1
|
Pihl K, McManus RJ, Stevens R, Tucker KL. Comparison of clinic and home blood pressure readings in higher risk pregnancies - Secondary analysis of the BUMP 1 trial. Pregnancy Hypertens 2024; 36:101114. [PMID: 38394949 DOI: 10.1016/j.preghy.2024.101114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/06/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE To compare clinic and home blood pressure readings in higher risk pregnancies in the antenatal period from 20 weeks gestation, and to evaluate differences between the two modalities. STUDY DESIGN A cohort study comprising a secondary analysis of a large randomised controlled trial (BUMP 1). POPULATION Normotensive women at higher risk of pregnancy hypertension randomised to self-monitoring of blood pressure. MAIN OUTCOME MEASURES The primary outcome was the overall mean difference between clinic and home readings for systolic blood pressure (sBP) and diastolic blood pressure (dBP). Blood pressure readings were averaged across each gestational week for each participant and compared within the same gestational week. Calculations of the overall differences were based on the average difference for each week for each participant. RESULTS The cohort comprised 925 participants. In total, 92 (10 %) developed a hypertensive disorder during the pregnancy. A significant difference in the overall mean sBP (clinic - home) of 1.1 mmHg (0.5-1.6 95 %CI) was noted, whereas no significant difference for the overall mean dBP was found (0.0 mmHg (-0.4-0.4 95 %CI)). No tendency of proportional bias was noted based on Bland-Altman plots. Increasing body mass index in general increased the difference (clinic - home) for both sBP and dBP in a multivariate analysis. CONCLUSIONS No clinically significant difference was found between clinic and home blood pressure readings in normotensive higher risk pregnancies from gestational week 20+0 until 40+0. Clinic and home blood pressure readings might be considered equal during pregnancy in women who are normotensive at baseline.
Collapse
Affiliation(s)
- Kasper Pihl
- Department for Continuing Education, University of Oxford, Oxford, United Kingdom; Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
| | - Richard Stevens
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Katherine L Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
2
|
Lavallee L, Roman C, Brace E, Mackillop L, Yang Y, Cairns A, Dockree S, Tarassenko L, McManus RJ, Wilson H, Tucker K. Rapid implementation of blood pressure self-monitoring in pregnancy at a UK NHS Trust during the COVID-19 pandemic: a quality improvement evaluation. BMJ Open Qual 2024; 13:e002383. [PMID: 38816006 PMCID: PMC11141177 DOI: 10.1136/bmjoq-2023-002383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/13/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND This service evaluation describes the rapid implementation of self-monitoring of blood pressure (SMBP) into maternity care at a tertiary referral centre during the COVID-19 pandemic. It summarises findings, identifies knowledge gaps and provides recommendations for further research and practice. INTERVENTION Pregnant and postpartum women monitored their blood pressure (BP) at home, with instructions on actions to take if their BP exceeded pre-determined thresholds. Some also conducted proteinuria self-testing. DATA COLLECTION AND ANALYSIS Maternity records, app data and staff feedback were used in interim evaluations to assess process effectiveness and guide adjustments, employing a Plan-Do-Study-Act and root cause analysis approach. RESULTS Between March 2020 and August 2021, a total of 605 women agreed to self-monitor their BP, including 10 women with limited English. 491 registered for telemonitoring (81.2%). 21 (3.5%) took part in urine self-testing. Engagement was high and increased over time with no safety issues. Biggest concerns related to monitor supply and postnatal monitoring. In December 2020, SMBP was integrated into the standard maternity care pathway. CONCLUSIONS This project demonstrated successful integration of SMBP into maternity care. Early stakeholder engagement and clear guidance were crucial and community midwifery support essential. Supplying BP monitors throughout pregnancy and post partum could improve the service and fully digitised maternity records would aid data collection. More research is needed on SMBP in the postnatal period and among non-English speakers. These findings support efforts to implement app-supported self-monitoring and guide future research.
