Hans van den Heuvel

4 INTRODUCTION In pregnancies considered at high risk for hypertensive complications, frequent outpatient visits are recommended to monitor maternal and fetal wellbeing. 1 Risk groups include women with chronic hypertension, preeclampsia or fetal growth restriction in a prior pregnancy, obesity, diabetes, or renal and cardiac disease. Prenatal appointments can range from visits every two weeks up to 1-4 times a week. During these visits, the focus is on blood pressure (BP), symptoms, weight, urine or blood analysis and fetal heartrate. Recurrent visits, either planned or unplanned, interfere with daily life and can be burdensome for the pregnant patient and her support system but also pose a substantial burden to perinatal care resources. 2 Young women, in their reproductive years, are frequent users of Internet, social media and smartphone apps. 3 Home monitoring or telemonitoring of BP self-measurements could be a possible solution to improve care satisfaction while achieving more cost-effective care. American guidelines now recommend home monitoring for patients with chronic hypertension and gestational hypertension. 4,5 Contrarily, different guidelines regarding preeclampsia caution against automated blood pressure measuring devices for diagnosis and treatment threshold of preeclampsia, because both overestimation and underestimation of BP can occur in comparison with auscultatory measurements. 1,5 Pregnant women are willing to undertake repeated self-measurements and are able to record blood pressure accurately. 6 Self-monitoring is more acceptable to pregnant women than frequent clinic visits and over 98% of women with hypertension in pregnancy reported they liked to be involved in their blood pressure management. 7 Despite this evidence on self-measurement of BP in pregnancy, there is little information on the use of a platform that allows for repeated BP measures in combination with symptom reporting. Therefore, we developed a telemonitoring platform for BPmonitoring in antenatal care with an integrated preeclampsia symptom checklist. The aim of this study is to examine the patient acceptability of telemonitoring using the app and BP monitor and to review the internal infrastructure to survey all observed measurements. In this feasibility study, the patient compliance, the efficacy of the automatic alert system, the usability and patient satisfaction of this novel telemonitoring strategy is examined. METHODS Recruitment In June 2017, low-risk pregnant women at the outpatient clinic of the University Medical Center Utrecht Birth Center (The Netherlands), were asked to participate in this prospective observational study. Women between 18 and 40 years old with a gestational age < 34 weeks were eligible if they didnotmeet any of the following exclusion criteria: chronic hypertension, hypertensive disorder in a prior pregnancy, cardiac or renal pathology, obesity (BMI> 35), FEASIBILITY STUDY OF BLOOD PRESSURE TELEMONITORING IN PREGNANCY 55