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      Impact of Remote Blood Pressure Monitoring Device Connectivity on Engagement Among Pregnant Individuals Enrolled in the Delfina Care Platform: Observational Study

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          Abstract

          User engagement with remote blood pressure monitoring during pregnancy is critical to optimize the associated benefits of blood pressure control and early detection of hypertensive disorders of pregnancy. In our study population of pregnant individuals, we found that connected blood pressure cuffs, which automatically sync measures to a monitoring platform or health record, increase engagement (2.13 [95% CI 1.36‐3.35] times more measures per day) with remote blood pressure monitoring compared to unconnected cuffs that require manual entry of measures.

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          Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy.

          Jennifer A Hutcheon, Sarka Lisonkova, K.S. Joseph (2011)
          Hypertensive disorders of pregnancy include chronic hypertension, gestational hypertension, pre-eclampsia and chronic hypertension with superimposed pre-eclampsia. Pre-eclampsia complicates about 3% of pregnancies, and all hypertensive disorders affect about five to 10% of pregnancies. Secular increases in chronic hypertension, gestational hypertension and pre-eclampsia have occurred as a result of changes in maternal characteristics (such as maternal age and pre-pregnancy weight), whereas declines in eclampsia have followed widespread antenatal care and use of prophylactic treatments (such as magnesium sulphate). Determinants of pre-eclampsia rates include a bewildering array of risk and protective factors, including familial factors, sperm exposure, maternal smoking, pre-existing medical conditions (such as hypertension, diabetes mellitus and anti-phospholipid syndrome), and miscellaneous ones such as plurality, older maternal age and obesity. Hypertensive disorders are associated with higher rates of maternal, fetal and infant mortality, and severe morbidity, especially in cases of severe pre-eclampsia, eclampsia and haemolysis, elevated liver enzymes and low platelets syndrome. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Testing the Feasibility of Remote Patient Monitoring in Prenatal Care Using a Mobile App and Connected Devices: A Prospective Observational Trial

            Kathryn Marko, Jill Krapf, Andrew C. Meltzer … (2016)
            Background Excessive weight gain and elevated blood pressure are significant risk factors for adverse pregnancy outcomes such as gestational diabetes, premature birth, and preeclampsia. More effective strategies to facilitate adherence to gestational weight gain goals and monitor blood pressure may have a positive health benefit for pregnant women and their babies. The impact of utilizing a remote patient monitoring system to monitor blood pressure and weight gain as a component of prenatal care has not been previously assessed. Objective The objective of this study is to determine the feasibility of monitoring patients remotely in prenatal care using a mobile phone app and connected digital devices. Methods In this prospective observational study, 8 women with low risk pregnancy in the first trimester were recruited at an urban academic medical center. Participants received a mobile phone app with a connected digital weight scale and blood pressure cuff for at-home data collection for the duration of pregnancy. At-home data was assessed for abnormal values of blood pressure or weight to generate clinical alerts to the patient and provider. As measures of the feasibility of the system, participants were studied for engagement with the app, accuracy of remote data, efficacy of alert system, and patient satisfaction. Results Patient engagement with the mobile app averaged 5.5 times per week over the 6-month study period. Weight data collection and blood pressure data collection averaged 1.5 times and 1.1 times per week, respectively. At-home measurements of weight and blood pressure were highly accurate compared to in-office measurements. Automatic clinical alerts identified two episodes of abnormal weight gain with no false triggers. Patients demonstrated high satisfaction with the system. Conclusions In this pilot study, we demonstrated that a system using a mobile phone app coupled to remote monitoring devices is feasible for prenatal care.
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              Blood pressure self-monitoring in pregnancy: examining feasibility in a prospective cohort study

