Hans van den Heuvel

5 Figure 1. Predefined antenatal visit schedule as part of the intervention for patients at risk of development of preeclampsia Women who gave written informed consent were provided access to the secured platform from 16 weeks gestational age onwards. They were trained to obtain correct measurements with the iHealth Track. From study enrolment to delivery date, they were asked to submit a single blood pressure on weekdays before 10.00AM. In-app or email reminders were sent automatically at 7.00AM. The blood pressure measurement was transferred to the app with Bluetooth, and the pregnant woman could forward it to the platform after manual check. If blood pressure was raised, participants answered an in-app symptom checklist, containing 10 yes/no questions for symptoms that occur in (the development of) preeclampsia as well as general pregnancy symptoms (Table 1). Uploaded values were visible for both the patient and the healthcare provider, on a monitoring dashboard in the electronic health record. Values exceeding the set threshold values led to alerts on the monitoring dashboard, reviewed by a member of the telemonitoring team every weekday at 10.30 AM. Alerts were set for a systolic value of >140mmHg or diastolic >90mmHg and/or an increase of 20mmHg compared to the previousmeasurement. These thresholds were chosen as they indicate new- onset of gestational hypertension following international consensus, but can be altered in the dashboard to provide individual care. 15-17 For the symptom checklist, the platform alarmed if �1 symptoms were present. Alerts were reviewed with a protocol of flowcharts taking into account several combinations of hypertension and symptoms (Supplemental Figure 1). If needed, the telemonitoring team would consult the obstetrician and subsequently contact the participant to advice one of the following: 1) expectant management or 2) same-day clinical assessment of blood pressure and symptoms and 3) if necessary with blood/urine analysis, 4) adjustment of antihypertensive therapy, 5) admission to the antenatal ward, and 6) induction of labour. To ensure patient safety, all alerts in the dashboard had to be switched off manually after processing the protocolled steps. In both study groups therapeutic interventions including induction of labour or caesarean section were started according to local protocol based on the Dutch national guideline. 13 SAFE@HOME TELEMONITORING FOR WOMEN AT RISK OF PREECLAMPSIA 71