Key PointsQuestion
Does self-monitoring of blood pressure (BP) by pregnant individuals at higher risk for preeclampsia lead to earlier detection of pregnancy hypertension compared with usual antenatal care?
Findings
In this randomized clinical trial that included 2441 pregnant individuals at increased risk for preeclampsia, self-monitoring of BP with telemonitoring compared with usual care resulted in a mean time to clinic-based detection of hypertension of 104 vs 106 days, a difference that was not statistically significant.
Meaning
Among pregnant individuals at higher risk of preeclampsia, self-monitoring of BP with telemonitoring did not lead to earlier clinic-based detection of hypertension.
Importance
Inadequate management of elevated blood pressure (BP) is a significant contributing factor to maternal deaths. Self-monitoring of BP in the general population has been shown to improve the diagnosis and management of hypertension; however, little is known about its use in pregnancy.
Objective
To determine whether self-monitoring of BP in higher-risk pregnancies leads to earlier detection of pregnancy hypertension.
Design, Setting, and Participants
Unblinded, randomized clinical trial that included 2441 pregnant individuals at higher risk of preeclampsia and recruited at a mean of 20 weeks’ gestation from 15 hospital maternity units in England between November 2018 and October 2019. Final follow-up was completed in April 2020.
Interventions
Participating individuals were randomized to either BP self-monitoring with telemonitoring (n = 1223) plus usual care or usual antenatal care alone (n = 1218) without access to telemonitored BP.
Main Outcomes and Measures
The primary outcome was time to first recorded hypertension measured by a health care professional.
Results
Among 2441 participants who were randomized (mean [SD] age, 33 [5.6] years; mean gestation, 20 [1.6] weeks), 2346 (96%) completed the trial. The time from randomization to clinic recording of hypertension was not significantly different between individuals in the self-monitoring group (mean [SD], 104.3 [32.6] days) vs in the usual care group (mean [SD], 106.2 [32.0] days) (mean difference, −1.6 days [95% CI, −8.1 to 4.9]; P = .64). Eighteen serious adverse events were reported during the trial with none judged as related to the intervention (12 [1%] in the self-monitoring group vs 6 [0.5%] in the usual care group).
Conclusions and Relevance
Among pregnant individuals at higher risk of preeclampsia, blood pressure self-monitoring with telemonitoring, compared with usual care, did not lead to significantly earlier clinic-based detection of hypertension.
Trial Registration
ClinicalTrials.gov Identifier: NCT03334149