Home BP monitoring in pregnancy - Covid 19

Raised blood pressure (BP) affects approximately 10% of pregnancies worldwide; almost half of these women develop pre-eclampsia. Globally, around 15% of maternal mortality is due to pre-eclampsia so early detection and prevention are paramount.

The COVID-19 pandemic has required the NHS to urgently consider reducing face to face contacts for pregnant and postnatal women. BP monitoring is a key aspect of antenatal care therefore in order to safely reduce the number of consultations home BP monitoring will be required in particular, for women at higher risk of developing hypertension. Self-monitoring is easy to accomplish and is now commonplace in adults with hypertension outside of pregnancy.

BP self-monitoring in pregnancy can either be used to replace BP measurements on the day of a scheduled clinic (i.e. intermittently) or can be done routinely and more frequently (e.g. daily or weekly) in addition to usual care.

Self-monitoring of BP allows for multiple measurements providing a better estimate of the underlying BP than intermittent clinic measurements. Self-monitoring in pregnancy could improve the detection and subsequent management of gestational hypertensive disorders including pre-eclampsia, while also increasing convenience, empowering and engaging women in their own care and adherence to medication. Service evaluations have been carried out examining its use and the results of trialling this intervention in over 2,400 normotensive women and 600 hypertensive women are expected later in 2020. Self-monitoring has been embedded within NHS maternity care in other parts of the UK including Sunderland and St Georges with service evaluations indicating that home blood pressure monitoring is preferred by women, reduces hospital attendance and is associated with improved blood pressure control. No concerns have been raised to date over safety.

The Scottish Government is supporting rapid implementation and roll-out of BP self-monitoring in pregnant women who are either shielded or at high-risk of hypertensive complications of pregnancy across Scotland.

Building on our experience of Scale-Up BP (home monitoring in the non-pregnant population), we plan to undertake a service evaluation of rapid scale-up of home BP monitoring in pregnancy using routinely recorded clinical data platforms and sources including MaternityTRAK, Badgernet and Florence (https://www.getflorence.co.uk), with/without supplementation with near me consultations (https://services.nhslothian.scot/NHSNearMe/Pages/default.aspx) and to assess the acceptability of home BP monitoring to pregnant women and assess the views and experiences of women and staff using home BP monitoring in antenatal care.