eHealth and Hypertensive Disorders of Pregnancy: Systematic Review

Background: Hypertensive disorders of pregnancy (HDP) affect up to 10% of pregnancies and can have adverse short and long-term implications for women and their babies. eHealth interventions include any health service or treatment delivered using the internet and related technology that aims to facilitate, capture, or exchange knowledge. eHealth interventions are increasingly used across many health care settings with improved outcomes. Objective: There have been no previous systematic reviews examining eHealth interventions and HDP. It is important to conduct this review as strategies to improve the monitoring and management of HDP can reduce morbidity, and potentially, mortality associated with HDP. Methods: We conducted a systematic review to examine all eHealth interventions targeted at patients at risk of or with HDP, the feasibility, acceptability of these interventions, and secondary outcomes, including clinical outcomes and resource utilization. The searches included two main concepts: eHealth interventions and HDP. Subject headings for the terms "telehealth," "ehealth," "digital health," "telemedicine" and "preeclampsia," "pregnancy induced hypertension," "gestational hypertension," and "high blood pressure" were used. The search was conducted on all papers published from the database inception to August 24, 2024. Meta-analyses of randomized controlled trial findings were conducted where possible. Other outcomes were reported in a narrative style with a summation of findings. Results: A total of 100 publications were identified with 61,539 participants. Interventions were primarily targeted at self-monitoring of blood pressure (BP) with reminders for BP checks, transmission of BP and HDP symptom data, and two-way communication between patients and care providers. In observational studies, there was no significant difference in clinical outcomes. Within qualitative outcomes, eHealth interventions appeared to be feasible, and all studies showed that participants were satisfied and found eHealth interventions easy to use. There was equivocal evidence regarding the cost benefits of eHealth interventions, but it did demonstrate largely reduced health care service utilization. In a meta-analysis of randomized controlled trial data, eHealth interventions reduced readmission rates (odds ratio OR 0.4, 95% CI 0.23-0.71), improved the likelihood of BP ascertainment (OR 7.02, 95% CI 4.41-11.15), and improved attendance at postpartum hypertension clinic (OR 1.44, 95% CI 0.98-2.12). Conclusions: The current evidence for the use of eHealth interventions targeted at patients at risk of or with HDP is of low quality and insufficient to make a recommendation regarding their routine use in clinical care. Our findings indicate that there is poor quality and low-level evidence that eHealth interventions are feasible, safe, and acceptable to patients. There is very limited evidence that it has the potential to reduce health care utilization, improve follow-up and BP ascertainment, reduce admissions, as well as confer some economic benefit compared to usual care with a generally positive patient experience with minimal patient concerns.