Dr Theepika Rajkumar1,2, Professor Annemarie Hennessy4, Associate Professor Renuka Shanmugalingam1,2, Dr Jun Mai1, Dr Daniela Potter1, Jill Freyne5, Kaley Butten5, Marlien Varnfield5, Professor Angela Makris1,3
1South Western Sydney LHD, Liverpool, Australia, 2Western Sydney University, , Australia, 3University of New South Wales, , Australia, 4Sydney University, , Australia, 5Commonwealth Scientific and Industrial Research Organisation, , Australia
Biography:
Dr Theepika Rajkumar is a nephrologist and obstetric medicine physician in South Western Sydney Local Health District. She is a PhD candidate at Western Sydney University, with her research focusing on remote blood pressure monitoring for high-risk pregnant women.
Aim:
To assess safety of remote blood pressure monitoring (RBPM) in pregnant women at high risk of developing preeclampsia.
Background:
Women at high risk of developing preeclampsia require more frequent blood pressure (BP) measurements than low-risk women undergoing standard antenatal care. Remote blood pressure monitoring allows clinicians to remotely review patients’ home BP readings, offering greater convenience and reducing the need for in-person reviews, however robust safety evidence is limited.
Methods:
The REMOTE CONTROL trial is a multicentre, non-inferiority, randomised controlled trial, which compares RBPM in high-risk pregnant women with conventional in-person review. Women randomised to RBPM measured their BP using an automated BP machine with data transmitted for clinician review via an integrated, purpose-built smartphone application (MoTHer). Women randomised to usual care attended specialist hypertension clinics for BP monitoring.
Results:
270 women were included in the final analysis. There was no difference in the primary outcome (composite fetal outcome of perinatal loss, high-level neonatal care for >48 hours or small for gestational age) [HR 1.0 95%CI 0.57-1.76; p-value 0.99]. Participants undertaking RBPM recorded more episodes of severe hypertension [HR 5.58 95%CI 2.92-10.67; p-value<0.01], yet there was no difference in composite maternal complications [HR 1.01 95%CI 0.52-1.97; p-value 0.97], preeclampsia diagnoses [HR 0.78 95%CI 0.39-1.55; p-value 0.48], and number of deliveries expedited due to hypertension [HR 1.31 95%CI 0.63-2.71; p-value 0.47]. Additionally, women undertaking RBPM had less hospital attendances than those in usual care [p-value<0.01].
Conclusions:
Remote blood pressure monitoring is a safe alternative to conventional clinic visits for BP monitoring in high-risk pregnant women, allowing less antenatal hospital attendances without increased risk of adverse maternofetal outcomes.