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Pregnancy Hypertension 18 (2019) 14–20

Contents lists available at ScienceDirect

Pregnancy Hypertension
journal homepage: www.elsevier.com/locate/preghy

Pregnancy outcomes following home blood pressure monitoring in T

gestational hypertension
Erkan Kalafata,b, Karin Leslieb,c, Amar Bhideb,c, Basky Thilaganathanb,c, Asma Khalilb,c,
⁎

a
Fetal Medicine Unit, St. George’s University Hospitals NHS Foundation Trust, London, UK
b
Middle East Technical University, Department of Statistics, Ankara, Turkey
c
Molecular & Clinical Sciences Research Institute, St. George’s University of London, London, UK

ARTICLE INFO ABSTRACT

Keywords: Objectives: To assess the safety and efficacy of home blood pressure monitoring (HBPM) and office (traditional)
Hypertension blood pressure measurements in a cohort of pregnant women with gestational hypertension (GH).
Pregnancy induced Study design: This was a cohort study at St. George’s Hospital, University of London conducted between
Preeclampsia December 2013 and August 2018. The inclusion criteria was pregnant women with a diagnosis of GH. Eligible
Pregnant
patients were counseled and trained by a specialist midwife and were provided with an automated Microlife®
Safety
White coat
“WatchBP Home” BP machine. Each patient followed an individualised schedule of hospital visits and BP
measurements based on the HBPM pathway or standard hospital protocol which was based on the National
Institute of Health and Care Excellence (NICE) guideline.
Main outcome measures: Adverse fetal, neonatal and maternal outcomes as well as number of antenatal hospital
visits were recorded and compared between HBPM and office (traditional) pathways.
Results: 143 women with GH were included in the study (80 HBPM vs 63 standard care). There were no sig-
nificant difference between the two groups in maternal high-dependency unit admission (P = 0.999), birth
weight centile (P = 0.803), fetal growth restriction (p = 0.999), neonatal intensive care unit admissions
(p = 0.507) and composite neonatal (p = 0.654), maternal (p = 0.999) or fetal adverse outcomes (p = 0.999).
The number of Day Assessment Unit (DAU) visits was significantly lower in the HBPM group than the traditional
pathway (median 4.0 vs. 5.0, P = 0.009). The difference was greater when the number of visits were adjusted for
the duration of monitoring in weeks (median: 1.0 vs 1.5, P < 0.001). There were no significant difference
between the two groups in the total number of outpatient (P = 0.357) and triage visits (p = 0.237). However,
the total number of antenatal visits adjusted for the duration of monitoring was significantly lower for the HBPM
group compared to the traditional pathway (median 1.4 vs 1.8, P = 0.020).
Conclusions: HBPM in women with GH results in significantly less antenatal visits compared to women on a
standard pathway of care. The two groups had comparable fetal, neonatal and maternal adverse outcomes. Large
multicentre studies are needed to ascertain the safety of rare adverse pregnancy outcomes.

1. Introduction follow-up requirements for the pregnant women at risk for hyperten-
sion as recommended by NICE guidelines [3]. Women deemed to be at
Hypertensive disorders of pregnancy (HDP) remain a major cause of high risk for HDP are required to attend the maternity day assessment
morbidity and mortality in pregnancy worldwide [1]. Recent evidence unit (DAU) or their community care center at regular intervals for blood
suggests there has been a sustained reduction in maternal mortality in pressure (BP) measurements.
the United Kingdom largely as a consequence of effective management Home blood pressure monitoring (HBPM) of women at high risk or
and timely intervention [2]. However, HDP remain a significant re- with a diagnosis of HDP has been proposed as a safe alternative to
source burden on the healthcare system due to intensive antenatal standard care [4]. HBPM is a safe and a recommended tool in the

Abbreviations: HDP, Hypertensive disorders of pregnancy; HBPM, Home blood pressure monitoring; NICE, National Institute of Health and Care Excellence; BP,
Blood pressure; GH, Gestational hypertension; ISSHP, International Society for the Study of Hypertension in Pregnancy; DAU, Daily assessment unit; FGR, Fetal
growth restriction; SGA, Small for gestational age
⁎
Corresponding author at: St. George’s University of London, London SW17 0RE, UK.
E-mail address: akhalil@sgul.ac.uk (A. Khalil).

https://doi.org/10.1016/j.preghy.2019.07.006
Received 26 March 2019; Received in revised form 6 July 2019; Accepted 14 July 2019
Available online 15 July 2019
2210-7789/ © 2019 Published by Elsevier B.V. on behalf of International Society for the Study of Hypertension in Pregnancy.