Collapse
Affiliation(s)
- Layla Lavallee
- Nuffield Department of Primary Care Health Sciences, University of Oxford Medical Sciences Division, Oxford, UK
| | - Cristian Roman
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford Mathematical, Physical and Life Sciences Division, Oxford, UK
| | - Emily Brace
- Maternity Safety Support Program, NHS England and NHS Improvement London, London, UK
| | - Lucy Mackillop
- Nuffield Department of Women's & Reproductive Health, University of Oxford Medical Sciences Division, Oxford, UK
| | - Yaling Yang
- Nuffield Department of Primary Care Health Sciences, University of Oxford Medical Sciences Division, Oxford, UK
| | | | - Samuel Dockree
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, University of Oxford Mathematical, Physical and Life Sciences Division, Oxford, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford Medical Sciences Division, Oxford, UK
| | - Hannah Wilson
- King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Katherine Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford Medical Sciences Division, Oxford, UK
| |
Collapse
|
3
|
Gerits ML, Bielen S, Lanssens D, Luyten J, Gyselaers W. Experience Counts: Unveiling Patients' Willingness to Pay for Remote Monitoring and Patient Self-Measurement. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02371-4. [PMID: 38795963 DOI: 10.1016/j.jval.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/18/2024] [Accepted: 05/13/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES This study aimed to (1) estimate patients' willingness to pay (WTP) for remote monitoring (RM) and patient self-measurement (PSM) for pregnant women at risk of gestational hypertensive disorders, (2) assess the impact of experience with these technologies on WTP, and (3) determine their impact on health-related quality of life (HRQoL). METHODS Data collection was part of a multicentric randomized controlled trial, Pregnancy Remote Monitoring II, with 2 interventions: RM and PSM. A contingent valuation survey, combining a payment card and open-ended question, was completed twice by 199 participants. Two-part models analyze the impact of experience on WTP, regression models estimated using ordinary least squares the impact of RM and PSM on HRQoL. RESULTS The mean WTP amount was approximately €120 for RM and €80 for PSM. Compared with having no experience, WTP RM was €63 higher after a long-term exposure to RM (P = .01) and WTP PSM was €26 lower after a short-term exposure to RM (P = .07). No significant impact of RM or PSM on HRQoL was found. CONCLUSIONS This study contributes to the discussion on the impact of experience on WTP. Those who had a long-term experience with RM, were willing to pay more for RM than those without experience. This confirms our hypothesis that involving patients without experience with the valued treatment, possibly underestimates WTP. A long-term experience has, however, no impact on the WTP for technologies for which the potential benefits are apparent without experiencing them, such as PSM.
Collapse
Affiliation(s)
- Marie-Lien Gerits
- Faculty of Business Economics, Hasselt University, Hasselt, Limburg, Belgium.
| | - Samantha Bielen
- Faculty of Business Economics, Hasselt University, Hasselt, Limburg, Belgium
| | - Dorien Lanssens
- Department of Physiology, Hasselt University, Hasselt, Limburg, Belgium; Mobile health unit, Hasselt University, Hasselt, Limburg, Belgium
| | - Janis Luyten
- Faculty of Business Economics, Hasselt University, Hasselt, Limburg, Belgium
| | - Wilfried Gyselaers
- Department of Physiology, Hasselt University, Hasselt, Limburg, Belgium; Department of Obstetrics, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium
| |
Collapse
|
4
|
Chisholm A, Tucker KL, Crawford C, Green M, Greenfield S, Hodgkinson J, Lavallee L, Leeson P, Mackillop L, McCourt C, Sandall J, Wilson H, Chappell LC, McManus RJ, Hinton L. Self-monitoring blood pressure in Pregnancy: Evaluation of health professional experiences of the BUMP trials. Pregnancy Hypertens 2024; 35:88-95. [PMID: 38301352 DOI: 10.1016/j.preghy.2024.01.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/15/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The BUMP trials evaluated a self-monitoring of blood pressure intervention in addition to usual care, testing whether they improved detection or control of hypertension for women at risk of hypertension or with hypertension during pregnancy. This process evaluation aimed to understand healthcare professionals' perspectives and experiences of the BUMP trials of self-monitoring of blood pressure during pregnancy. METHODS Twenty-two in-depth qualitative interviews and an online survey with 328 healthcare professionals providing care for pregnant people in the BUMP trials were carried out across five maternity units in England. RESULTS Analysis used Normalisation Process Theory to identify factors required for successful implementation and integration into routine practice. Healthcare professionals felt self-monitoring of blood pressure did not over-medicalise pregnancy for women with, or at risk of, hypertension. Most said self-monitored readings positively affected their clinical encounters and professional roles, provided additive information on which to base decisions and enriched their relationships with pregnant people. Self-monitoring of blood pressure shifts responsibilities. Some healthcare professionals felt women having responsibility to decide on timing of monitoring and whether to act on self-monitored readings was unduly burdensome, and resulted in healthcare professionals taking additional responsibility for supporting them. CONCLUSIONS Despite healthcare professionals' early concerns that self-monitoring of blood pressure might over-medicalise pregnancy, our analysis shows the opposite was the case when used in the care of pregnant people with, or at higher risk of, hypertension. While professionals retained ultimate clinical responsibility, they viewed self-monitoring of blood pressure as a means of sharing responsibility and empowering women to understand their bodies, to make judgements and decisions, and to contribute to their care.
