Examining the Feasibility of Smart Blood Pressure Home Monitoring: Advancing Remote Prenatal Care in Rural Appalachia

Background: Hypertensive disorders of pregnancy are a leading cause of U.S. maternal morbidity and mortality. Home blood pressure (BP) monitoring can provide early detection of hypertension (HTN) outside of routine prenatal visits. Yet little is understood about how well self-monitored BP performs during pregnancy, particularly in rural America. Objective: To examine the feasibility and patient adherence to a self-monitoring BP program and to remotely collect data on pregnant women during the third trimester at a rural health clinic. Materials and Methods: A repeated-measures prospective design was used to remotely monitor home BP readings. We examined retention and persistence of weekly BP monitoring in late-stage pregnancy, differences between weekly self-monitored and clinic BP measures, the performance of self-monitored BP in early detection of pregnancy-induced HTN, and receptivity to technology-enabled prenatal monitoring. Results: A total of 30 women enrolled. Women reported high satisfaction with prenatal care, but missed 5 out of 13 clinic visits (54%). Women contributed an average of 31.2 days of home BP monitoring. Findings showed that home systolic and diastolic BP readings slightly varied from clinic readings. Women reported high health-related internet use and e-health literacy. Participants (93%, n = 25) reported a willingness to change their behavior during pregnancy in response to personalized recommendations from a smartphone. Although preliminary, we confirmed that remote monitoring can detect elevated BP earlier than in routine clinic visits. Conclusion: Findings from this study can be used to inform a novel remote monitoring protocol to improve pregnancy care in a rural care setting.