Fetal Medicine Unit, St. George's University Hospitals NHS Foundation Trust, London, UK; Middle East Technical University, Department of Statistics, Ankara, Turkey.
Middle East Technical University, Department of Statistics, Ankara, Turkey; Molecular & Clinical Sciences Research Institute, St. George's University of London, London, UK.
Pregnancy Hypertens. 2019 Oct;18:14-20. doi: 10.1016/j.preghy.2019.07.006. Epub 2019 Jul 15.
To assess the safety and efficacy of home blood pressure monitoring (HBPM) and office (traditional) blood pressure measurements in a cohort of pregnant women with gestational hypertension (GH).
This was a cohort study at St. George's Hospital, University of London conducted between December 2013 and August 2018. The inclusion criteria was pregnant women with a diagnosis of GH. Eligible patients were counseled and trained by a specialist midwife and were provided with an automated Microlife® "WatchBP Home" BP machine. Each patient followed an individualised schedule of hospital visits and BP measurements based on the HBPM pathway or standard hospital protocol which was based on the National Institute of Health and Care Excellence (NICE) guideline.
Adverse fetal, neonatal and maternal outcomes as well as number of antenatal hospital visits were recorded and compared between HBPM and office (traditional) pathways.
143 women with GH were included in the study (80 HBPM vs 63 standard care). There were no significant difference between the two groups in maternal high-dependency unit admission (P = 0.999), birth weight centile (P = 0.803), fetal growth restriction (p = 0.999), neonatal intensive care unit admissions (p = 0.507) and composite neonatal (p = 0.654), maternal (p = 0.999) or fetal adverse outcomes (p = 0.999). The number of Day Assessment Unit (DAU) visits was significantly lower in the HBPM group than the traditional pathway (median 4.0 vs. 5.0, P = 0.009). The difference was greater when the number of visits were adjusted for the duration of monitoring in weeks (median: 1.0 vs 1.5, P < 0.001). There were no significant difference between the two groups in the total number of outpatient (P = 0.357) and triage visits (p = 0.237). However, the total number of antenatal visits adjusted for the duration of monitoring was significantly lower for the HBPM group compared to the traditional pathway (median 1.4 vs 1.8, P = 0.020).
HBPM in women with GH results in significantly less antenatal visits compared to women on a standard pathway of care. The two groups had comparable fetal, neonatal and maternal adverse outcomes. Large multicentre studies are needed to ascertain the safety of rare adverse pregnancy outcomes.
评估妊娠期高血压（GH）孕妇群体中家庭血压监测（HBPM）和诊室（传统）血压测量的安全性和有效性。
这是 2013 年 12 月至 2018 年 8 月期间在伦敦圣乔治大学医院进行的一项队列研究。纳入标准为诊断为 GH 的孕妇。符合条件的患者由一名专科助产士进行咨询和培训，并提供自动 Microlife®“WatchBP Home”BP 机。每位患者都根据 HBPM 路径或基于国家卫生与保健卓越研究所（NICE）指南的标准医院方案制定个体化的医院就诊和血压测量时间表。
记录并比较 HBPM 和诊室（传统）路径的不良胎儿、新生儿和产妇结局以及产前医院就诊次数。
本研究纳入 143 例 GH 孕妇（80 例 HBPM 与 63 例标准护理）。两组在母体高依赖单位入院率（P=0.999）、出生体重百分位数（P=0.803）、胎儿生长受限（p=0.999）、新生儿重症监护病房入院率（p=0.507）和复合新生儿（p=0.654）、产妇（p=0.999）或胎儿不良结局（p=0.999）方面无显著差异。HBPM 组的日间评估病房（DAU）就诊次数明显少于传统路径（中位数 4.0 对 5.0，P=0.009）。当根据监测周数调整就诊次数时，差异更大（中位数：1.0 对 1.5，P<0.001）。两组的门诊就诊次数（P=0.357）和分诊就诊次数（p=0.237）无显著差异。然而，与传统路径相比，HBPM 组调整监测时间后的产前就诊次数明显减少（中位数 1.4 对 1.8，P=0.020）。
与标准护理路径相比，GH 女性的 HBPM 可显著减少产前就诊次数。两组的胎儿、新生儿和产妇不良结局相当。需要开展大型多中心研究以确定罕见妊娠不良结局的安全性。
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