Collapse
Affiliation(s)
- Alison Chisholm
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Katherine L Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Carole Crawford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Marcus Green
- Action on Pre-eclampsia, The Stables, 80 B High Street, Evesham, Worcestershire, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, College of Medical and Dental Sciences, Birmingham B15 2TT, UK
| | - James Hodgkinson
- Institute of Applied Health Research, University of Birmingham, College of Medical and Dental Sciences, Birmingham B15 2TT, UK
| | - Layla Lavallee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Paul Leeson
- Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, University of Oxford, Level 1 Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Lucy Mackillop
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Level 3, Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Christine McCourt
- Centre for Maternal & Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
| | - Jane Sandall
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Hannah Wilson
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Lucy C Chappell
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| |
Collapse
|
5
|
Tucker KL, Hinton L, Green M, Chappell LC, McManus RJ. Using self-monitoring to detect and manage raised blood pressure and pre-eclampsia during pregnancy: the BUMP research programme and its impact. Hypertens Res 2024; 47:714-720. [PMID: 38062200 PMCID: PMC10912026 DOI: 10.1038/s41440-023-01474-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/06/2023] [Accepted: 09/27/2023] [Indexed: 03/06/2024]
Abstract
Raised blood pressure affects around ten percent of pregnancies worldwide, causing maternal and perinatal morbidity and mortality. Self-monitoring of blood pressure during higher-risk or hypertensive pregnancy has been shown to be feasible, acceptable, safe, and no more expensive than usual care alone. Additionally, self-testing for proteinuria has been shown to be just as accurate as healthcare professional testing, creating the potential for monitoring of multiple indicators through pregnancy. The work suggests however, that an organisational shift is needed to properly use and see benefits from self-monitored readings. This paper describes the findings from a large programme of work examining the use of self-monitoring in pregnancy, summarising the findings in the context of the wider literature and current clinical context. The BUMP Research Programme developed and tested self-monitoring and self-testing interventions for pregnancy. The work showed that self-monitoring during pregnancy was feasible, acceptable, safe, and no more expensive, but did not improve the detection or control of hypertension.
Collapse
Affiliation(s)
- Katherine L Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lisa Hinton
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Marcus Green
- Action on Pre-Eclampsia (APEC), Charity, Worcestershire, UK
| | - Lucy C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| |
Collapse
|
6
|
Tran KC, Freiman S, Chaworth-Musters T, Purkiss S, Foster C, Khan NA, Chan WS. Implementation of a home blood pressure monitoring program for the management of hypertensive disorders of pregnancy, an observational study in British Columbia, Canada. Obstet Med 2024; 17:22-27. [PMID: 38660327 PMCID: PMC11037197 DOI: 10.1177/1753495x231172050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/09/2023] [Indexed: 04/26/2024] Open
Abstract
Background COVID-19 pandemic has influenced health care delivery. We conducted an observational study to understand how obstetric medicine (ObM) physicians utilized home blood pressure monitoring (HBPM) to manage hypertension in pregnancy. Methods Pregnant participants with risk factors or diagnosis of hypertensive disorders of pregnancy (HDP) were enrolled, May 2020-December 2021, and provided with validated home blood pressure (BP) monitor. ObM physicians completed questionnaires to elicit how home BP readings were interpreted to manage HDP. Results We enrolled 103 people: 44 antepartum patients (33.5 ± 5 years, gestational age of 24 ± 5 weeks); 59 postpartum patients (35 ± 6 years, enrolled 6 ± 4 days post-partum). ObM physicians used range of home BP readings (70%) for management of HDP. Conclusions HBPM to manage HDP is acceptable and can be used to manage hypertension during pregnancy. Further studies are needed to assess the generalizability of our findings and the safety of HBPM reliance alone in management of HDP.
