Hypertensive disorders of pregnancy affect 5%‐10% of pregnancies and increase the risk of adverse pregnancy and postpartum outcomes [1,2]. Typically, management of these disorders involves blood pressure (BP) monitoring and initiation of antihypertensive therapy. Remote BP monitoring (RBPM) enables at-home BP monitoring to inform clinical decision-making in a timely manner [2-4]. Previous studies have shown that RBPM facilitates earlier detection of elevated BP and reduces prenatal hospitalizations and clinic visits [2,3]. Despite studies establishing feasibility and patient acceptability of RBPM [4-9], best practices for integrating RBPM within prenatal care have not yet been established. One open question is whether connected BP cuffs, which automatically sync measures to a health record, improve data quality and frequency over standard BP cuffs, which require users to manually enter measures [3-8]. The goal of this study was to compare user engagement with RBPM between connected and unconnected BP devices among users of a pregnancy care platform.

During the study period, 164 users with BP cuffs were enrolled in the Delfina Care platform. Restricting to those with covariate data, the analytic sample consisted of 163 users (97 unconnected device users and 66 connected device users). Users with connected devices had more mean BP measure entries per day (0.51 vs 0.32) and a higher proportion completed the recommended ≥2 daily BP measures (12% vs 7%) compared to users with unconnected devices (Table 1). At the weekly level, the mean entries per week (3.37 vs 2.07) and the proportion of users who completed the recommended ≥1 weekly BP measure (63% vs 47%) were higher for connected users than for unconnected device users (Table 1).

Adjusting for confounders, users with connected devices had 2.13 (95% CI 1.36‐3.35) times more measures per day and 5.62 (95% CI 2.28‐13.83) times the odds of meeting the recommendation of ≥2 daily BP measures than unconnected device users (Table 2).

We observed user engagement with RBPM was significantly higher among those with connected devices than those with unconnected devices. Previous studies among pregnant individuals have shown that the recommended frequency of BP measures ranges from several times daily to once weekly [4,7,8,11]. In our cohort, the proportion of users meeting the twice-daily recommendation was low, but the majority of users completed the once-weekly entry at least, and connected device users still had higher utilization than unconnected device users (63% vs 47%; P=.003). Compared to in-clinic BP measures, all users had a higher average number of weekly readings than the in-clinic average (2.59 vs 0.50 BP readings/week). Our study corroborated the feasibility of at-home RBPM during pregnancy and highlights the potential advantages of device connectivity on user engagement.