Comparing standard office-based follow-up with text-based remote monitoring in the management of postpartum hypertension: a randomised clinical trial

Hirshberg, Adi; Downes, Katheryne; Srinivas, Sindhu K.

doi:10.1136/bmjqs-2018-007837

Cited by 133 publications

(157 citation statements)

References 13 publications

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“…While hypertensive diagnoses are frequently made closer to delivery than GDM, there remain opportunities at the time of diagnosis or during antenatal testing to discuss postpartum concerns and recommendations. Technologybased interventions, such as outpatient blood pressure monitoring with text-based feedback, may be another avenue for communicating with women in the postpartum period [21].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Postpartum Counseling on Future Health Risks Associated with Hypertensive Disorders of Pregnancy

Langen¹,

Lewey²,

Triebwasser³

2020

JICOA

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Background: The American College of Obstetricians and Gynecologists and the American Heart Association recommend that women with hypertensive disorders of pregnancy be counseled on lifelong cardiovascular risks and transitioned to primary care for ongoing screening and management. Objective: To assess frequency and content of postpartum counseling regarding cardiovascular risk and follow-up among women with hypertensive disorders of pregnancy. Study Design: A secondary analysis of a randomized trial of women with hypertensive disorders of pregnancy, excluding chronic hypertension, performed at a single tertiary care academic hospital. We abstracted documented counseling on hypertensive disorders from the discharge summary and postpartum visit note in the electronic medical record. We defined counseling as documentation of any one of the following: 1) recommending aspirin in a future pregnancy, 2) follow-up with primary care, or 3) lifelong risk of cardiovascular disease. We used logistic regression models to estimate adjusted odds for receiving counseling. Results: Seventy-four women enrolled in the study. A hypertensive diagnosis was documented for 71 women (96.0%) in the discharge summary, but only 11 (14.9%) had any documented counseling in the discharge summary or postpartum visit note. Of the 11 women counseled, 5 (6.7%) were counseled on taking aspirin in a future pregnancy, 5 (6.7%) were counseled on follow-up with primary care, and only 3 (4.1%) were counseled on the lifelong cardiovascular risk associated with hypertension in pregnancy. Two women (2.7%) were counseled on follow-up with primary care and lifelong cardiovascular risk. There were no participants counseled on all three components. Later gestational age at delivery was associated with lower odds of counseling (adjusted OR 0.49, 95% CI 0.27-0.89). Conclusion: Despite consistent evidence on long-term risks of hypertensive disorders of pregnancy, counseling about those risks is suboptimal. Improved communication of risks is the first step towards improving maternal health in the “fourth trimester” and beyond.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Postpartum Counseling on Future Health Risks Associated with Hypertensive Disorders of Pregnancy

Langen¹,

Lewey²,

Triebwasser³

2020

JICOA

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“…10 In another study that coupled home blood pressure cuffs with text message reminders for remote postpartum blood pressure monitoring, 84% of participants were able to obtain at least one blood pressure reading at home within the first 10 days postpartum, consistent with ACOG guidelines, compared with 30 to 50% of patients receiving a single office-based blood pressure reading. 11 Home telemonitoring following hypertensive pregnancies may additionally serve to reduce disparities in postpartum care. Black women are at higher risk of developing hypertensive disorders of pregnancy and at higher risk of death and poor pregnancy outcomes due to hypertension compared with nonblack peers.…”

Section: Current Evidence For Postpartum Remote Blood Pressure Monitomentioning

confidence: 99%

“…Similarly, the majority of studies on remote blood pressure monitoring were conducted in English-speaking populations, and phone-accessible translation services and multilanguage text messaging options will be critical to establishing more robust evidence for deploying remote monitoring universally and equitably. [8][9][10][11] The impact of changes in insurance coverage for telehealth and blood pressure cuffs during COVID-19 is also a critical area for research. Prior to the pandemic, limited insurance coverage during the postpartum period, as well as for telehealth visits, presented a major barrier to scaling up remote hypertension monitoring.…”

Section: Future Research Directions For Postpartum Remote Monitoringmentioning

confidence: 99%

Establishing Better Evidence on Remote Monitoring for Postpartum Hypertension: A Silver Lining of the Coronavirus Pandemic

Jaffe

Naqvi

Sarma

et al. 2020

AJP Rep

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The transformation of our health care system in response to coronavirus disease 2019 (COVID-19) provides a unique opportunity to examine the use of telehealth for postpartum care. The postpartum period can pose significant risks and challenges, particularly for women with hypertensive disorders of pregnancy. Remote blood pressure monitoring has proven feasible and acceptable among women and providers but has not been widely implemented or researched. Early studies have identified improved outcomes with use of telehealth, including increased compliance with care and decreased disparity in hypertension follow-up. Preliminary data make a compelling case for remote monitoring as a promising treatment strategy to manage postpartum hypertension. Remote monitoring technology should be incorporated as a standard component for the comprehensive management of postpartum hypertension during COVID-19. As a consequence of the pandemic, we now have an opportunity to research the impact of postpartum remote blood pressure monitoring on maternal outcome and disparities within these outcomes.

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“…3 We previously showed that a text messageebased remote blood pressure monitoring program in the early postpartum period was more effective in obtaining these critical blood pressure values compared to in-person office visits in all at-risk women. 4 Non-Hispanic black women suffer a disproportionate amount of hypertensive-related morbidities and are 3 times more likely to die of preeclampsia than white women, 5 likely because of a combination of patient, community, provider, and systems factors. Our office-based follow-up experience is that nonblack women are twice as likely to return for an in-person blood pressure check shortly after discharge compared with black women (42.5% vs 24.1% attendance rate, respectively).…”

Section: Objectivementioning

confidence: 99%

Text message remote monitoring reduced racial disparities in postpartum blood pressure ascertainment

Hirshberg

Sammel

Srinivas

2019

American Journal of Obstetrics and Gynecology

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Comparing standard office-based follow-up with text-based remote monitoring in the management of postpartum hypertension: a randomised clinical trial

Abstract: NCT03185455, Remote Surveillance of Postpartum Hypertension (TextBP), https://clinicaltrials.gov.

Cited by 133 publications

References 13 publications

Evaluation of Postpartum Counseling on Future Health Risks Associated with Hypertensive Disorders of Pregnancy

Evaluation of Postpartum Counseling on Future Health Risks Associated with Hypertensive Disorders of Pregnancy

Establishing Better Evidence on Remote Monitoring for Postpartum Hypertension: A Silver Lining of the Coronavirus Pandemic

Text message remote monitoring reduced racial disparities in postpartum blood pressure ascertainment

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