Home Versus Clinic Blood Pressure Monitoring in Women with Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis.

Background/

Objectives

Home blood pressure monitoring (HBPM) is increasingly used in pregnancy, but evidence regarding its safety and clinical utility in women with hypertensive disorders of pregnancy (HDPs) remains limited. We aimed to compare maternal and fetal outcomes and healthcare use with HBPM versus clinic-based blood pressure monitoring.

Methods

Cochrane, MEDLINE, Embase and PubMed were searched for randomized controlled trials published from January 1970 to December 2022; this review was undertaken to inform guideline development of hypertension in pregnancy in Australia and New Zealand. Two reviewers independently screened studies, extracted data and assessed risk of bias using RoB. Outcomes reported by at least two clinically comparable trials were pooled and heterogeneity was summarized using I2. Outcomes reported by a single trial are presented as individual study estimates and were not meta-analyzed. Certainty of evidence was assessed using GRADE.

Results

Four randomized trials involving 3533 participants were included. HBPM was not associated with a statistically significant difference in preeclampsia, adverse maternal composite outcomes, severe hypertension (≥160/110 mmHg), emergency delivery for hypertension, stillbirth, small-for-gestational-age birth or neonatal mortality. A single trial also found no statistically significant difference in preterm birth before 34 weeks. Serious fetal outcomes were uncommon and confidence intervals were wide. In one pilot trial, HBPM was associated with fewer antenatal visits and a longer duration of blood pressure monitoring.

Conclusions

In structured care pathways with clinician oversight and predefined escalation protocols, HBPM was not associated with evidence of increased maternal or fetal risk and may be a useful adjunct to standard antenatal care. The small number of United Kingdom trials, sparse serious events and limited evidence in established or severe preeclampsia preclude conclusions of equivalence or definitive safety.