Self-monitoring of blood pressure among women with hypertensive disorders of pregnancy: a systematic review

Abstract

Background The World Health Organization (WHO) recommends self-monitoring of blood pressure (SMBP) for hypertension management. In addition, during the COVID-19 response, WHO guidance also recommends SMBP supported by health workers although more evidence is needed on whether SMBP of pregnant individuals with hypertension (gestational hypertension, chronic hypertension, or pre-eclampsia) may assist in early detection of pre-eclampsia, increase end-user autonomy and empowerment, and reduce health system burden. To expand the evidence base for WHO guideline on self-care interventions, we conducted a systematic review of SMBP during pregnancy on maternal and neonatal outcomes. Methods We searched for publications that compared SMBP with clinic-based monitoring during antenatal care. We included studies measuring any of the following outcomes: maternal mortality, pre-eclampsia, long-term risk and complications, autonomy, HELLP syndrome, C-section, antenatal hospital admission, adverse pregnancy outcomes, device-related issues, follow-up care with appropriate management, mental health and well-being, social harms, stillbirth or perinatal death, birthweight/size for gestational age, and Apgar score. After abstract screening and full-text review, we extracted data using standardized forms and summarized findings. We also reviewed studies assessing values and preferences as well as costs of SMBP. Results We identified 6 studies meeting inclusion criteria for the effectiveness of SMBP, 6 studies on values and preferences, and 1 study on costs. All were from high-income countries. Overall, when comparing SMBP with clinic-monitoring, there was no difference in the risks for most of the outcomes for which data were available, though there was some evidence of increased risk of C-section among pregnant women with chronic hypertension. Most end-users and providers supported SMBP, motivated by ease of use, convenience, self-empowerment and reduced anxiety. One study found SMBP would lower health sector costs. Conclusion Limited evidence suggests that SMBP during pregnancy is feasible and acceptable, and generally associated with maternal and neonatal health outcomes similar to clinic-based monitoring. However, more research is needed in resource-limited settings. Systematic review registration PROSPERO CRD42021233839.

Disruption of diabetes and hypertension care during the COVID-19 pandemic and recovery approaches in the Latin America and Caribbean region: a scoping review protocol

“…Of 175 international systematic reviews identified in PubMed (date of search: 9 December 2022), 10 potentially relevant reviews described impact on glycaemic control,17–20 diabetic ketoacidosis21 and interventions to recover or sustain diabetes or hypertension care 22–26. Overall, improvements in glycaemic control were seen in high-income countries during the pandemic, likely reflecting a high motivation for diabetes self-management due to associations with COVID-19 outcomes, supportive care through teleconsultations, and easier meal-planning, improved sleep habits and reduced access to fast food when staying at home during movement restrictions 17 18.…”

“…Four systematic reviews reported on interventions to sustain diabetes or hypertension care during the COVID-19 pandemic internationally,22 23 25 26 and one review protocol was identified 24. Telehealth and home visits were mentioned as modalities to manage diabetic foot conditions 25.…”

“…Therapies enabling longer durations between consecutive treatments and better triaging of high-risk patients were mentioned as strategies to mitigate healthcare disruptions in a study on diabetes-related retinal deterioration 23. Two reviews indicated self-monitoring of blood pressure as a suitable alternative approach to support hypertension management 22 26. Moreover, a systematic review protocol was identified of a study investigating the impact of telehealth on the quality of life among paediatric diabetes patients 24.…”

“…Moreover, a systematic review protocol was identified of a study investigating the impact of telehealth on the quality of life among paediatric diabetes patients 24. None of the intervention reviews included studies from LAC 22 23 25 26…”

Exploring perceptions and operational considerations for use of a smartphone application to self-monitor blood pressure in pregnancy in Lombok, Indonesia: protocol for a qualitative study

“…A Cochrane systematic review on the different approaches to SMBP in pregnancy indicated uncertainties in the benefits of SMBP of hypertensive pregnancies due to limited number of studies 37. Other systematic reviews on SMBP during antenatal and postpartum periods demonstrated its feasibility but no difference in clinical outcomes,38 while another meta-analyses reported reductions in ANC visits, hospital admissions and diagnosis of pre-eclampsia 39. All systematic reviews highlighted the lack of studies from LMICs and the need for more evidence, particularly across lower resource settings 37–39…”