Understanding the rapid implementation of self-monitoring of blood pressure during pregnancy due to the Covid-19 pandemic

Raised blood pressure is a common problem during pregnancy. Pilot work in pregnancy has shown that self-monitoring of both blood pressure and proteinuria (increased levels of protein in the urine) is feasible and acceptable. (Tucker et al., 2017, Hinton et al., 2017 & Tucker et al., 2017 ) Furthermore, following hypertensive pregnancy postpartum women were able to self-manage their anti-hypertensive medication based on their home readings. (Cairns et al., 2018 & 2020)

We know from a recent survey of over 5000 pregnant women that around half of pregnant women with hypertension already informally self-monitor their blood pressure, although many do not share their readings with health care professionals (Tucker et al., 2020 ). 

Our work exploring antenatal staff attitudes demonstrated they are generally in favour of self-monitoring of blood pressure but had concerns about its impact on women and staff workload and the reliability and accuracy of readings (Hinton et al., 2020 ). No concerns have been raised to date over the safety of self-monitoring (Kalafat et al., 2020).

Self-monitoring of blood pressure was rapidly introduced into antenatal care during the Spring of 2020 due to a need to reduce face-to-face contact. This experience of real life implementation will be valuable in our understanding of how clinical teams and women adapt to using self-monitoring, allowing us to identify barriers and facilitators of successful implementation.

This is a mixed methods research project that will collect the following data:

• Routinely collected data from hospitals and self-monitored readings will be analysed to understand how the remote blood pressure monitoring was used during the pandemic by health care teams and by women.
• Interviews with women and staff about their experiences of self-monitoring.
• Surveys of women and health care professionals.

Patient and public collaborators are integral to this research. The research team includes PPI representatives and we work with the charity Action on Pre-eclampsia to ensure our research is sensitive, suitable, and fits with the attitudes and needs of women.

It is important that our findings are shared with healthcare professionals, the general public and the academic community. We will :

• Work with all collaborators to enable dissemination to health care professionals and within academia
• Work with the charity Action of Pre-Eclampsia to communicate findings to women and clinical teams
• Publish our findings in peer reviewed journals and conference presentations