Hans van den Heuvel

5 be beneficial for the full course of pregnancy. Absence of both hypertension and symptoms requires no further action, while symptoms in case of hypertension indicate need for evaluation. Strengths and limitations Our digital platformis one of the first to combinebothbloodpressure and symptomreporting, used with a reduced visit schedule. Prior to the study start, we validated the blood pressure monitor and carried out a feasibility study to test the Bluetooth-connected platform. 12,14 Eligible candidates were willing to participate in telemonitoring, which is reflected in the high consent rate. Only 2/109 participants were transferred to standard care because of non-compliance. A limitation of this study is the comparison to a retrospective control group, which is likely to have caused selection bias. The greater proportion of included women with kidney disease in the SAFE@HOME group adds to heterogeneity, because of the specific etiology of kidney disease as an increased risk factor for preeclampsia. This might limit generalizability of results. Our study was not powered adequately to draw conclusions regarding adverse perinatal outcomes and therefore, future studies with substantial sample size would be needed. Lastly, the studied strategy is a combination of both a digital health platform for remote monitoring and a reduced visit schedule. It is unknown whether the implementation of either of these components of the intervention individually would result in a similar effect on healthcare consumption and adverse outcomes. Future implications Our results imply that use of telemonitoring at home of blood pressure and preeclampsia symptoms in high risk pregnancies allows for fewer antenatal visits, notably after 34 weeks of gestation. The use of home measurements did not lead to an increase in health care consumption. Increased experience and compliance of obstetric care professionals to the new strategy may enhance the reduction of care use in the future. Several implications of blood pressure telemonitoring in pregnancy still need evaluation. Before widespread use of telemonitoring, more evidence is needed from larger prospective studies. Studied groups should include both women at risk of hypertension or preeclampsia at start of pregnancy, as well as those with established gestational hypertension or mild preeclampsia. 22 Current knowledge gaps include the safety and impact of telemonitoring on (early) detection and/or prediction of complications as well as its effect on subsequent interventions as medication use and hypertension control, induction of labour, optimal administration of corticosteroids. In general, digital health has the potential to have profound cost-saving effects because of the decline in visits, admissions, travel time, and work absence. 23 Women of reproductive age are interested in digital health, as shown by their frequent use of smartphones and SAFE@HOME TELEMONITORING FOR WOMEN AT RISK OF PREECLAMPSIA 79