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請遵守請遵守著作權法之規範：本館以電子檔案傳遞具有保全設定之文獻，僅供列印使用，請勿任意傳送與重製；應覽人供個人研究之要求，得重製已公開發表著作之一部分，或期刊或已公開發表之研討會論文集之單篇著作，每人以一份為限

E. Kalafat, et al. Pregnancy Hypertension 18 (2019) 14–20

management of chronic hypertension in adults, but the safety profile of mmHg or a diastolic blood pressure of > 100 mmHg as the trigger for a
HBPM during pregnancy is less well established [5]. We have pre- patient to contact the hospital for review, to avoid patients developing
viously reported that HBPM is acceptable to women and effective in severe hypertension at home.
reducing the number of hospital visits without compromising maternal Data on maternal age, parity, self-reported ethnicity, mode of con-
and perinatal outcomes [4,6]. A health economic analysis suggests that ception, smoking status, type of HDP at delivery, adverse fetal, neonatal
the reduced burden of hospital attendance could lead to cost savings and maternal outcomes were recorded. Adverse fetal outcome was de-
[7]. fined as preterm delivery prior to 34 weeks’ gestation, birth weight
HDP includes gestational hypertension, pre-eclampsia and pre- centile below the 3rd or intrauterine demise. Fetal growth restriction
pregnancy hypertension. Previous studies of HBPM in pregnancy in- (FGR) and small-for-gestational age (SGA) diagnoses were made ac-
cluded women with various types of HDP or at high-risk of developing cording to the Delphi consensus criteria by Gordjin et al. [11]. Adverse
HDP [4]. The heterogeneity of the study cohort has been highlighted as maternal outcome included acute renal failure (maternal serum crea-
a limitation as it can impact on the reported pregnancy outcomes. The tinine level above 100 μmol/L antenatally or above 130 μmol/L post-
natural history of pre-existing hypertension differs from that of gesta- natally) or need for dialysis, acute myocardial ischemia, need for third
tional hypertension [8,9]. Therefore, the aim of this study was to in- intravenous agent to control BP (i.e. in addition to labetalol and hy-
vestigate the pregnancy outcomes of HBPM in a cohort of pregnant dralazine), hypertensive encephalopathy (altered mental status with
women with GH. characteristic cerebral imaging), cortical blindness, retinal detachment,
stroke (ischemic or hemorrhagic), pulmonary edema or adult re-
2. Methods spiratory distress syndrome (defined by characteristic pulmonary ima-
ging in addition to oxygen requirement), need for mechanical ventila-
2.1. Study population tory support (other than for Cesarean section), disseminated
intravascular coagulation, thrombotic thrombocytopenic purpura or
This was a cohort study at St. George’s Hospital, University of hemolytic uremic syndrome, acute fatty liver, liver hematoma or rup-
London conducted between December 2017 and August 2018. The in- ture, placental abruption, and maternal death. Adverse neonatal out-
clusion criteria was having an initial diagnosis of GH according to the come included neonatal death, respiratory distress syndrome, in-
International Society for the Study of Hypertension in Pregnancy traventricular hemorrhage, necrotizing enterocolitis,
(ISSHP) criteria [10]. Women presented via referral to the hypertension bronchopulmonary dysplasia, periventricular leukomalacia, retino-
clinic or the DAU. Those who satisfied the inclusion criteria were in- pathy of prematurity, seizure and admission to the neonatal unit for
vited to participate in the HBPM pathway. The exclusion criteria were more than 48 h (for full-term infant). Diagnoses of GH and preeclampsia
diagnosis of chronic hypertension, maternal age less than 16 years, were made according to the criteria of the ISSHP [8]. GH was diagnosed
systolic BP above 155 mmHg, diastolic BP above 100 mmHg, significant in the presence of systolic BP ≥ 140 mmHg and/or diastolic
proteinuria (≥2+ on dipstick testing or protein/creatinine ratio > 30 BP ≥ 90 mmHg at least 4 h apart in the absence of proteinuria, after