Collapse
Affiliation(s)
- Karen C Tran
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Sabina Freiman
- Internal Medicine Residency Training Program, University of British Columbia, Vancouver, Canada
| | - Tessa Chaworth-Musters
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Susan Purkiss
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Colleen Foster
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Nadia A Khan
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Wee Shian Chan
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|
7
|
Sentilhes L, Schmitz T, Arthuis C, Barjat T, Berveiller P, Camilleri C, Froeliger A, Garabedian C, Guerby P, Korb D, Lecarpentier E, Mattuizzi A, Sibiude J, Sénat MV, Tsatsaris V. [Preeclampsia: Guidelines for clinical practice from the French College of Obstetricians and Gynecologists]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:3-44. [PMID: 37891152 DOI: 10.1016/j.gofs.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To identify strategies to reduce maternal and neonatal morbidity related to preeclampsia. MATERIAL AND METHODS The quality of evidence of the literature was assessed following the GRADE® method with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on PubMed, Cochrane, EMBASE and Google Scholar databases. The quality of the evidence was assessed (high, moderate, low, very low) and recommendations were formulated as a (i) strong, (ii) weak or (iii) no recommendation. The recommendations were reviewed in two rounds with external reviewers (Delphi survey) to select the consensus recommendations. RESULTS Preeclampsia is defined by the association of gestational hypertension (systolic blood pressure≥140mmHg and/or diastolic blood pressure≥90mmHg) and proteinuria≥0.3g/24h or a Proteinuria/Creatininuria ratio≥30mg/mmol occurring after 20 weeks of gestation. Data from the literature do not show any benefit in terms of maternal or perinatal health from implementing a broader definition of preeclampsia. Of the 31 questions, there was agreement between the working group and the external reviewers on 31 (100%). In general population, physical activity during pregnancy should be encouraged to reduce the risk of preeclampsia (Strong recommendation, Quality of the evidence low) but an early screening based on algorithms (Weak recommendation, Quality of the evidence low) or aspirin administration (Weak recommendation, Quality of the evidence very low) is not recommended to reduce maternal and neonatal morbidity related to preeclampsia. In women with preexisting diabetes or hypertension or renal disease, or multiple pregnancy, the level of evidence is insufficient to determine whether aspirin administration during pregnancy is useful to reduce maternal and perinatal morbidity (No recommendation, Quality of the evidence low). In women with a history of vasculo-placental disease, low dose of aspirin (Strong recommendation, Quality of the evidence moderate) at a dosage of 100-160mg per day (Weak recommendation, Quality of the evidence low), ideally before 16 weeks of gestation and not after 20 weeks of gestation (Strong recommendation, Quality of the evidence low) until 36 weeks of gestation (Weak recommendation, Quality of the evidence very low) is recommended. In a high-risk population, additional administration of low molecular weight heparin is not recommended (Weak recommendation, Quality of the evidence moderate). In case of preeclampsia (Weak recommendation, Quality of the evidence low) or suspicion of preeclampsia (Weak recommendation, Quality of the evidence moderate, the assessment of PlGF concentration or sFLT-1/PlGF ratio is not routinely recommended) in the only goal to reduce maternal or perinatal morbidity. In women with non-severe preeclampsia antihypertensive agent should be administered orally when the systolic blood pressure is measured between 140 and 159mmHg or diastolic blood pressure is measured between 90 and 109mmHg (Weak recommendation, Quality of the evidence low). In women with non-severe preeclampsia, delivery between 34 and 36+6 weeks of gestation reduces severe maternal hypertension but increases the incidence of moderate prematurity. Taking into account the benefit/risk balance for the mother and the child, it is recommended not to systematically induce birth in women with non-severe preeclampsia between 34 and 36+6 weeks of gestation (Strong recommendation, Quality of evidence high). In women with non-severe preeclampsia diagnosed between 37+0 and 41 weeks of gestation, it is recommended to induce birth to reduce maternal morbidity (Strong recommendation, Low quality of evidence), and to perform a trial of labor in the absence of contraindication (Strong recommendation, Very low quality of evidence). In women with a history of preeclampsia, screening maternal thrombophilia is not recommended (Strong recommendation, Quality of the evidence moderate). Because women with a history of a preeclampsia have an increased lifelong risk of chronic hypertension and cardiovascular complications, they should be informed of the need for medical follow-up to monitor blood pressure and to manage other possible cardiovascular risk factors (Strong recommendation, Quality of the evidence moderate). CONCLUSION The purpose of these recommendations was to reassess the definition of preeclampsia, and to determine the strategies to reduce maternal and perinatal morbidity related to preeclampsia, during pregnancy but also after childbirth. They aim to help health professionals in their daily clinical practice to inform or care for patients who have had or have preeclampsia. Synthetic information documents are also offered for professionals and patients.
