109. Using blood pressure self-monitoring in pregnancy: A systematic review and individual patient data meta-analysis

Introduction Hypertensive disorders during pregnancy result in substantial maternal morbidity and are a leading cause of maternal deaths worldwide. Self-monitoring of blood pressure might improve the detection and management of hypertensive disorders of pregnancy but few data are available, including regarding appropriate thresholds. Objective This systematic review and individual patient data analysis aimed to assess the current evidence regarding differences between clinic and self-monitored blood pressure through pregnancy. Methods MEDLINE and ten other electronic databases were searched for articles published up to and including July 2016 using a strategy designed to capture all the literature concerning self-monitoring of blood pressure during pregnancy. Investigators of included studies were contacted requesting individual patient data: self-monitored and clinic blood pressure and demographic data. Results Twenty-one studies that utilised self-monitoring of blood pressure during pregnancy were identified. Individual patient data from self-monitored and clinic readings were available from seven plus one unpublished paper (eight studies, n = 758) and two further studies published summary data. Analysis revealed a mean self-monitoring -clinic difference of ⩽1.2 mmHg systolic BP throughout pregnancy, though there was significant heterogeneity (difference in means I 2  > 80% throughout pregnancy). Although the overall population difference was small, though levels of ‘white coat hypertension’ were high, particularly towards the end of pregnancy. Discussion The available literature includes no evidence of a systematic difference between self and clinic readings, suggesting that appropriate treatment and diagnostic thresholds for self-monitoring during pregnancy would be equivalent to standard clinic thresholds.