Approbation of self-remote monitoring in high-risk pregnant women

Aim. To study the possibilities of self-remote monitoring of blood pressure and heart rate in high-risk pregnant women.

 Material and methods. Women from 18 to 45 years old with hypertension (chronic and gestational), a history of preeclampsia, a high level of preeclampsia risk (above 1:100), body mass index (BMI) > 30 kg/m² were included in the study to test selfmonitoring of blood pressure using the MedSenger platform. The patients used a home tonometer to measure blood pressure and heart rate daily in the morning and evening and entered data into the personal account of the MedSenger application for 1 month. The doctor monitored the parameters of pregnant women, received notifications in case of deviations and decided on further tactics.

 Results. We planned to include 59 patients in the study, but 25 women (42.4%) refused to participate. 5 Out of 34 pregnant women (average age 30.1±2.3 years) did not activate the program and were excluded. Finally, 29 women took part in the study (49.1% of the initial number). The main reasons for refusing monitoring: no tonometer (30%), no trust in technology (23.3%), no email adress (16.7%), no free time (13.3%), no reason (16.7%).

The average systolic blood pressure in the study was 115±3.7 mmHg, the average diastolic blood pressure was 73±2.8 mmHg, the average heart rate was 84±3.5 per minute. 17 (58.6%) out of the 29 pregnant women completed the monitoring program on time. 12 women (41.8%) (average age 33.1±3.1 years) completed monitoring ahead of schedule.

 Conclusions. Self-remote monitoring of high-risk pregnant women is a feasible technology for remote monitoring.

1. Trends in Maternal Mortality: 2000 to 2017: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality. Accessed May 26, 2023.

2. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). What Are Some Factors That Make a Pregnancy High Risk? Available at: https://www.nichd.nih.gov/health/topics/high-risk/conditioninfo/factors#f1/. Accessed May 26, 2023.

3. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, Gülmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014; 2(6): e323-33. doi: 10.1016/S2214-109X(14)70227-X.

4. Ghulmiyyah L, Sibai B. Maternal mortality from preeclampsia/eclampsia. Semin Perinatol. 2012; 36(1): 56-9. doi: 10.1053/j.semperi.2011.09.011.

5. English FA, Kenny LC, McCarthy FP. Risk factors and effective management of preeclampsia. Integr Blood Press Control. 2015; 8: 7-12. doi: 10.2147/IBPC.S50641.

6. Shanmugalingam R, Wang X, Motum P, Fulcher I, Lee G, Kumar R, et al. Clinical influence of nonadherence with prophylactic aspirin in preventing preeclampsia in high-risk pregnancies: a multicenter, prospective, observational cohort study. Hypertension. 2020; 75(4): 1125-32. doi: 10.1161/HYPERTENSIONAHA.119.14107.

7. Powe CE, Levine RJ, Karumanchi SA. Preeclampsia, a disease of the maternal endothelium: the role of antiangiogenic factors and implications for later cardiovascular disease. Circulation. 2011; 123(24): 2856-69. doi: 10.1161/CIRCULATIONAHA.109.853127.

8. Tooher J, Chiu CL, Yeung K, Lupton SJ, Thornton C, Makris A, et al. High blood pressure during pregnancy is associated with future cardiovascular disease: an observational cohort study. BMJ Open. 2013; 3(7): e002964. doi: 10.1136/bmjopen-2013-002964.

9. Kristensen JH, Basit S, Wohlfahrt J, Damholt MB, Boyd HA. Pre-eclampsia and risk of later kidney disease: nationwide cohort study. BMJ. 2019; 365: l1516. doi: 10.1136/bmj.l1516.

10. Sukhikh GT, Oganov RG, Tkacheva ON, et al. Rezul'taty Rossijskogo mnogocentrovogo epidemiologicheskogo issledovaniya «Lechebno-diagnosticheskaya taktika vedeniya beremennyh s arterial'noj gipertoniej v Rossii «Dialog II». Arterial'naya gipertenziya. 2010; 16(1): 45-51. (In Russ.)

11. Yoder SR, Thornburg LL, Bisognano JD. Hypertension in pregnancy and women of childbearing age. Am J Med. 2009; 122: 890-895. doi: 10.1016/j.amjmed.2009.03.036.

12. Mathews TJ, Hamilton BE. Delayed childbearing: more women are having their first child later in life. National Center for Health Statistics Data Brief. 2009; 21.

