| Summary: | <p>This thesis aimed to examine the role of blood pressure self-monitoring (SMBP) for the management of hypertension in pregnancy. Hypertensive disorders of pregnancy (HDP) affect around one in ten pregnancies. They contribute to considerable maternal and fetal morbidity and mortality. Currently, pregnant women with hypertension have more frequent clinic surveillance to monitor for any deterioration in blood pressure and emerging pre-eclampsia or fetal complications. This places a considerable burden on both the woman and the health service and deterioration may occur between visits. An SMBP intervention for use in pregnancy hypertension was developed and tested using a mixed methods approach comprising a randomised controlled feasibility study and parallel qualitative studies.</p>
<p>The pilot randomised controlled trial compared SMBP with usual care (2:1) recruiting pregnant women from four UK maternity centres. 86 women with chronic hypertension (55 SMBP, 31 control) and 72 with gestational hypertension (49 SMBP, 23 control) were randomised and outcome data and analysis were completed for 154 (97%). There were high recruitment (71%), adherence (SMBP 5.5 days per week) and persistence rates (SMBP for >80% of enrolment time). There were similar quality of life scores between randomised groups and greater preference shown by participating women for BP self-monitoring versus usual clinic monitoring. There were no overall group differences in BP control.</p>
<p>Parallel qualitative studies explored the experiences and perceptions of pregnant women and their clinicians using the self-monitoring intervention. These included observations of 38 clinics and semi-structured interviews with 24 women and 8 clinicians. Women with hypertension were highly motivated to use BP self-monitoring. This enthusiasm was in the context of valued continuity of care from expert clinicians. Despite women’s and clinicians’ joint goal for a healthy mother and baby, there wasn’t always consensus regarding how best to achieve this. For example women and clinicians gave difference precedence to home and clinic BP readings with important implications for antihypertensive medication adherence which could ultimately affect maternal BP control.</p>
<p>These findings together suggest that SMBP is a feasible and acceptable intervention to trial on a larger scale for the management of hypertension in pregnancy. However, because women and their clinicians could ascribe different meanings to the home and clinic BP readings this in turn influenced subsequent perspectives around treatment. Clinicians could better support shared decision making with enhanced awareness of and discussion around women’s experiences of home monitoring and treatment concerns. Further research is needed to understand the relationship between home blood pressure readings and clinical outcomes to inform these discussions.</p>
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