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Changes to management of hypertension in pregnancy, and attitudes to self-management: An online survey of obstetricians, before and following the first wave of the COVID-19 pandemic

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B. Fletcher, L. C. Chappell, L. Lavallee, H. M. Wilson, R. Stevens, L. Mackillop, R. J. McManus, K. L. Tucker

Original languageEnglish
Pages (from-to)54-61
Number of pages8
JournalPregnancy Hypertension
Volume26
DOIs
Published1 Sep 2021

Bibliographical note

Funding Information: BF was funded to complete this research by Research Capability Funding from Oxford Health NHS foundation trust and the National Institute for Health Research (NIHR) programme for applied research (RP-PG-0614-20005). RM and LC are supported by Research Professorships from the National Institute for Health Research (NIHR-RP-R2-12-015 and RP-2014-05-019 respectively). KT, RM and LL have received funding from the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford (CLAHRC Oxford) now recommissioned as NIHR Applied Research Collaboration Oxford and Thames Valley (ARC-OxTV). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. LM is supported by the NIHR Oxford Biomedical Research Centre and is a part-time employee and shareholder in Sensyne Health plc. Funding Information: This research was funded by Research Capability Funding from Oxford Health NHS foundation trust and a National Institute for Health Research (NIHR) programme for applied research (RP-PG-0614–20005). Researchers also received funding from the National Institute for Health Research (NIHR). Publisher Copyright: © 2021 The Author(s) Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors

Abstract

Objective: This study aimed to understand the views and practice of obstetricians regarding self-monitoring for hypertensive disorders of pregnancy (blood pressure (BP) and proteinuria), the potential for self-management (including actions taken on self-monitored parameters) and to understand the impact of the COVID-19 pandemic on such views. Design: Cross-sectional online survey pre- and post- the first wave of the COVID-19 pandemic. Setting and Sample: UK obstetricians recruited via an online portal. Methods: A survey undertaken in two rounds: December 2019-January 2020 (pre-pandemic), and September-November 2020 (during pandemic) Results: 251 responses were received across rounds one (1 5 0) and two (1 0 1). Most obstetricians considered that self-monitoring of BP and home urinalysis had a role in guiding clinical decisions and this increased significantly following the first wave of the COVID-19 pandemic (88%, (132/150) 95%CI: 83–93% first round vs 96% (95%CI: 92–94%), (97/101), second round; p = 0.039). Following the pandemic, nearly half were agreeable to women self-managing their hypertension by using their own readings to make a pre-agreed medication change themselves (47%, 47/101 (95%CI: 37–57%)). Conclusions: A substantial majority of UK obstetricians considered that self-monitoring had a role in the management of pregnancy hypertension and this increased following the pandemic. Around half are now supportive of women having a wider role in self-management of hypertensive treatment. Maximising the potential of such changes in pregnancy hypertension management requires further work to understand how to fully integrate women's own measurements into clinical care.

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