248. Optimising the monitoring and management of raised blood pressure during and after pregnancy - developing an self-monitoring intervention in the English NHS

Abstract

Introduction Raised blood pressure (BP) is a common problem in pregnancy and may develop into pre-eclampsia in the presence of proteinuria or other metabolic changes. Raised BP and pre-eclampsia affect about one in ten women and are a major cause of death and premature birth worldwide. While maternal deaths from pre-eclampsia in the UK are lower than ever, there is still room for improvement in detecting and managing hypertensive women in pregnancy. Asking women to self-monitor their own blood pressure might improve outcomes. Pilot work has suggested that, with support from midwives and doctors, it is possible for women to monitor BP and urine safely, potentially identifying problems earlier and controlling BP better. We aimed to develop a comprehensive self-monitoring interventions for a full trial. Methods Focus groups and interviews were undertaken with NHS staff (obstetricians, community and hospital midwives). We conducted ’think alouds’ with women talking through their experiences of using a self-monitoring app and the trial materials. Results Focus groups and interviews were conducted with 144 NHS staff (obstetricians, community and hospital midwives, GPs, trainees, pharmacists and healthcare assistants) at seven different hospital sites. Areas important to staff included: providing clear patient information as BP in pregnancy is a complex phenomenon and not the only indicator of pre-eclampsia; concerns about the use of validated monitors and reliability of readings; supporting staff in decision-making in the context of discrepant readings. Discussion Our analysis suggests SMBP will be welcomed by staff, while highlighting potential barriers. This hashelped develop user-friendly, accessible patient-facing materials.A large multi-centre, randomized-controlled trial, underpinned by theories of behaviour change, is now underway in the UK to determine the usefulness of SMBP in the detection and management of raised BP during pregnancy.