13. Bateman BT, Bansil P, Hernandez-Diaz S, Mhyre JM, Callaghan WM, Kuklina EV. Prevalence, trends, and outcomes of chronic hypertension: a nationwide sample of delivery admissions. Am J Obstet Gynecol. 2012; 206: 134.e1-8. doi: 10.1016/j.ajog.2011.10.878.

14. Bramham K, Parnell B, Nelson-Piercy C, Seed PT, Poston L, Chappell LC. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ. 2014; 348: g2301. doi: 10.1136/bmj.g2301.

15. Rath W, Fischer T. The diagnosis and treatment of hypertensive disorders of pregnancy. Dtsch Arztebl Int. 2009; 106(45): 733-8. doi: 10.3238/artebl.2009.0733.

16. Borges do Nascimento IJ, Abdulazeem HM, Vasanthan LT, Martinez EZ, Zucoloto ML, et al. The global effect of digital health technologies on health workers' competencies and health workplace: an umbrella review of systematic reviews and lexical-based and sentence-based meta-analysis. Lancet Digit Health. 2023; 5(8): e534-e544. doi: 10.1016/S2589-7500(23)00092-4.

17. Lanssens D, Vonck S, Storms V, Thijs IM, Grieten L, Gyselaers W. The impact of a remote monitoring program on the prenatal follow-up of women with gestational hypertensive disorders. J Med Internet Res. 2018; 223: 72-8. doi: 10.1016/j.ejogrb.2018.02.015.

18. Lanssens D, Vandenberk T, Smeets C, De Cannière H, Vonck S, Claessens J, et al. Cost- analysis of prenatal remote monitoring of women with gestational hypertensive diseases. J Med Internet Res. 2018; 20(3): e102. doi: 10.2196/jmir.9552.

19. Lanssens D, Vonck S, Vandenberk T, Schraepen C, Storms V, Thijs IM, et al. A prenatal remote monitoring program in pregnancies complicated with gestational hypertensive disorders: what are the contributors to the cost savings? Telemed J E Health. 2019; 25(8): 686-92. doi: 10.1089/tmj.2018.0147.

20. Imershein AW, Turner C, Wells JG, Pearman A. Covering the costs of care in neonatal intensive care units. Pediatrics. 1992; 89(1): 56-61.

21. Pourat N, Martinez AE, Jones JM, Gregory KD, Korst L, Kominski GF. Costs of gestational hypertensive disorders in California: hypertension, preeclampsia, and Eclampsia. Los Angles: UCLA Center for Health Policy Research; 2013.

22. Cuevas MAR, Martínez IL, Domínguez EL, Velázquez YH, Isidro SD, et al. Telemonitoring System Oriented towards High-Risk Pregnant Women. Healthcare. 2022; 10(12): 2484. doi: 10.3390/healthcare10122484.

23. Aquino M, Munce S, Griffith J, Pakosh M, Munnery M, et al. Exploring the Use of Telemonitoring for Patients at High Risk for Hypertensive Disorders of Pregnancy in the Antepartum and Postpartum Periods: Scoping Review. JMIR Mhealth Uhealth. 2020; 8(4): e15095. doi: 10.2196/15095.

24. Perry H, Sheehan E, Thilaganathan B, Khalil A. Home blood-pressure monitoring in a hypertensive pregnant population. Ultrasound Obstet Gynecol. 2018; 51(4): 524-530. doi: 10.1002/uog.19023.

25. Ankudinov NO, Sitnikov AF, Sitnikov FA. Distancionnyj monitoring sostoyaniya zdorov'ya beremennyh v gruppe riska po preeklampsii. Vrach. 2022; 33(1): 49-52. (In Russ.)] doi:10.29296/25877305-2022-01-07.

26. Ankudinov NO, Sitnikov AF, Sitnikov FA. How to optimize the work in obstetrics with the help of «lean» information technologies. Russian Journal of Telemedicine and E-Health. 2021; 7(4): 58-62. (In Russ.)] doi: 10.29188/2712-9217-2021-7-4-58-62.

27. Kontsevaya AV, Shalnova SA, Drapkina OM. ESSERF study: epidemiology and public health promotion. Cardiovascular Therapy and Prevention. 2021; 20(5): 225-232. (In Russ.)] doi:10.15829/1728-8800-2021-2987.