mg/mmol), an estimated fetal weight below the 10th centile, signs of 20 weeks’ gestation in a previously normotensive woman. Preeclampsia
severe preeclampsia (oliguria < 500 mL/24 h, cerebral or visual dis- was diagnosed when GH was complicated with significant proteinuria
turbance, pulmonary edema, epigastric or right-upper quadrant pain, (≥2+ protein on dipstick testing or PCR ≥ 30 mg/mmol). White-coat
impaired liver function, platelet count < 100,000/mm3), significant hypertension was diagnosed when office measurements were con-
mental health concerns or insufficient understanding of the English sistently higher than home measurements which were normal. Ethical
language. The pregnancy outcomes and number of hospital visits of approval was obtained for the study (16/NW/0206).
women with GH who had HBPM were compared with those of another
group of pregnant women with GH, but were managed via the tradi-
2.2. Literature review
tional pathway (hospital BP monitoring), as per the National Institute of
Health and Care Excellence (NICE) guideline [3]. The latter group was
A literature review using the MEDLINE database was also under-
derived retrospectively from maternity databases and consisted of a
taken in December 2018 to summarize the evidence regarding HBPM
historic cohort of women who presented to the DAU with GH and were
use in pregnant women. Search parameters of “home”, “blood pres-
managed as per the local hospital protocol prior to the implementation
sure”, “ambulatory”, “pregnancy” were used to identify relevant studies
of HBPM.
which compared BP monitoring with standard care and also reported on
Eligible patients for the HBPM pathway were counseled and trained
the pregnancy outcomes. Studies in which home blood pressure mon-
by a specialist midwife and were provided with an automated
itoring was performed with either ambulatory or automated monitors
Microlife® “WatchBP Home” BP machine which is validated for use in
and also reported on adverse maternal or fetal outcomes were included.
pregnancy. The same BP device was used to record their BP at the
Validation studies were excluded. Studies characteristics and adverse
hospital. Women were taught how to measure their BP accurately ac-
outcomes were summarized in review tables.
cording to our previously published technique: appropriate size arm
cuff, taken at rest after 5 min, sitting with the back supported and the
feet flat on the floor, keeping the arm at the level of heart and removing 2.3. Statistical analysis
tight or excessive layers of clothing and avoiding excessive consump-
tion of stimulant drinks (i.e. coffee). Women recorded readings in their Continuous variables were presented as medians and interquartile
notes or on a specially designed smartphone app (Hampton Medical®, ranges. Binary and categorical variables were presented as fraction of
Trakka Medical, UK, Downloadable at https://itunes.apple.com/us/ the total and percentages. Distribution assumptions for continuous
app/hampton-medical/id1328312740?mt=8). Each patient followed variables were visually assessed with quartile-quartile plots and then
an individualised schedule of hospital visits and BP measurements were confirmed with Shapiro-Wilk test. Differences between home and
based on the HBPM pathway or standard hospital protocol, which was office BP measurements groups were tested with Wilcoxon rank sum
based on the NICE guideline [3]. Patients were given written instruc- test, t-test or Fisher’s exact test, where appropriate. P values below 0.05
tions regarding when to present to hospital based on their HBPM were deemed statistically significant. All statistical analyses were per-
readings being out of normal range or on their reporting symptoms of formed using R for Statistical Computing Software® (Version 3.4.2)
preeclampsia. Our protocol used a systolic blood pressure of > 155 [12].

