Postpartum remote home blood pressure monitoring: the new frontier
There has been an alarming and substantial increase in hypertensive disorders of pregnancy, which are a significant driver of maternal morbidity and mortality. The postpartum period is an especially high-risk time, with >50% of pregnancy-related deaths and significant morbidity occurring during t...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-08-01
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| Series: | AJOG Global Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666577823000928 |
| _version_ | 1797769049515491328 |
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| author | Tiffany Corlin, MD Nandini Raghuraman, MD, MSCI Roxane M. Rampersad, MD Bethany A. Sabol, MD, MAS |
| author_facet | Tiffany Corlin, MD Nandini Raghuraman, MD, MSCI Roxane M. Rampersad, MD Bethany A. Sabol, MD, MAS |
| author_sort | Tiffany Corlin, MD |
| collection | DOAJ |
| description | There has been an alarming and substantial increase in hypertensive disorders of pregnancy, which are a significant driver of maternal morbidity and mortality. The postpartum period is an especially high-risk time, with >50% of pregnancy-related deaths and significant morbidity occurring during this period. The American College of Obstetricians and Gynecologists suggests inpatient or equivalent monitoring of blood pressures in patients with hypertensive disorders of pregnancy for the immediate 72 hours postpartum and again within 7 to 10 days postpartum. Hypertensive disorders of pregnancy significantly contribute to healthcare costs through increasing admission lengths, rates of readmissions, the number of medications given, and laboratory studies ordered, and through the immeasurable impact on the patient and society. Telemedicine is an essential option for patients with barriers to accessing care, particularly those in remote areas with difficulty accessing subspecialty care, transportation, childcare, or job security. The implementation of these programs also has potential to mitigate racial inequities given that patients of color are disproportionately affected by the morbidity and mortality of hypertensive disorders of pregnancy.Remote blood pressure monitoring programs are generally acceptable, with high levels of satisfaction in the obstetrical population without posing an undue burden of care. Studies have reported different, but encouraging, measures of feasibility, including rates of recruitment, consent, engagement, adherence, and retention in their programs. Considering these factors, the widespread adoption of postpartum blood pressure monitoring programs holds promise to improve the identification and care of this at-risk population. These immediate clinical effects are significant and can reduce short-term hypertension-related morbidity and even mortality, with the potential for long-term benefit with culturally competent, well-reimbursed, and widespread use of these programs. This clinical opinion aims to show that remote monitoring of postpartum hypertensive disorders of pregnancy is a reliable and effective alternative to current follow-up care models that achieves improved blood pressure control and diminishes racial disparities in care while simultaneously being acceptable to providers and patients and cost-saving to hospital systems. |
| first_indexed | 2024-03-12T21:02:13Z |
| format | Article |
| id | doaj.art-a325cf7654fd4db6a7a57b77929e1f52 |
| institution | Directory Open Access Journal |
| issn | 2666-5778 |
| language | English |
| last_indexed | 2024-03-12T21:02:13Z |
| publishDate | 2023-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AJOG Global Reports |
| spelling | doaj.art-a325cf7654fd4db6a7a57b77929e1f522023-07-31T04:09:24ZengElsevierAJOG Global Reports2666-57782023-08-0133100251Postpartum remote home blood pressure monitoring: the new frontierTiffany Corlin, MD0Nandini Raghuraman, MD, MSCI1Roxane M. Rampersad, MD2Bethany A. Sabol, MD, MAS3Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, MN (Drs Corlin and Sabol)Department of Obstetrics and Gynecology, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO (Drs Raghuraman and Rampersad)Department of Obstetrics and Gynecology, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO (Drs Raghuraman and Rampersad)Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, MN (Drs Corlin and Sabol); Corresponding author: Bethany A. Sabol, MD, MAS.There has been an alarming and substantial increase in hypertensive disorders of pregnancy, which are a significant driver of maternal morbidity and mortality. The postpartum period is an especially high-risk time, with >50% of pregnancy-related deaths and significant morbidity occurring during this period. The American College of Obstetricians and Gynecologists suggests inpatient or equivalent monitoring of blood pressures in patients with hypertensive disorders of pregnancy for the immediate 72 hours postpartum and again within 7 to 10 days postpartum. Hypertensive disorders of pregnancy significantly contribute to healthcare costs through increasing admission lengths, rates of readmissions, the number of medications given, and laboratory studies ordered, and through the immeasurable impact on the patient and society. Telemedicine is an essential option for patients with barriers to accessing care, particularly those in remote areas with difficulty accessing subspecialty care, transportation, childcare, or job security. The implementation of these programs also has potential to mitigate racial inequities given that patients of color are disproportionately affected by the morbidity and mortality of hypertensive disorders of pregnancy.Remote blood pressure monitoring programs are generally acceptable, with high levels of satisfaction in the obstetrical population without posing an undue burden of care. Studies have reported different, but encouraging, measures of feasibility, including rates of recruitment, consent, engagement, adherence, and retention in their programs. Considering these factors, the widespread adoption of postpartum blood pressure monitoring programs holds promise to improve the identification and care of this at-risk population. These immediate clinical effects are significant and can reduce short-term hypertension-related morbidity and even mortality, with the potential for long-term benefit with culturally competent, well-reimbursed, and widespread use of these programs. This clinical opinion aims to show that remote monitoring of postpartum hypertensive disorders of pregnancy is a reliable and effective alternative to current follow-up care models that achieves improved blood pressure control and diminishes racial disparities in care while simultaneously being acceptable to providers and patients and cost-saving to hospital systems.http://www.sciencedirect.com/science/article/pii/S2666577823000928hypertensionpostpartumpreeclampsiapregnancyremote blood pressure monitoringtelehealth |
| spellingShingle | Tiffany Corlin, MD Nandini Raghuraman, MD, MSCI Roxane M. Rampersad, MD Bethany A. Sabol, MD, MAS Postpartum remote home blood pressure monitoring: the new frontier AJOG Global Reports hypertension postpartum preeclampsia pregnancy remote blood pressure monitoring telehealth |
| title | Postpartum remote home blood pressure monitoring: the new frontier |
| title_full | Postpartum remote home blood pressure monitoring: the new frontier |
| title_fullStr | Postpartum remote home blood pressure monitoring: the new frontier |
| title_full_unstemmed | Postpartum remote home blood pressure monitoring: the new frontier |
| title_short | Postpartum remote home blood pressure monitoring: the new frontier |
| title_sort | postpartum remote home blood pressure monitoring the new frontier |
| topic | hypertension postpartum preeclampsia pregnancy remote blood pressure monitoring telehealth |
| url | http://www.sciencedirect.com/science/article/pii/S2666577823000928 |
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