Collapse
Affiliation(s)
- Loïc Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France.
| | - Thomas Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, Paris, France
| | - Chloé Arthuis
- Service d'obstétrique et de médecine fœtale, Elsan Santé Atlantique, 44819 Saint-Herblain, France
| | - Tiphaine Barjat
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Saint-Etienne, Saint-Etienne, France
| | - Paul Berveiller
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Poissy St-Germain, Poissy, France
| | - Céline Camilleri
- Association grossesse santé contre la pré-éclampsie, Paris, France
| | - Alizée Froeliger
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - Charles Garabedian
- Service de gynécologie-obstétrique, University Lille, ULR 2694-METRICS, CHU de Lille, 59000 Lille, France
| | - Paul Guerby
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Toulouse, Toulouse, France
| | - Diane Korb
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, Paris, France
| | - Edouard Lecarpentier
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Créteil, Créteil, France
| | - Aurélien Mattuizzi
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - Jeanne Sibiude
- Service de gynécologie-obstétrique, hôpital Louis-Mourier, AP-HP, Colombes, France
| | - Marie-Victoire Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Vassilis Tsatsaris
- Maternité Port-Royal, hôpital Cochin, GHU Centre Paris cité, AP-HP, FHU PREMA, Paris, France
| |
Collapse
|
8
|
Tucker KL, McManus RJ. Safe care from home for complicated pregnancies? Lancet Digit Health 2023; 5:e103-e104. [PMID: 36828601 DOI: 10.1016/s2589-7500(23)00018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Katherine L Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK.
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| |
Collapse
|
9
|
Wilson H, Tucker KL, Chisholm A, Hodgkinson J, Lavallee L, Mackillop L, Cairns AE, Hinton L, Podschies C, Chappell LC, McManus RJ. Self-monitoring of blood pressure in pregnancy: A mixed methods evaluation of a national roll-out in the context of a pandemic. Pregnancy Hypertens 2022; 30:7-12. [PMID: 35933759 PMCID: PMC9364829 DOI: 10.1016/j.preghy.2022.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/08/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022]
Abstract
Objective To evaluate how English maternity units implemented self-monitoring of blood pressure (SMBP) in pregnancy in response to the COVID-19 pandemic. Design Mixed methods including surveys, anonymised patient data and in-depth interviews with women. Setting Maternity units across England. Participants 45 maternity units completed a survey about the implementation of SMBP (supported by the provision of guidance and blood pressure monitors) during the pandemic, 166 women completed a survey about their experiences of SMBP, and 23 women took part in in-depth interviews. Clinical data from 627 women undertaking SMBP were available from 13 maternity units. Results SMBP was predominantly used to provide additional BP monitoring for hypertensive or high-risk pregnant women. Overall maternity units and women were positive about its use in terms of reducing the need for additional face-to-face contacts and giving women more control and insight into their own BP. However, there were challenges in setting up SMBP services rapidly and embedding them within existing care pathways, particularly around interpreting readings and managing the provision of monitors. Conclusions A considerable proportion of maternity units in England commenced a SMBP service for hypertensive or high-risk women from March 2020. There is a need for further research into appropriate care pathways, including guidance around white coat or masked hypertension and the use of SMBP postnatally.
Collapse
Affiliation(s)
- Hannah Wilson
- School of Life Course Sciences, King's College London, London, UK
| | - Katherine L Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Alison Chisholm
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - James Hodgkinson
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - Layla Lavallee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lucy Mackillop
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford
| | - Alexandra E Cairns
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford
| | - Lisa Hinton
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Charlie Podschies
- Maternity and Women's Health Policy Team, NHS England and NHS Improvement, UK
| | - Lucy C Chappell
- School of Life Course Sciences, King's College London, London, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
10
|
McCulloch H, Morelli A, Free C, Syred J, Botelle R, Baraitser P. Agreement between self-reported and researcher-measured height, weight and blood pressure measurements for online prescription of the combined oral contraceptive pill: an observational study. BMJ Open 2022; 12:e054981. [PMID: 35613749 PMCID: PMC9131065 DOI: 10.1136/bmjopen-2021-054981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To compare agreement between self-reported height, weight and blood pressure measurements submitted to an online contraceptive service with researcher-measured values and document strategies used for self-reporting. DESIGN An observational study. SETTING An online sexual health service which provided the combined oral contraceptive pill, free of charge, to users in Southeast London, England. PARTICIPANTS Between August 2017 and August 2019, 365 participants were recruited. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome, for which the study was powered, was the agreement between self-reported and researcher-measured body mass index (BMI) and blood pressure measurements, compared using kappa coefficients. Secondary measures of agreement included sensitivity, specificity and Bland Altman plots. The study also describes strategies used for self-reporting and classifies their clinical appropriateness. RESULTS 327 participants fully described their process of blood pressure measurement with 296 (90.5%) classified as clinically appropriate. Agreement between self-reported and researcher-measured BMI was substantial (0.72 (95% CI 0.42 to 1.0)), but poor for blood pressure (0.06 (95% CI -0.11 to 0.23)). Self-reported height and weight readings identified 80.0% (95% CI 28.4 to 99.5) of individuals with a researcher-measured high BMI (≥than 35 kg/m2) and 9.1% (95% CI 0.23 to 41.3) of participants with a researcher-measured high blood pressure (≥140/90 mm Hg). CONCLUSION In this study, while self-reported BMI was found to have substantial agreement with researcher-measured BMI, self-reported blood pressure was shown to have poor agreement with researcher-measured blood pressure. This may be due to the inherent variability of blood pressure, overdiagnosis of hypertension by researchers due to 'white coat syndrome' or inaccurate self-reporting. Strategies to improve self-reporting of blood pressure for remote prescription of the combined pill are needed.
