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AIMS:

To explore whether giving pregnant women the means to monitor their own blood pressure and urine safely from home can result in an earlier diagnosis of raised blood pressure (hypertension) and pre-eclampsia, resulting in faster access to treatment.

Why this is important:

Raised blood pressure is a common problem during pregnancy. Pre-eclampsia is diagnosed if the mother has raised blood pressure and protein in her urine after the 20th week of pregnancy. Raised blood pressure and pre-eclampsia affect about one in ten women and are a major cause of death and premature birth in the UK and worldwide.

We want to see if we can develop a simple and accurate way for pregnant women to measure their own blood pressure and urine from home, and to determine whether this approach can improve the detection of raised blood pressure and pre-eclampsia diagnosis compared with usual antenatal care.

- Dr Kath Tucker, University of Oxford

Diagnosis is currently made from monitoring blood pressure and urine at antenatal visits throughout the pregnancy (these take place around every 4 weeks). Early diagnosis of raised blood pressure and pre-eclampsia is important and can reduce complications for both the mother and the baby.

Many women have expressed an interest in monitoring their own blood pressure in between antenatal visits but there has been very little research to guide this. We would like to know if we could improve the diagnosis of raised blood pressure if women were able to monitor their own blood pressure and urine safely at home.

Methods:

We will work with pregnant women, doctors and midwives to:

  1. Develop a simple and accurate method of self-monitoring blood pressure and urine in pregnancy.
  2. Compare self-monitoring with current care in terms of detection of raised blood pressure and protein in the urine.
  3. See if self-monitoring helps doctors to decide the dose of blood pressure medication needed in those with raised blood pressure.
  4. Assess if self-monitoring in pregnancy is cost effective.

The work involves

  • Intervention development – we will work with NHS staff, pregnant women and experts in BP monitoring and pregnancy to develop the best method of self-monitoring blood pressure and urine, that will fit into current practice.
  • BUMP RCT: A large randomised controlled trial to determine whether self-monitoring of blood pressure will help us detect hypertension (raised blood pressure) during pregnancy. This will take place across NHS sites in London, Thames Valley and the West Midlands and will involve over 2,000 pregnant women.
  • OPTIMUM-BP: A pilot trial of self-monitoring in 160 women who have already developed high blood pressure in pregnancy to assess its potential usefulness in the adjustment of blood pressure medication.
  • U-DIP: A study assessing whether self-testing for protein in urine, is as good as midwife/health professional testing involving over 300 pregnant women with raised blood pressure.
  • Economic evaluation of the cost effectiveness within the trial and for longer term use in practice.

Pregnant women who chose to take part in these studies will be asked to monitor their own blood pressure and/or urine during their pregnancy in addition to their usual antenatal care.

How this could benefit patients:

Self-monitoring has the potential to improve the detection and management of raised blood pressure in pregnancy by providing much more data on blood pressure without a large increase in burden for women, who might not need to attend hospital so often. Increasing women’s involvement through self-monitoring could underpin a new cost-effective model of care during pregnancy which improves satisfaction and delivers quality outcomes.

Further information:

Full project title:

Optimising the monitoring and management of raised blood pressure during and after pregnancy

Length of project:

2016 – 2021

Funder:

NIHR

NIHR Programme Grants for Applied Research (RP-PG-0614-20005)

Relevant pilot studies:

The BuMP Study

Collaborators:

  • Dr James Hodgkinson (University of Birmingham)
  • Professor Lucy Chappell (St Thomas’ Hospital, King's College London)
  • Dr Lucy Mackillop (Oxford University Hospitals NHS Trust)
  • Dr Oliver Rivero-Arias (National Perinatal Epidemiology Unit (NPEU), University of Oxford)
  • Mr Stuart Bell (Oxford Health NHS Foundation Trust)
  • Professor Christine McCourt (City, University London)
  • Professor Jane Sandall (St Thomas’ Hospital, King's College London)
  • Professor Khalid Khan (Queen Mary, University of London)
  • Professor Paul Leeson (Oxford University Hospitals NHS Trust)
  • Professor Sheila Greenfield (University of Birmingham)

Relevant publication:

More publications