28. Zhou B, Carrillo-Larco RM, Danaei G, et al. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021; 398(10304): 957-80. doi: 10.1016/S0140-6736(21)01330-1.

29. Burnier M, Egan BM. Adherence in Hypertension. Circ Res. 2019; 124(7): 1124-40. doi: 10.1161/CIRCRESAHA.118.313220.

30. Abegaz TM, Shehab A, Gebreyohannes EA, et al. Nonadherence to antihypertensive drugs: A systematic review and meta-analysis. Medicine (Baltimore). 2017; 96(4): e5641. doi: 10.1097/MD.0000000000005641.

31. Shalnova SA, Konradi AО, Balanova YuA, et al. What factors do influence arterial hypertension control in Russia. Cardiovascular Therapy and Prevention. 2018; 17(4): 53-60. (In Russ.) doi: 10.15829/1728-8800-2018-4-53-60.

32. Lee EKP, Poon P, Yip BHK, et al. Global Burden, Regional Differences, Trends, and Health Consequences of Medication Nonadherence for Hypertension During 2010 to 2020: A MetaAnalysis Involving 27 Million Patients. J Am Heart Assoc. 2022; 11(17): e026582. doi: 10.1161/JAHA.122.026582.

33. Helou A, Stewart K, George J. Adherence to anti-hypertensive medication in pregnancy. Pregnancy Hypertens. 2021; 25: 230-234. doi: 10.1016/j.preghy.2021.06.002.

34. Bowen L, Pealing L, Tucker K, McManus RJ, Chappell LC. Adherence with blood pressure self monitoring in women with pregnancy hypertension, and comparisons to clinic readings: A secondary analysis of OPTIMUM-BP. Pregnancy Hypertens. 2021; 25: 68-74. doi: 10.1016/j.preghy.2021.05.016.

35. Mitrofanova IS, Stolbova MV, Sharapov SV, Morina AA. The compliance of pregnant women with arterial hypertension. Nacional'naya associaciya uchenyh. 2015; 4(9): 9-81. (In Russ.)

36. Zhusupova ZhK, Zejnalova DE, Kryukova AYU. Main determinants of addition to treatment of arterial hypertension in pregnant women as prevention of ancient complications. Vestnik soveta molodyh uchyonyh i specialistov Chelyabinskoj oblasti. 2020; 1(28): 17-21. (In Russ.)

37. Shaderkin IA. Telemedicine barriers and ways to overcome them. Russian Journal of Telemedicine and E-Health. 2022; 8(2): 59-76. (In Russ.)] doi: 10.29188/2712-9217-2022-8-2-59-76

38. Vandenberk T, Lanssens D, Storms V, Thijs IM, Bamelis L, Grieten L, Gyselaers W, Tang E, Luyten P. Relationship between adherence to remote monitoring and patient characteristics: observational study in women with pregnancy-induced hypertension. JMIR MhealthUhealth. 2019; 7(8): e12574. doi: 10.2196/12574.

39. van den Heuvel JFM, Teunis CJ, Franx A, Crombag NMTH, Bekker MN. Home-based telemonitoring versus hospital admission in high risk pregnancies: a qualitative study on women's experiences. BMC Pregnancy Childbirth. 2020; 20(1): 77. doi: 10.1186/s12884-020-2779-4.

40. Kerner RYY, Belkin A, Ben-Haroush A, Zeevi B, Hod M. Maternal self-administered fetal heart rate monitoring and transmission from home in high-risk pregnancies. Int J Gynecol Obstet. 2004; 84(1): 33-9. doi: 10.1016/s0020-7292(03)00331-x.

41. Babaeva AD. Vzaimoobuslovlennost' pokazatelej kachestva zhizni i priverzhennosti k lecheniyu i profilaktike arterial'noj gipertonii sredi zhenshchin reproduktivnogo vozrasta. Aktual'nі problemi suchasnoї medicini: Vіsnik ukraїns'koї medichnoї stomatologіchnoї akademії. 2016; 3(55): 33-37. (In Russ.)

42. Dorofeeva EG, Vinogradov VE, Berdinskiy VA. The use of telemedicine technologies in monitoring and supporting of nephrological patients. Digital Diagnostics. 2022; 3(S1): 25-26. (In Russ.)] doi: 10.17816/DD105745.

43.