Collapse
Affiliation(s)
- Hannah McCulloch
- King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Alessandra Morelli
- King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Jonathan Syred
- King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Riley Botelle
- King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Paula Baraitser
- Sexual Health, King's College Hospital, London, UK
- Clinical and Evaluation, SH:24 CIC, London, UK
| |
Collapse
|
11
|
Chappell LC, Tucker KL, Galal U, Yu LM, Campbell H, Rivero-Arias O, Allen J, Band R, Chisholm A, Crawford C, Dougall G, Engonidou L, Franssen M, Green M, Greenfield S, Hinton L, Hodgkinson J, Lavallee L, Leeson P, McCourt C, Mackillop L, Sandall J, Santos M, Tarassenko L, Velardo C, Wilson H, Yardley L, McManus RJ. Effect of Self-monitoring of Blood Pressure on Blood Pressure Control in Pregnant Individuals With Chronic or Gestational Hypertension: The BUMP 2 Randomized Clinical Trial. JAMA 2022; 327:1666-1678. [PMID: 35503345 PMCID: PMC9066282 DOI: 10.1001/jama.2022.4726] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/11/2022] [Indexed: 01/02/2023]
Abstract
Importance Inadequate management of elevated blood pressure is a significant contributing factor to maternal deaths. The role of blood pressure self-monitoring in pregnancy in improving clinical outcomes for the pregnant individual and infant is unclear. Objective To evaluate the effect of blood pressure self-monitoring, compared with usual care alone, on blood pressure control and other related maternal and infant outcomes, in individuals with pregnancy hypertension. Design, Setting, and Participants Unblinded, randomized clinical trial that recruited between November 2018 and September 2019 in 15 hospital maternity units in England. Individuals with chronic hypertension (enrolled up to 37 weeks' gestation) or with gestational hypertension (enrolled between 20 and 37 weeks' gestation). Final follow-up was in May 2020. Interventions Participants were randomized to either blood pressure self-monitoring using a validated monitor and a secure telemonitoring system in addition to usual care (n = 430) or to usual care alone (n = 420). Usual care comprised blood pressure measured by health care professionals at regular antenatal clinics. Main Outcomes and Measures The primary maternal outcome was the difference in mean systolic blood pressure recorded by health care professionals between randomization and birth. Results Among 454 participants with chronic hypertension (mean age, 36 years; mean gestation at entry, 20 weeks) and 396 with gestational hypertension (mean age, 34 years; mean gestation at entry, 33 weeks) who were randomized, primary outcome data were available from 444 (97.8%) and 377 (95.2%), respectively. In the chronic hypertension cohort, there was no statistically significant difference in mean systolic blood pressure for the self-monitoring groups vs the usual care group (133.8 mm Hg vs 133.6 mm Hg, respectively; adjusted mean difference, 0.03 mm Hg [95% CI, -1.73 to 1.79]). In the gestational hypertension cohort, there was also no significant difference in mean systolic blood pressure (137.6 mm Hg compared with 137.2 mm Hg; adjusted mean difference, -0.03 mm Hg [95% CI, -2.29 to 2.24]). There were 8 serious adverse events in the self-monitoring group (4 in each cohort) and 3 in the usual care group (2 in the chronic hypertension cohort and 1 in the gestational hypertension cohort). Conclusions and Relevance Among pregnant individuals with chronic or gestational hypertension, blood pressure self-monitoring with telemonitoring, compared with usual care, did not lead to significantly improved clinic-based blood pressure control. Trial Registration ClinicalTrials.gov Identifier: NCT03334149.