15

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請遵守請遵守著作權法之規範：本館以電子檔案傳遞具有保全設定之文獻，僅供列印使用，請勿任意傳送與重製；應覽人供個人研究之要求，得重製已公開發表著作之一部分，或期刊或已公開發表之研討會論文集之單篇著作，每人以一份為限

E. Kalafat, et al. Pregnancy Hypertension 18 (2019) 14–20

Table 1
Comparison of baseline demographics and pregnancy related variables in women with gestational hypertension according to whether they had home blood-pressure
monitoring or standard hospital blood pressure pathways.
Home blood pressure monitoring (n = 80) Standard hospital blood pressure pathway (n = 63) P value*

Maternal age in years, median (IQR) 34.0 (30.0–37.0) 31.0 (28.0–33.5) < 0.001
Self-reported ethnicity, n (%)
- Caucasian 56 (70.0) 39 (61.9) 0.676
- Afrocarribean 8 (10.0) 6 (9.5)
- Asian 10 (12.5) 12 (19.1)
- Mixed 6 (7.5) 6 (9.5)
Multiparous, n (%) 21 (26.3) 12 (19.1) 0.326
Body-mass index in kg/m2, median (IQR) 26.4 (23.6–30.0) 27.1 (24.2–30.3) 0.162
Body mass index ≥ 30 kg/m2, n (%) 21 (26.3) 18 (28.6) 0.850
Body mass index ≥ 40 kg/m2, n (%) 2 (2.5) 4 (6.3) 0.405
Smoker, n (%) 1 (1.3) 0 (0.0) 0.999
End diagnosis, n (%)
- Gestational hypertension 56 (70.0) 41 (65.1) 0.353
- Preeclampsia 20 (25.0) 22 (34.9)
- Other (White-coat, normotensive) 4 (2.5) 0
Gestational age at inclusion, median (IQR) 34.0 (28.2–36.3) 36.0 (33.0–37.3) 0.002
Gestational age at delivery, median (IQR) 38.9 (37.5–39.7) 39.4 (38.3–40.4) 0.064
Duration of monitoring in weeks, median (IQR) 4.8 (1.8–8.6) 3.6 (2.2–5.3) 0.162

†
Including emergency cesareans and instrumental deliveries.
IQR: interquartile range.
* Calculated with either t-test, Wilcoxon rank sum test or Fisher’s exact where appropriate.

3. Results surveillance (Table 3). The primary outcome was feasibility or accep-
tance of HBPM in most studies, while two studies focused on number of
A total of 143 women with GH were included in the study. 80 antenatal visits. Overall, the inclusion criteria, type of studies, method
women were enrolled in the HBPM pathway whereas 63 women re- of HBPM and reported outcomes varied significantly among those stu-
ceived standard care. Women in the HBPM group were older compared dies (Table 3). The incidence of various pregnancy outcomes were ex-
to controls (median 34.0 vs. 31.0 years, respectively, P < 0.001), but tracted from the individual studies. Some studies demonstrated a lower
no significant differences were observed regarding ethnicity rate of induction of labor, NICU admission, serious maternal morbidity
(P = 0.676), parity (P = 0.326), body-mass index (P = 0.162) or with HBPM (Table 4) [4,17,18]. Moreover, the postpartum visit ad-
smoking status (P = 0.999) (Table 1). The gestational age at inclusion herence was higher in the HBPM group in two studies with postpartum
was significantly lower in the HBPM group compared to controls follow-up [14,16].
(median: 34.0 vs. 36.0 weeks, respectively, P < 0.002). However, no
significant differences were observed regarding the gestational age at
4. Discussion
delivery (P = 0.064). The incidence of preterm birth prior to 34 weeks
was similar between the two groups (P = 0.582). The incidence of va-
4.1. Summary of the study findings
ginal delivery, operative delivery and elective cesarean section were
similar between the HBPM and control groups (P = 0.171) (Table 2).
HBPM in women with GH results in significantly less antenatal
No significant differences were observed regarding maternal high-de-
visits, per week of monitoring and total, than women on a standard
pendency unit admission (P = 0.999), birth weight centile (0.803),
pathway of care. The two groups had comparable adverse maternal and
fetal growth restriction (p = 0.999), neonatal intensive care unit ad-
perinatal outcomes.
missions (p = 0.507) and composite neonatal (p = 0.654), maternal
(p = 0.999) or fetal adverse outcomes (p = 0.999) (Table 2).
HBPM pathway significantly reduced the number of DAU visits 4.2. Strength and limitations
(median 4.0 vs. 5.0, P = 0.009) (Table 2). The difference was greater
when the number of visits were adjusted for the duration of monitoring Our study has several strengths. Firstly, this study focused on
in weeks (median: 1.0 vs 1.5, P < 0.001). No difference was observed women with GH at the initial diagnosis, and therefore, avoids the po-
between the groups regarding the total number of outpatient tential heterogeneity in some of the previous studies. GH is the most
(P = 0.357) and triage visits (p = 0.237). However, the total number of common form of HDP with a different outcome profile compared to
antenatal visits adjusted for the duration of monitoring was sig- other HDP [22]. This study provides more relevant individualized data
nificantly lower for the HBPM group compared to controls (median 1.4 for the majority of women experiencing hypertension in pregnancy.
vs 1.8, P = 0.020) (Table 2). Secondly, we included a relatively large cohort of pregnancies with GH
and used a measurement device validated for pregnancy. Thirdly, we
summarized the published evidence on the use of HBPM in pregnancy.
3.1. Literature review We cannot exclude a possibility for intervention or selection bias in
our study in view of its observational design. However, the primary
The literature search revealed 10 studies to be included in the re- outcomes (maternal, fetal, neonatal adverse events) are unlikely to be
view table [4,13–21]. Seven studies applied HBPM to women in an- affected by this potential bias. In fact, appropriate selection of pregnant
tenatal period whereas three studies used HBPM for postpartum women who would be eligible for HBPM is instrumental to ensure

