Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, and the Center for Digital Health, Brown School of Public Health, Providence, Rhode Island; and the Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Obstet Gynecol. 2024 Sep 1;144(3):339-345. doi: 10.1097/AOG.0000000000005690. Epub 2024 Jul 25.
Perinatal mortality and severe maternal morbidity among individuals with hypertensive disorders of pregnancy (HDP) are often driven by persistent, uncontrolled hypertension. Whereas traditional perinatal blood pressure (BP) ascertainment occurs through in-person clinic appointments, self-measured blood pressure (SMBP) programs allow individuals to measure their BP remotely and receive remote management by a medical team. Though data remain limited on clinically important outcomes such as maternal morbidity, these programs have shown promise in improving BP ascertainment rates in the immediate postpartum period and enhancing racial and ethnic equity in BP ascertainment after hospital discharge. In this narrative review, we provide an overview of perinatal SMBP programs that have been described in the literature and the data that support their efficacy. Furthermore, we offer suggestions for practitioners, institutions, and health systems that may be considering implementing SMBP programs, including important health equity concerns to be considered. Last, we discuss opportunities for ongoing and future research regarding SMBP programs' effects on maternal morbidity, long-term health outcomes, inequities that are known to exist in HDP and HDP-related outcomes, and the cost effectiveness of these programs.
围产期死亡率和严重孕产妇发病率在患有妊娠高血压疾病(HDP)的个体中往往是由持续、不受控制的高血压引起的。虽然传统的围产期血压(BP)评估是通过门诊预约进行的,但自我测量血压(SMBP)计划允许个体远程测量血压,并接受医疗团队的远程管理。尽管关于孕产妇发病率等临床重要结局的数据仍然有限,但这些计划已显示出在改善产后即刻血压评估率以及提高医院出院后 BP 评估的种族和族裔公平性方面的潜力。在这篇叙述性综述中,我们概述了文献中描述的围产期 SMBP 计划及其支持其疗效的数据。此外,我们为可能考虑实施 SMBP 计划的从业者、机构和医疗系统提供建议,包括需要考虑的重要公平性问题。最后,我们讨论了关于 SMBP 计划对孕产妇发病率、长期健康结局、HDP 和 HDP 相关结局中已知存在的不平等以及这些计划的成本效益的持续和未来研究的机会。