Collapse
Affiliation(s)
- Lucy C. Chappell
- Department of Women and Children’s Health, King’s College London, London, United Kingdom
| | - Katherine L. Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ushma Galal
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Helen Campbell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Julie Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rebecca Band
- Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Alison Chisholm
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Carole Crawford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Greig Dougall
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Lazarina Engonidou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Marloes Franssen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Marcus Green
- Action on Pre-eclampsia, The Stables, Evesham, Worcestershire, United Kingdom
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Lisa Hinton
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
| | - James Hodgkinson
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Layla Lavallee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Paul Leeson
- Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Christine McCourt
- Centre for Maternal and Child Health Research, City, University of London, London, United Kingdom
| | - Lucy Mackillop
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Jane Sandall
- Department of Women and Children’s Health, King’s College London, London, United Kingdom
| | - Mauro Santos
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Carmelo Velardo
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Hannah Wilson
- Department of Women and Children’s Health, King’s College London, London, United Kingdom
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
12
|
Tucker KL, Mort S, Yu LM, Campbell H, Rivero-Arias O, Wilson HM, Allen J, Band R, Chisholm A, Crawford C, Dougall G, Engonidou L, Franssen M, Green M, Greenfield S, Hinton L, Hodgkinson J, Lavallee L, Leeson P, McCourt C, Mackillop L, Sandall J, Santos M, Tarassenko L, Velardo C, Yardley L, Chappell LC, McManus RJ. Effect of Self-monitoring of Blood Pressure on Diagnosis of Hypertension During Higher-Risk Pregnancy: The BUMP 1 Randomized Clinical Trial. JAMA 2022; 327:1656-1665. [PMID: 35503346 PMCID: PMC9066279 DOI: 10.1001/jama.2022.4712] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
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.
Collapse
Affiliation(s)
- Katherine L. Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sam Mort
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Helen Campbell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Hannah M. Wilson
- Department of Women and Children’s Health, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Julie Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rebecca Band
- Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Alison Chisholm
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Carole Crawford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Greig Dougall
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Lazarina Engonidou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Marloes Franssen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Marcus Green
- Action on Pre-eclampsia, The Stables, Evesham, Worcestershire, United Kingdom
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
| | - James Hodgkinson
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Layla Lavallee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Paul Leeson
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Christine McCourt
- Centre for Maternal and Child Health Research, City, University of London, London, United Kingdom
| | - Lucy Mackillop
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Jane Sandall
- Department of Women and Children’s Health, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Mauro Santos
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Carmelo Velardo
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Lucy C. Chappell
- Department of Women and Children’s Health, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
13
|
Postel-Vinay N, Shao JD, Pinton A, Servais A, Gebara N, Amar L. Home Blood Pressure Measurement and Self-Interpretation of Blood Pressure Readings During Pregnancy: Hy-Result e-Health Prospective Study. Vasc Health Risk Manag 2022; 18:277-287. [PMID: 35449534 PMCID: PMC9017708 DOI: 10.2147/vhrm.s350478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Hy-Result is a rule management system designed to help patients to be compliant with the home blood pressure measurement (HBPM) monitoring schedule and to understand their BP readings. The aim of the Hy-Result e-Health prospective study is to evaluate the practice and experience of women using the Hy-Result coaching app for self-interpretation of BP readings during and after pregnancy. Methods Participants were asked to: i) measure their BP at home; ii) use the Hy-Result app and send their PDF report to the researcher; iii) answer anonymously to 3 online independent questionnaires (Q). Results A total of 107 women accepted to measure their BP and use the app. Among them 82 (77%) performed HBPM and used successfully the system and 72 (88%) shared to the investigator their PDF report by email. Of these, 95% declared the software was “easy” or “very easy” to use; 93% believe the software helps them to monitor their BP more effectively (74% agree, 18% somewhat agree); 94% that the color code classification was “clear”; 76 (93%) affirmed that the app helped them when consulting their physician for their BP evaluation. Majority (87%) perceived the software to be reliable. Furthermore, 71 (87%) said they trust the system and 51 (62%) declared that performing HBPM and self-interpret their readings was “reassuring” whereas 6 (7%) felt that it was “a concern”. Conclusion This study shows that the majority (88%) of pregnant women performed HBPM and successfully used the Hy-Result software for self-interpretation of the BP readings. The use of the validated Hy-Result system by pregnant women may thus be recommended in common practice by healthcare professionals and patient associations.