16

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E. Kalafat, et al. Pregnancy Hypertension 18 (2019) 14–20

Table 2
Comparison of the number of antenatal visits stratified by the type of visit and pregnancy outcomes in women with gestational hypertension according to whether
they had home blood-pressure monitoring or standard hospital blood pressure pathways.
Home blood pressure monitoring (n = 80) Control (n = 63) P value*

Preterm delivery below 34 weeks, n (%) 1 (1.3) 2 (3.2) 0.582

Induction of labour, n (%) 37 (46.3) 39 (61.9) 0.066
Mode of delivery, n (%)
- Vaginal delivery 35 (43.8) 28 (44.4) 0.171
- Elective cesarean 13 (16.2) 4 (6.4)
- Operative delivery† 32 (40.0) 31 (49.2)
High Dependency Unit admission, n (%) 6 (7.5) 4 (6.4) 0.999
Birthweight in grams, median (IQR) 3100 (2570–3602) 3200 (2885–3625) 0.247
Birthweight percentile, median (IQR) 33.4 (13.5–73.8) 33.0 (14.1–66.4) 0.803
Small-for-gestational age at birth, n (%) 19 (23.8) 11 (17.5) 0.412
Fetal growth restriction at birth, n (%) 5 (6.3) 4 (6.4) 0.999
Neonatal intensive care unit admission, n (%) 4 (5.0) 5 (7.9) 0.507
Livebirth, n (%) 80 (100.0) 63 (100.0) 0.999
Composite adverse outcomes, n (%)
- Fetal 6 (7.5) 4 (6.4) 0.999
- Maternal 1 (1.3) 1 (1.8) 0.999
- Neonatal 2 (2.5) 3 (4.8) 0.654
- All 9 (11.3) 6 (9.5) 0.790
Day assessment unit (DAU) visits
- Total, median (IQR) 4.0 (2.0–6.0) 5.0 (4.0–7.0) 0.009
- Per monitoring week, median (IQR) 1.0 (0.5–1.8) 1.5 (1.0–2.0) < 0.001
Maternity Triage visits (out of hours)
- Total, median (IQR) 0.0 (0.0–1.0) 0.0 (0.0–1.0) 0.237
- Per monitoring week, median (IQR) 0.0 (0.0–0.2) 0.0 (0.0–0.2) 0.553
Outpatient visits†
- Total, median (IQR) 1.0 (0.0–2.0) 0.0 (0.0–2.0) 0.357
- Per monitoring week, median (IQR) 0.1 (0.0–0.5) 0.0 (0.0–0.5) 0.545
All visits
- Total, median (IQR) 6.5 (4.0–9.0) 6.0 (5.0–8.0) 0.681
- Per monitoring week, median (IQR) 1.4 (0.8–2.4) 1.8 (1.2–2.5) 0.020

* Wilcoxon rank sum test.

