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Key Points: Question: Does self-monitoring of blood pressure (BP) by pregnant individuals at higher risk for preeclampsia lead to earlier detection of pregnancy hypertension compared with usual antenatal care? Findings: In this randomized clinical trial that included 2441 pregnant individuals at increased risk for preeclampsia, self-monitoring of BP with telemonitoring compared with usual care resulted in a mean time to clinic-based detection of hypertension of 104 vs 106 days, a difference that was not statistically significant. Meaning: Among pregnant individuals at higher risk of preeclampsia, self-monitoring of BP with telemonitoring did not lead to earlier clinic-based detection of hypertension. Importance: Inadequate management of elevated blood pressure (BP) is a significant contributing factor to maternal deaths. Self-monitoring of BP in the general population has been shown to improve the diagnosis and management of hypertension; however, little is known about its use in pregnancy. Objective: To determine whether self-monitoring of BP in higher-risk pregnancies leads to earlier detection of pregnancy hypertension. Design, Setting, and Participants: Unblinded, randomized clinical trial that included 2441 pregnant individuals at higher risk of preeclampsia and recruited at a mean of 20 weeks' gestation from 15 hospital maternity units in England between November 2018 and October 2019. Final follow-up was completed in April 2020. Interventions: Participating individuals were randomized to either BP self-monitoring with telemonitoring (n = 1223) plus usual care or usual antenatal care alone (n = 1218) without access to telemonitored BP. Main Outcomes and Measures: The primary outcome was time to first recorded hypertension measured by a health care professional. Results: Among 2441 participants who were randomized (mean [SD] age, 33 [5.6] years; mean gestation, 20 [1.6] weeks), 2346 (96%) completed the trial. The time from randomization to clinic recording of hypertension was not significantly different between individuals in the self-monitoring group (mean [SD], 104.3 [32.6] days) vs in the usual care group (mean [SD], 106.2 [32.0] days) (mean difference, −1.6 days [95% CI, −8.1 to 4.9]; P =.64). Eighteen serious adverse events were reported during the trial with none judged as related to the intervention (12 [1%] in the self-monitoring group vs 6 [0.5%] in the usual care group). Conclusions and Relevance: Among pregnant individuals at higher risk of preeclampsia, blood pressure self-monitoring with telemonitoring, compared with usual care, did not lead to significantly earlier clinic-based detection of hypertension. Trial Registration: ClinicalTrials.gov Identifier: NCT03334149 This randomized clinical trial compares the efficacy of self-monitoring of blood pressure with telemonitoring vs usual antenatal care in detecting hypertension among pregnant individuals at higher risk of preeclampsia. [ABSTRACT FROM AUTHOR]

Objective: To identify outcomes relevant to women with lived experience of pre-eclampsia.Design: Qualitative interview study.Setting: A national study conducted in the United Kingdom.Sample: Purposive sample of women with lived experience of pre-eclampsia.Methods: Thematic analysis of qualitative interview transcripts.Results: Thirty women with lived experience of pre-eclampsia were interviewed. Thematic analysis identified 71 different treatment outcomes. Fifty-nine of these had been previously reported by pre-eclampsia trials. Outcomes related to maternal and neonatal morbidity, commonly reported by pre-eclampsia trials, were frequently discussed by women with lived experience of pre-eclampsia. Twelve outcomes had not been previously reported by pre-eclampsia trials. When compared with published research, it was evident that the outlook of women with lived experience of pre-eclampsia was broader. They considered pre-eclampsia in relation to the 'whole' person and attached special significance to outcomes relating to emotional wellbeing and the future health, development and wellbeing of their offspring.Conclusions: Selecting, collecting and reporting outcomes relevant to women with pre-eclampsia should ensure that future pre-eclampsia research has the necessary reach and relevance to inform clinical practice. Future core outcome set development studies should use qualitative research methods to ensure that the long list of potential core outcomes holds relevance to patients.Tweetable Abstract: What do women want? A national study identifies key treatment outcomes for women with pre-eclampsia. Next step: @coreoutcomes for #preeclampsia @NIHR_DC. [ABSTRACT FROM AUTHOR]

The article mentions the pregnant women's preference for self monitoring of blood pressure and discusses available evidence on the practice. Topics cited include the health effects of hypertension on pregnant women, the role of blood pressure in the detection of pre-eclampsia and the accuracy of self monitoring. A table showing the advantages and disadvantages of home monitoring of blood pressure in pregnancy is also presented. INSETS: Box 1 Advantages and disadvantages of home monitoring of blood;Box 2 Types of hypertension during pregnancy.

Objective: To determine the accuracy of self-testing for proteinuria during pregnancy., Design: Diagnostic accuracy study., Setting: Antenatal clinics, maternity assessment units and inpatient wards at three hospital sites., Population or Sample: 345 pregnant women., Methods: Pregnant women self-tested in-clinic for urinary protein using visually read dipsticks with samples then sent for laboratory estimation of the spot protein-creatinine ratio (PCR) (primary reference test). Secondary index tests included testing by antenatal healthcare professionals and an automated colorimetric reader., Main Outcome Measures: Sensitivity, specificity, negative predictive value, positive predictive value and likelihood ratios were calculated for self-testing (primary index test) along with healthcare professional and colorimetric testing compared to the primary reference test (PCR)., Results: 335/345 (97%) had sufficient data to be included in the analysis. Self-testing had a sensitivity of 0.71 (95% confidence interval [CI] 0.62-0.79) and a specificity of 0.89 (95% CI 0.84-0.92) compared to PCR. Sensitivity and specificity of testing by healthcare professionals and the colorimetric reader were similar: sensitivity 0.73 (95% CI 0.64-0.80) and 0.78 (95% CI 0.69-0.85), respectively; specificity 0.88 (95% CI 0.82-0.92) and 0.83 (95% CI 0.78-0.88), respectively., Conclusion: Pregnant women can visually read a dipstick for urinary protein with similar accuracy to antenatal healthcare professionals. Automated colorimetric testing was not significantly different, in contrast to some previous studies. Self-testing has the potential to form part of a self-monitoring regime in pregnancy., (© 2022 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Guidelines encourage the use of self monitoring of blood pressure in pregnancy, and research suggests that women prefer it. But HODGKINSON AND COLLEAGUES: explain that our enthusiasm may run ahead of the evidence and call for more research before it is routinely adopted., (© BMJ Publishing Group Ltd 2014.)