Collapse
Affiliation(s)
- Nicolas Postel-Vinay
- Hypertension Unit, ESH Excellence Center, Hôpital Européen Georges Pompidou, APHP, Paris, France
- Hospital at Home, Fondation Santé Service, Levallois, France
- Correspondence: Nicolas Postel-Vinay, Email
| | - Jiali-Delphine Shao
- Faculté de médecine de l’Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Anne Pinton
- Department of Obstetrics and Gynecology, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Aude Servais
- Nephrology and Transplantation Department, Necker Hospital, APHP, Paris, France
| | - Nicole Gebara
- Hypertension Unit, ESH Excellence Center, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Laurence Amar
- Hypertension Unit, ESH Excellence Center, Hôpital Européen Georges Pompidou, APHP, Paris, France
| |
Collapse
|
14
|
Helou A, Stewart K, Ryan K, George J. Pregnant women's experiences with the management of hypertensive disorders of pregnancy: a qualitative study. BMC Health Serv Res 2021; 21:1292. [PMID: 34856992 PMCID: PMC8638107 DOI: 10.1186/s12913-021-07320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022] Open
Abstract
Background Hypertensive disorders are a leading cause of mortality and morbidity during pregnancy. Despite multiple national and international clinical guidelines and a plethora of research in the field of optimising management, there has been limited research describing the perspectives and experiences of pregnant women with the management of hypertensive disorders of pregnancy (HDP). Understanding these perceptions and experiences is imperative to the optimisation of HDP management. Methods A qualitative study involving face-to-face, in-depth interviews were undertaken with 27 pregnant women diagnosed with and being treated for HDP to explore their perspectives of and experiences with clinical management. Written consent was obtained individually from each participant, and the interviews ranged from 16 to 54 min. Inductive codes were generated systematically for the entire data set. Line-by-line analysis was then performed and nodes were created within NVivo, a qualitative data management software. Data collection was continued until thematic saturation was reached. Thematic analysis was employed to interpret the data. Results Three major descriptive themes were discerned regarding the women’s perspectives on and experiences with the management of HDP: attitudes towards monitoring of HDP, attitudes and perceptions towards development and management of complications, and perceptions of pregnant women with chronic hypertension. Trust in the hospital system, positive attitudes towards close blood pressure monitoring as well as self-monitoring of blood pressure, and a realistic approach to emergency antenatal hospital admissions contributed to a positive attitude towards monitoring of HDP. Women with prior experiences of HDP complications, including pre-eclampsia, were more confident in their clinical management and knew what to expect. Those without prior experience were often in shock when they developed pre-eclampsia. Some women with chronic hypertension displayed limited understanding of the potential risks that they may experience during pregnancy and thus lacked comprehension of the seriousness of the condition. Conclusions The clinical management experiences of pregnant women with HDP were varied. Many women did not feel that they were well informed of management decisions and had a desire to be more informed and involved in decision-making. Clear, concise information about various facets of HDP management including blood pressure monitoring, prescription of the appropriate antihypertensive agent, and planning for potential early delivery are required.
Collapse
Affiliation(s)
- Amyna Helou
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Melbourne, Victoria, Australia
| | - Kay Stewart
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Melbourne, Victoria, Australia
| | - Kath Ryan
- Reading School of Pharmacy, University of Reading, Whiteknights, Reading, RG6 6AP, UK
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Melbourne, Victoria, Australia.
| |
Collapse
|
15
|
Changes to management of hypertension in pregnancy, and attitudes to self-management: An online survey of obstetricians, before and following the first wave of the COVID-19 pandemic. Pregnancy Hypertens 2021; 26:54-61. [PMID: 34508949 PMCID: PMC8425952 DOI: 10.1016/j.preghy.2021.08.117] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/18/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aimed to understand the views and practice of obstetricians regarding self-monitoring for hypertensive disorders of pregnancy (blood pressure (BP) and proteinuria), the potential for self-management (including actions taken on self-monitored parameters) and to understand the impact of the COVID-19 pandemic on such views. DESIGN Cross-sectional online survey pre- and post- the first wave of the COVID-19 pandemic. SETTING AND SAMPLE UK obstetricians recruited via an online portal. METHODS A survey undertaken in two rounds: December 2019-January 2020 (pre-pandemic), and September-November 2020 (during pandemic) RESULTS: 251 responses were received across rounds one (150) and two (101). Most obstetricians considered that self-monitoring of BP and home urinalysis had a role in guiding clinical decisions and this increased significantly following the first wave of the COVID-19 pandemic (88%, (132/150) 95%CI: 83-93% first round vs 96% (95%CI: 92-94%), (97/101), second round; p = 0.039). Following the pandemic, nearly half were agreeable to women self-managing their hypertension by using their own readings to make a pre-agreed medication change themselves (47%, 47/101 (95%CI: 37-57%)). CONCLUSIONS A substantial majority of UK obstetricians considered that self-monitoring had a role in the management of pregnancy hypertension and this increased following the pandemic. Around half are now supportive of women having a wider role in self-management of hypertensive treatment. Maximising the potential of such changes in pregnancy hypertension management requires further work to understand how to fully integrate women's own measurements into clinical care.
Collapse
|