Hans van den Heuvel

User experiences and data on home measurements The online survey on SAFE@HOME experiences was answered by 51 (49%) participants. Few had difficulties with using the system (4%, 2/51) and instructions regarding the use of the BP monitor and app were clear to almost all (96%, 49/51) (Supplemental Figure 2). Daily measurements took ≤5 minutes for 81% (mean 4.6 min), and 98% (50/51) could easily perform their routine tasks while using the platform. The vast majority was satisfied with the use of the app and platform (92%, 47/51) and especially parous participants would recommend it to other women (96.9% of multiparous vs. 73.7% of nulliparous women). Telemonitoring participants started their home measurements on average at 17.9 weeks of gestation (SD 3.9) and continued this for 20.2 weeks (SD 4.0) until delivery (Table 2). During pregnancy, the median number of uploaded blood pressure measurements per participant was 90.0 in total (IQR 68.0-107.0, range 18-201) or 4.5 per week of telemonitoring (IQR 3.6-5.0, range 0.9 – 12). The median compliance rate for all scheduled blood pressure measurements was 91.2% (IQR 70-100, range 34 – 100). Perinatal outcome Table 4 shows the pregnancy outcomes in both groups. At delivery, diagnoses of gestational hypertension, preeclampsia, chronic hypertension without superimposed preeclampsia or normotensive pregnancy were similar between groups. Approximately 20% of all participants developed preeclampsia, and fetal growth restriction (estimated fetal weight <10th centile) occurred in ±10% of all pregnancies (Table 3). Labour induction was more frequent in the SAFE@HOME group (56.3 vs 38.3%, p=0.006). However, hypertension as the main indication for induction was not significantly different between groups (56.9 vs 54.9 % of inductions, p=0.99). Planned induction for patients with cardiac disease was more frequent, although not significant, in the SAFE@HOME group (16.5 vs 9.0%, p=0.08). No other differences were found regarding mode of delivery. One antepartum fetal death, not related to telemonitoring, occurred in the SAFE@HOME group, in a woman included because of a history of preeclampsia. There were no maternal complications. No other serious adverse events were observed in both groups. In general, no differences were detected in use of (iv) anti-hypertensive drugs, magnesium sulphate or glucocorticoids for fetal lung maturation (Table 4). Results were also similar for gestational age at delivery (mean 38.3 weeks (2.1) vs 38.8 weeks (2.3) p=0.11), birth weight <5th centile (4.9 vs 9.0 %, p=0.22), and admission to neonatal intensive care unit (1.9 vs 4.5 %, p= 0.47). CHAPTER 5 76