Maternal mortality rates in the United States remain alarmingly high, with severe maternal morbidity on the rise. In 2019, there were 20.1 maternal deaths per 100,000 live births. This rate rose to 23.8 deaths per 100,000 live births in 2020. Data from 2021 indicates the maternal mortality rate has continued climbing to 32.9 deaths for every 100,000 live births. Most recent 2022 data shows 817 women in the U.S. died of maternal causes with a rate of 22.3 maternal deaths per 100,000 live births. This is a drop from the 2021 maternal death data. Obstetric hypertension contributes significantly to these statistics.
Hypertension also called high blood pressure, can lead to health issues at any point in life. Usually, asymptomatic hypertension during pregnancy that is uncontrolled or severe may cause complications for both mother and fetus.
Some women have pre-existing high blood pressure before pregnancy, while others develop it for the first time while pregnant. During pregnancy, the body creates more blood to support the growth of the fetus. If blood pressure increases during pregnancy, it can stress the heart and kidneys.
This stress can lead to heart disease, kidney disease, or even stroke. High blood pressure during pregnancy also increases the risk of preeclampsia, preterm birth, placental abruption, and cesarean birth. Preeclampsia, a serious hypertensive disorder, can also occur during pregnancy or soon after delivery.
Obstetric Hypertension Study Overview
A study by researchers at Kaiser Permanente of Georgia represents the largest remote patient monitoring initiative for obstetric hypertension. Researchers examined 937 pregnant patients from diagnosis through six weeks postpartum to determine whether a remote blood pressure monitoring program could improve outcomes compared to historical controls.
The Kaiser Permanente healthcare team used the Cocoon Pregnancy Care Model, which integrates telehealth, remote patient monitoring for pregnancy, and psychosocial support into routine prenatal care. The remote patient monitoring hypertensive disorders of pregnancy program (RPM HTN) was designed for pregnant or postpartum women diagnosed with or at high risk for developing obstetric hypertension. The RPM HTN program provided daily remote blood pressure monitoring in pregnancy and postpartum patients diagnosed with chronic hypertension or pregnancy-induced hypertension.
The program aimed to track blood pressure more closely outside the clinical setting and intervene more rapidly when abnormal readings occurred. Patients transmitted home readings to their physicians using remote patient monitoring medical devices. Abnormal readings triggered contact with a qualified healthcare professional who collaborated with patients and their doctors to adjust treatment as needed.
Improving Postpartum Blood Pressure Control
The study included 1,030 patients enrolled in the RPM HTN compared to 937 matched historical controls. Additionally, 50.2% of the RPM HTN cohort enrolled during the antepartum period, and 49.8% enrolled postpartum. The researchers concluded the following about the program for obstetric hypertension management: “A remote HTN monitoring program for 937 obstetric patients was associated with improved BP monitoring, better postpartum BP control, and improved linkages to clinician care after delivery when compared to historical controls.”
Key findings from the study showed:
- Post-hospital discharge remote blood pressure monitoring in pregnancy improved, with a 1.56-fold increase in measurements within the first 20 days after delivery.
- Postpartum blood pressure control saw a 1.43-fold increase in normal readings. Patients in the RPM HTN cohort were 1.27 times more likely to be on antihypertensives postpartum and 1.50 times more likely to be evaluated by an obstetric clinician within 20 days of delivery.
Remote Blood Pressure Monitoring in Pregnancy for Obstetric Hypertension
This study highlights the effectiveness of providing daily remote blood pressure monitoring from the diagnosis of hypertensive disorders in the antepartum or postpartum period until six weeks postpartum. The program’s success is attributed to Kaiser Permanente of Georgia’s integrated medical system, electronic medical records (EMR), and supportive elements within the Cocoon Pregnancy Care Model.
The findings underscore the potential of remote blood pressure monitoring to improve postpartum blood pressure control and strengthen linkages to clinician care after delivery. As the U.S. grapples with escalating maternal mortality rates, this research offers a replicable model for other clinical settings to adapt and implement. Additionally, it provides promising solutions to address maternal mortality related to obstetric hypertensive disorders.