              Katherine L. Tucker, Kathryn Taylor, Carole Crawford … (2017)
              Background Raised blood pressure (BP) affects approximately 10% of pregnancies worldwide, and a high proportion of affected women develop pre-eclampsia. This study aimed to evaluate the feasibility of self-monitoring of BP in pregnancy in women at higher risk of pre-eclampsia. Methods This prospective cohort study of self-monitoring BP in pregnancy was carried out in two hospital trusts in Birmingham and Oxford and thirteen primary care practices in Oxfordshire. Eligible women were those defined by the UK National Institute for Health and Care Excellence (NICE) guidelines as at higher risk of pre-eclampsia. A total of 201 participants were recruited between 12 and 16 weeks of pregnancy and were asked to take two BP readings twice daily three times a week through their pregnancy. Primary outcomes were recruitment, retention and persistence of self-monitoring. Study recruitment and retention were analysed with descriptive statistics. Survival analysis was used to evaluate the persistence of self-monitoring and the performance of self-monitoring in the early detection of gestational hypertension, compared to clinic BP monitoring. Secondary outcomes were the mean clinic and self-monitored BP readings and the performance of self-monitoring in the detection of gestational hypertension and pre-eclampsia compared to clinic BP. Results Of 201 women recruited, 161 (80%) remained in the study at 36 weeks or to the end of their pregnancy, 162 (81%) provided any home readings suitable for analysis, 148 (74%) continued to self-monitor at 20 weeks and 107 (66%) at 36 weeks. Self-monitored readings were similar in value to contemporaneous matched clinic readings for both systolic and diastolic BP. Of the 23 who developed gestational hypertension or pre-eclampsia and self-monitored, 9 (39%) had a raised home BP prior to a raised clinic BP. Conclusions Self-monitoring of BP in pregnancy is feasible and has potential to be useful in the early detection of gestational hypertensive disorders but maintaining self-monitoring throughout pregnancy requires support and probably enhanced training. Electronic supplementary material The online version of this article (10.1186/s12884-017-1605-0) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                Mia Charifson:
                ORCID: http://orcid.org/0000-0001-9918-3617
                Timothy Wen:
                ORCID: http://orcid.org/0000-0002-1749-3142
                Bonnie Zell:
                ORCID: http://orcid.org/0009-0005-7203-268X
                Priyanka Vaidya:
                ORCID: http://orcid.org/0009-0006-9299-8657
                Cynthia I Rios:
                ORCID: http://orcid.org/0009-0007-8783-0187
                C Funsho Fagbohun:
                ORCID: http://orcid.org/0009-0000-0404-8819
                Isabel Fulcher:
                ORCID: http://orcid.org/0000-0002-1209-824X
                Journal
                Journal ID (nlm-ta): JMIR Mhealth Uhealth
                Journal ID (iso-abbrev): JMIR Mhealth Uhealth
                Journal ID (hwp): JMU
                Journal ID (publisher-id): mhealth
                Journal ID (index): 13
                Title: JMIR mHealth and uHealth
                Publisher: JMIR mHealth and uHealth
                ISSN (Electronic): 2291-5222
                Publication date Collection: 2024
                Publication date (Electronic): 12 July 2024
                Volume: 12
                Electronic Location Identifier: e55617
                Affiliations
                [1 ]Delfina Care Inc , San Francisco, CA, United States
                [2 ]departmentDepartment of Population Health , New York University , New York, NY, United States
                [3 ]departmentDepartment of Obstetrics, Gynecology, and Reproductive Sciences , University of California San Francisco , San Francisco, CA, United States
                [4 ]Center for Women's Health , Richmond, TX, United States
                Author notes
                MiaCharifsonBA, MA, Delfina Care Inc, 2021 Fillmore St, Ste 37, San Francisco, 94115, CA, United States, 1 5084465769; miac@ 123456delfina.com

                MC reports serving as a data science consultant for Delfina, Inc. TW reports serving as the associate chief medical officer for Delfina, Inc. BZ reports serving as the chief medical officer for Delfina, Inc. PV reports serving as the chief product officer for Delfina, Inc. IF reports serving as the chief scientific officer for Delfina, Inc

                Author information
                http://orcid.org/0000-0001-9918-3617
                http://orcid.org/0000-0002-1749-3142
                http://orcid.org/0009-0005-7203-268X
                http://orcid.org/0009-0006-9299-8657
                http://orcid.org/0009-0007-8783-0187
                http://orcid.org/0009-0000-0404-8819
                http://orcid.org/0000-0002-1209-824X
                Article
                Publisher ID: 55617
                DOI: 10.2196/55617
                PMC ID: 11259580
                PubMed ID: 39012077
                SO-VID: cd1b29aa-d364-466b-ab64-c98f4607ce8d
                Copyright © Copyright © Mia Charifson, Timothy Wen, Bonnie Zell, Priyanka Vaidya, Cynthia I Rios, C Funsho Fagbohun, Isabel Fulcher. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org)
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information, a link to the original publication on https://mhealth.jmir.org/, as well as this copyright and license information must be included.

                History
                Date received : 19 December 2023
                Date revision received : 03 May 2024
                Date accepted : 12 June 2024
                Categories
                Subject: Research Letter
                Subject: mHealth for Symptom and Disease Monitoring, Chronic Disease Management
                Subject: Mobile Health (mhealth)
                Subject: Telehealth and Telemonitoring
                Subject: Clinical Communication, Electronic Consultation and Telehealth
                Subject: Hypertension Prevention and Treatment
                Subject: Pregnancy Information, Education and Lifestyle Interventions
                Subject: Research Letter

                Keywords: blood pressure,hypertension,remote patient monitoring,pregnancy,digital health,remote monitoring,user engagement,users,connected,unconnected,comparison,patient engagement,prospective pregnancy cohort,device,devices,female,females,women,logistic regression,poisson
                Data availability:
                Keywords: blood pressure, hypertension, remote patient monitoring, pregnancy, digital health, remote monitoring, user engagement, users, connected, unconnected, comparison, patient engagement, prospective pregnancy cohort, device, devices, female, females, women, logistic regression, poisson

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