†
Including visits to general practitioner, Triage and outpatient antenatal clinic.

safety. Women with severe preeclampsia, systolic BP above 155 mmHg, 4.4. Clinical and research implications
diastolic BP above 100 mmHg, significant proteinuria, FGR, mental
health disorder or insufficient understanding of the English language Our work provides preliminary safety and feasibility data for future
were not eligible for HBPM. Severe adverse outcomes such as maternal trials. Larger studies are needed to compare HBPM and standard care.
or perinatal mortality are thankfully rare in well managed GH. As such There is a rising interest in HBPM among the clinicians and researchers,
the sample size in our study cannot provide robust evidence on these as indicated by the number of the recently published studies in 2018
outcomes with a HBPM pathway compared to standard care, and for compared to the previous years (Table 3). However, the published
this purpose, very large studies would be needed. Of note, in common evidence is very heterogeneous and lacks statistical power to ensure
with the literature review there were no concerning trends in adverse safety for rare adverse pregnancy ouctomes. Despite the fact that those
outcome seen. Finally, as we included a simple literature search of si- studies varied in the inclusion criteria, methods used for HBPM and the
milar published studies, rather than a systematic review, a meta-ana- reported outcomes, the vast majority demonstrate a potential benefit.
lysis is required to formally assess the efficacy of HBPM in pregnant Results from a recent meta-analysis suggest that there are no sys-
population. tematic differences between home and office measurements; however,
conflicting results have also been reported [23,24]. Furthermore, the
number of BP monitors which are validated for use in pregnancy is
4.3. Interpretation of study findings and comparison with existing literature limited and studies on the safety of HBPM with validated BP monitors
are scarce [4,25,26]. There is still a need for large studies on the safety
The literature on the use of HBPM in pregnant women is limited and profile of HBPM given the potential implications of HBPM in the
the safety profile of HBPM is yet to be fully ascertained. Most studies management of women with HDP during both the antenatal and post-
reported on the pregnancy related adverse events but the reported partum periods [14].
outcomes are inconsistent among those studies [13,15,17,18,20]. Only
two randomized trials were published investigating the use of HBPM
during the antenatal period with one of the studies employing ambu- 5. Conclusion
latory monitoring instead of self measurements with automated devices
[20,21]. Moreover, the inclusion criteria of observational studies on HBPM in women with GH results in significantly less antenatal visits
HBPM varied greatly [13,15,19]. Despite the observed heterogeneity in compared to women on a standard pathway of care. Our study further
the published literature, a reduction in the rate of induction of labor, expands the maternal, fetal and neonatal safety data of the use of HBPM
maternal morbidity and NICU admissions was observed in some studies during pregnancy. However, large multicentre studies are needed to
[4,17,18]. A systematic review is required to infer the direction of fu- ascertain the safety of rare adverse pregnancy outcomes.
ture studies on this topic.

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 E. Kalafat, et al.

Table 3
Characteristics of studies reporting on the home-blood pressure monitoring in pregnant women.
Study, year Study population and Study Period Exclusion criteria Method of home Primary Outcome Auxiliary outcomes
size type monitoring

