It’s time to give blood pressure monitoring to all pregnant moms

Remote blood pressure (BP) monitoring is a critical tool for reducing poor outcomes in high-risk pregnancies. Stakeholders across the maternal health space need to come together to provide it for all moms, regardless of risk.

The United States has the highest rates of maternal mortality in the developed world. Over 50% of those deaths occur in the postpartum period, and 60% of those deaths are preventable. Black women are 2-3x more likely to be victims of these statistics than their peers, regardless of income or status.

These facts are so ubiquitous that a quick Google search of any of them will bring up hundreds of hits. If we’re so aware of the issues, then why hasn’t the needle moved on outcomes?

Part of the problem is the sheer variety of causes — and they can’t be unilaterally abolished by the stroke of a pen on legislation.

We need to focus on fixing the issues that can help the most people in the shortest time, that don’t require decades of cultural and structural change to resolve.

We need to go after actionable targets, starting with preventable prenatal and postpartum deaths and the issues that can contribute to them, like hypertension.

Hypertensive disorders with onset during pregnancy are responsible for 7.8% of all pregnancy-related deaths, and that doesn’t take into consideration cardiovascular issues and other health problems to which hypertensive disorders of pregnancy (which occur in nearly 10% of all gestations) are often a precursor.

Maintaining a certain BP has been proven to directly affect the risk of hypertension and improve outcomes. In some cases, elevated BP is the only indication of a dangerous condition like preeclampsia. If a woman is only having her BP taken at her regularly scheduled prenatal visits, it is highly possible that high BP could go undetected.

During the postpartum period, the safety net is even worse — women typically do not see their doctor until a single follow-up appointment 6 weeks after giving birth. Many women fail to attend this appointment, and for some others, six weeks is already too late to catch life-threatening complications. A new mother who is normotensive at discharge can quickly become hypertensive, even if she experienced no BP complications before or during her pregnancy.

So what’s holding us back from the wide-scale adoption of remote BP monitoring?

Providing a BP cuff to every single pregnant person would cost upwards of $200M — a steep price, yes. But compared to nearly $3B dollars in cost associated with preeclampsia? The $13B+ for preterm birth (a result of 15% of preeclamptic pregnancies)? The $500M in readmission costs for postpartum hypertension? And those costs don’t take into account the massive downstream societal costs of maternal death and morbidity.

Of course, the BP cuff is only a part of the solution. Data is only as effective as the infrastructure that makes it actionable. We need to invest in infrastructure that communicates that data back to stakeholders (in this case, clinicians) in actionable ways — infrastructure that supports diagnostic data, integrates clinical protocols, functions within existing workflows, and communicates across different data platforms.

This infrastructure already exists and has only become more sophisticated with the advent of the Internet of Things, but healthcare industry standards are stuck in the past, and they need to adapt to incorporate and support it.

Payers can play a major role in encouraging these industry shifts — several years ago, Medicare unbundled remote patient monitoring (RPM) reimbursement and is now fully supporting the use of digital tools to provide access to care for its patient population.