Hans van den Heuvel

5 INTRODUCTION Hypertension in pregnancy is increasingly common, and an important cause of maternal and neonatal morbidity and mortality, at short as well as long term. 1,2 Frequent monitoring of blood pressure (BP), fetal growth, blood and urine during pregnancy is recommended to early identify and monitor hypertensive disease. 3 Interfering with daily life, (un)planned visits and hospitalization pose a substantial burden to patients and care resources. 4 International guidelines from 2013 onwards recommend self-measurements for patients with (gestational) hypertension. 5-7 Recent research has shown that pregnant women are willing to undertake repeated self-measurements for involvement of blood pressure management. 8-10 As such, the adoption of digital health has been suggested to achieve higher-value antenatal care. 11 Wedevelopedadigital telemonitoringplatformenablinghomebloodpressuremeasurements and preeclampsia symptom reporting. 12 This redesign of antenatal care, with a predefined minimal visit schedule and telemonitoring, is anticipated to enhance digital interaction and women’s autonomy while maintaining safety of antenatal care. Furthermore, telemonitoring might allow less frequent antenatal visits. It could potentially also lead to more visits as a result of an overload of data or questions in contrast. The precise role of digital exchange of home measurements in pregnancies at increased risk has yet to be established. We evaluated our digital health platform in antenatal care for patients at increased risk of developing preeclampsia, together with a newly developed reduced antenatal visit schedule, from 16 weeks gestational age onwards. METHODS Study population and design This case-control study was conducted in two perinatal centres in urban areas in the Netherlands: one university hospital (2500 deliveries annually, both secondary and tertiary care) and one general teaching hospital (3000 deliveries annually). The study population consisted pregnant women with a singleton pregnancy and one (or more) of the following risk factors for preeclampsia: chronic hypertension, preeclampsia in a prior pregnancy, maternal cardiac disease, or maternal kidney disease. A prospective group of women, managed with use of the digital platform, was compared with a retrospective group with identical risk factors at start of pregnancy, but managed with conventional care. This study was submitted to the Medical Ethics Committee of the University Medical Center in Utrecht (17/424). The committee judged that the Dutch Medical Research Involving Human Subjects Act (WMO) did not apply to this study. SAFE@HOME TELEMONITORING FOR WOMEN AT RISK OF PREECLAMPSIA 69