Barton et al. 1994 Mild gestational Cohort AN Other medical or obstetric comorbidities Portable BP monitor Not stated Antepartum hospitalization, pregnancy prolongation,
[13] hypertension with telemetry maternal and perinatal outcomes (small for gestational
(n = 592) age, preterm delivery, gestational age at delivery)
Peek et al. 1996 Women with HDP Cohort AN History of hypertension, renal disease, diabetes or collagen Ambulatory BP Not stated Development of proteinuria, preterm delivery, birth
[18] > 20 weeks’ vascular disease monitoring without weight < 10th centile, admission to NICU, cesarean
gestation telemetry delivery
Ross-McGill et al. Low risk women RCT AN Multiple pregnancy, previous early onset PE, serious medical Portable BP monitor Number of total hospital Anxiety scores, number of BP measured weeks
2000 [21] (n = 80) disease, history of late pregnancy loss without telemetry visits
Fukushima et al. Women with HDP Case- AN Patients who remained hospitalized until delivery, Portable BP monitor Not stated Gestational age at delivery, mean arterial BP,
2002 [15] (n = 199) control BP < 160/110 mm/Hg tested at least 3 times, delivery with telemetry birthweight, duration of pregnancy after recruitment,
within a week after the first test or before 20 weeks’ gestation perinatal death
Rhodes et al. Women with HDP RCT AN Concurrent medical conditions, multiple pregnancies, a Ambulatory BP Feasibility Need for antihypertensive medication, the number of
2017 [20] (n = 100) clinical BP requiring emergency medical intervention, age monitoring without antenatal clinic or day unit visits, the duration of hospital
< 16 years telemetry stay and induction of labour
Perry et al. 2018 Women with HDP Case- AN < 16 years, severe hypertension, significant proteinuria, Portable BP monitor Not stated Neonatal death, respiratory distress syndrome,
[4] (n = 166) control estimated fetal weight < 10th centile, signs of severe PE, with telemetry intraventricular hemorrhage, necrotizing enterocolitis,

18
significant mental health concerns or insufficient bronchopulmonary dysplasia, periventricular
understanding of the English language leukomalacia, retinopathy of prematurity, seizure and
admission to the NICU for more than 48 h, preterm
delivery, small-for-gestational age, perinatal fetal death,
serious maternal morbidity or mortality
Rhoads et al. Women with PE Cohort PP Psychiatric disorders, no phone access Portable BP monitor Factors for acceptance Perceived satisfaction, ease of use and benefits
2018 [19] (n = 48) with telemetry
Cairns et al. 2018 Women with GH or RCT PP > 3 antihypertensive medications, self-report of Portable BP monitor Feasibility Mean arterial BP, postnatal readmission rates, safety
[14] PE (n = 82) hypertension prior to pregnancy, and inability to speak with telemetry data, side effects, and quality of life scores
English
Lanssens et al. Women with HDP Cohort AN Women at gestational age of < 10 weeks, or lack of consent Portable BP monitor Number of prenatal Gestational age at delivery, intended and actual mode of
2018 [17] (n = 320) with telemetry consultations delivery. birth weight, Apgar scores, and NICU
admissions
Hirshberg et al. Women with HDP RCT PP Readmissions for new-onset postpartum hypertension Portable BP monitor Number of patients who Initiation of antihypertensive medication, number of
2018 [16] (n = 206) with telemetry reported a measured BP additional postpartum office or emergency room visits
within 10 days and readmission for persistent hypertension, attendance
of the 4–6 week postpartum visit, patient satisfaction
with BP surveillance and future health awareness

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AN: antenatal, PP: postpartum, RCT: randomized controlled trial, HDP: hypertensive disorders of pregnancy, NICU: neonatal intensive care unit, BP: blood-pressure. PE: preeclampsia, GH: gestational hypertension, CHT:
chronic hypertension, HELLP: hemolysis, elevated liver enzymes and low platelet.
請遵守請遵守著作權法之規範：本館以電子檔案傳遞具有保全設定之文獻，僅供列印使用，請勿任意傳送與重製；應覽人供個人研究之要求，得重製已公開發表著作之一部分，或期刊或已公開發表之研討會論文集之單篇著作，每人以一份為限

Pregnancy Hypertension 18 (2019) 14–20

 E. Kalafat, et al.

Table 4
Pregnancy outcomes following home blood pressure monitoring compared to standard hospital/clinic blood pressure monitoring.
Authors and years GA at delivery in Antenatal visits Follow-up duration SGA (< 10th Preterm delivery Induction of labor Maternal NICU admission Perinatal death PP visit adherence
weeks centile) n (%) (< 37 weeks) n (%) morbidity*

