Hans van den Heuvel

DISCUSSION This telemonitoring platform, with the feature to combine repeated BP measurements with associated preeclampsia symptom alerts, was found feasible for pregnancy care in the outpatient clinic. Compliance rate of participant interaction in the study period proved to be favourable with nearly 85% of the participants completing most of the daily measurements. The alert systemwas accurate and the novelty to report symptoms in an in-app questionnaire demonstrated to be of additional clinical value: incidental BP peaks without the presence of any preeclampsia symptoms could be handled with expectant management without extra in-hospital or phone consultations. The participants were content with the app and BP monitor and would recommend it to other patients. The 3-5 minute measurement activity did not interfere with daily activities. Participants reported favourable usability of the telemonitoring system and affirmed the usefulness for higher patient engagement in prenatal care. For patient safety it is strongly recommended to only use BP monitors that have been validated for use in pregnancy according to international consensus guidelines. 12 The iHealth Track used in this study has been validated in a pregnant population with and without preeclampsia. 8 Previous retrospective and prospective studies have used BP telemonitoring with weekly home measurements during the full course of pregnancy, or after diagnosis of (suspected) hypertension. 10,13-15 Their results confirm the acceptability and feasibility of telemonitoring and report a reduction of clinic visits without adverse perinatal effects. As social changes are demanding a shift to home-based care, both patients and care provides are embracing telemedicine for its usability, tendency to improve access to care, communication and outcomes while decreasing clinic visits and travel time. 16 This shift is assumed to have profound cost-saving effects in favor of telemonitoring, an important aspect regarding the ever-increasing health care costs – and workloads. 17 Enrolment of >2000 participants in the Pregnancy ResearchKit app in the United States showed high patient engagement of remote monitoring of maternal parameters (>100,000 measurements) and filling out surveys (>14,000) in a 9 months study period. The combination of patient education (using the WebMD Pregnancy app) and the visualization of personal data will help pregnant women to understand and interpret healthy behaviour and risks, adding to informed medical decision making. 18 Our use of both BP and pregnancy-related symptom collection is not described before in previous studies and may help preventing overconsumption as both objective (BP) home measurements are combined with subjective symptom reporting. This feasibility study was set up for uncomplicated pregnancies to test the use of technical devices and hospital logistics with the use of our telemonitoring platform. The study period comprised a maximum of 15 consecutive weekdays, as we did not want to impose daily CHAPTER 4 62