heuvel

Strengths and limitations While validated automated BP measuring devices for use in pregnancy are scarce, this study completed the validation trajectory of two devices of two different producers for use in pregnancy. This is a useful addition to the list of validated devices in pregnancy. Other strengths of this study include the use of an international standard protocol and the inclusion of pregnant patients both with and without preeclampsia. We chose to validate two monitors with Bluetooth functionality. In order to enhance maintenance and persistence of self-monitoring during pregnancy, we think easy connectivity with a smartphone is essential for telemonitoring. As there are no positive validation reports of devices with this function, to the best of our knowledge, these two monitors are now the first to be used by pregnant women. Although we tried to follow the EHS validation protocol to full extent as prescribed, we were not able to use mercury sphymanometers. The use of mercury is no longer allowed in the Netherlands for safety reasons and they were replaced with calibrated aneroic sphygmanometers many years ago. The study group consisted of inpatients, hospitalized in pregnancy due to different complications. We cannot ascertain that the measurements from admitted patients would correspond with self measurements at home, in a less controlled setting. The ESH protocol advises the subjects to rest for 10-15 minutes in upright position to start validating in a rested state. In telemonitoring instructions, patients at home are also advised to rest prior to BP measurement. The use of antihypertensive medication in a number of subjects could have possibly reduced variability in BP. Clinical implications Potential advantages of the use of home blood pressure monitoring in pregnancy include the exclusion of the ‘white coat effect’, improvement of patient empowerment, reduction of outdoor patient clinic visits and the ability of (more) frequent monitoring with less interference with daily life. Women of reproductive age are frequent users of Internet, smartphones and applications. 20 The introduction of automated BP devices with Bluetooth connectivity facilitates the pathway of telemonitoring of blood pressure and other maternal parameters as weight, heart rate, dietary intake or symptoms of hypertensive disease. After synchronization of BP values with their own customized smartphone application, this can be shared with health care providers in special telemonitoring units on a daily basis. Prenatal care is integrating mobile technology more and more in order to offer personalized pathways after individual risk stratification. The validation of these two Bluetooth connected automated BP monitors may contribute to remote monitoring in perinatal care. Acknowledgements This study was carried out in the context of the e-Health Citrien program, which is part of and funded by the Dutch Federation of University Medical Centers (NFU). CHAPTER 3 50