Barton et al. 1994 36.7 (3.6) – – 34 (5.7) 156 (30.1) – 133 (25.6) – –
[13]
Cairns et al. 2018 N/A postpartum – – – – – – – – 41/45 (91.1) vs.
[14] 43/46 (93.5)
Fukushima et al. 35.8 (3.4) vs. 38.2 – 108.0 (75.0) vs. – – – – – 1/19 (5.3) vs. 1/ –
2002 [15] (5.4) 70.0 (62.0) 180 (1.0)
Hirshberg et al. N/A postpartum – – – – – – – – 71/103 (68.9) vs.
2018 [16] 60/103 (58.3)
Lanssens et al. 2018 37.5 (2.8) vs. 36.8 6.93 (3.86) vs. – – – 28/86 (32.6) vs. 18/86 (20.9) vs. 8/86 (9.3) vs. 36/ – –
[17] (3.6) 7.62 (3.33) 100/215 (46.5) 104/215 (48.4) 215 (16.7)

19
Peek et al. 1996† – – – 13/77 (16.9) vs. 11/45 (24.4) vs. 6/24 – 20/77 (30.0) vs. 9/77 (11.7) vs. 6/ – –
[18] 6/38 (15.8) (25.0) 13/38 (34.2) 38 (15.8)
Perry et al. 2018 39.0 [37.6–40.3] vs. 0.8 [0.4–1.5] vs. 8.1 [3.4–16.5] vs. 27/108 (25.0) vs. 14/58 (24.1)‡ – 22/108 (20.4) vs. 12/108 (11.1) vs. 0/108 (0.0) vs. –
[4] 39.3 [38.0–40.6] 1.6 [1.0–2.3] 4.9 [3.3–9.3] 20/58 (34.5) 11/58 (19.0) 0/58 (0.0)
Rhodes et al. 2017 – – – – – 19/51 (37.3) vs. – – – –
[20] 24/49 (49.0)
Ross-McGill et al. – 4.5 (2.2) vs. 7.4 – – – – – – – –
2000 [18] (2.2)†
Current study 38.9 [37.5–39.7] vs. 1.4 [0.8–2.4] vs. 4.8 [1.8–8.6] vs. 19/80 (23.8) vs. – 37/80 (46.3) vs. 20/80 (25.0) vs. 4/80 (5.0) vs. 5/ 0/80 (0.0) vs. 0/ –
39.4 [38.3–40.4] 1.8 [1.2–2.5]† 3.6 [2.2–5.3] 11/63 (17.5) 39/63 (61.9) 22/63 (34.9) 63 (7.9) 63 (0.0)

Data are presented as mean (standard deviation), median [interquartile range] or n/N (%) for continuous and categorical variables, respectively.
NA: not applicable, –: not reported, HBPM: home blood-pressure monitoring, NICU: neonatal intensive care unit, PP: postpartum.
* Development of preeclampsia and/or HELLP syndrome.
†
Data from this study represents the number of pregnancy outcome cases occurring according to the home-blood pressure or day-care unit measurements.
‡
Reported as a composite outcome.

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請遵守請遵守著作權法之規範：本館以電子檔案傳遞具有保全設定之文獻，僅供列印使用，請勿任意傳送與重製；應覽人供個人研究之要求，得重製已公開發表著作之一部分，或期刊或已公開發表之研討會論文集之單篇著作，每人以一份為限

Pregnancy Hypertension 18 (2019) 14–20

請遵守請遵守著作權法之規範：本館以電子檔案傳遞具有保全設定之文獻，僅供列印使用，請勿任意傳送與重製；應覽人供個人研究之要求，得重製已公開發表著作之一部分，或期刊或已公開發表之研討會論文集之單篇著作，每人以一份為限

E. Kalafat, et al. Pregnancy Hypertension 18 (2019) 14–20

Declaration of Competing Interest disorders of pregnancy: a revised statement from the isshp, Pregnancy Hypertens. 4
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