Hans van den Heuvel

DISCUSSION Main findings We studied the use of a novel care path with telemonitoring of blood pressure and preeclampsia symptoms in a high-risk pregnant population. Our findings show that this strategy allows a reduced antenatal visit schedule, with fewer ultrasound assessments and antenatal hypertension-related admissions. However, evaluation was by comparison with a retrospective group without telemonitoring nor a fixed antenatal visit schedule. In our sample, no differences were found in adverse maternal or perinatal outcomes between the two strategies. Comparison to the literature and interpretation The NICE guideline on antenatal care recommendsmore frequent blood pressuremonitoring for those at risk of HDP and several others mention self-monitoring as a useful addendum to antenatal care. 7,16 A recent individual patient data meta-analysis of 758 subjects found an insignificant difference between clinic readings and self-monitored blood pressure values. 17 Based on this evidence, our threshold for alerts was set at 140/90 mmHg to be of clinical importance. Recent literature describes a variety of monitoring strategies for women with (a higher risk of) hypertension in pregnancy. 18-21 In general, reduction of antenatal visits with help of out- of-office self-measurements, as found in our study, are in line with several other studies. One retrospective study of blood pressure telemonitoring for diagnosed hypertension in pregnancy showed a reduction of antenatal visits and admissions. 18 Two case-control studies started blood pressure self-monitoring in women with diagnosed hypertension, without telemonitoring but providing written instructions to patients when to contact the hospital. 19,20 Starting self-monitoring at 30–36 weeks of gestation, fewer visits were required with self-monitoring compared to a retrospective group with traditional care, in both studies. More importantly, the shift from hospital to home care did not seem to negatively affect pregnancy outcomes, although study sample sizes were likely not large enough to determine this. 18-20 One other prospective study started telemonitoring at start of pregnancy but did not include a control group for comparison of results. 21 There is conflicting data on the rate of labour induction in the literature. As for our study, induction of labour was more frequently started in the SAFE@HOME group, however hypertension as the main reason for induction of labour was similar between groups. Our study differed from the described studies on several points. Our population of women, at risk of preeclampsia but without complications in first trimester, started telemonitoring eary in pregnancy (mean 17.9 weeks of gestation) in stead of starting at 30-36 weeks. Also, a symptom checklist was included within the platform. This combination proved to CHAPTER 5 78