Pre-eclampsia and high blood pressure in pregnancy

Medical research about self-monitoring blood pressure in pregnancy

Several women we spoke to had taken part in a medical research study called ‘BuMP’ (‘Blood pressure Monitoring in Pregnancy’). This study asked women to self-monitor their blood pressure for the second half of their pregnancy until six weeks after birth. The study was looking at how practical and acceptable self-monitoring of blood pressure in pregnancy was. Some women who participated in the BuMP study went on to develop high blood pressure problems, but others didn’t.
Study design
 
The BuMP study asked women to check their blood pressure from half way through their pregnancy until six weeks after they had given birth. They were asked to take their blood pressure on three days each week (Monday, Wednesday and Friday). On each of these days, women were asked to test their blood pressure twice in the morning (five minutes apart) and twice in the evening (five minutes apart). They were advised to rest for a few minutes before testing, so that their blood pressure was more likely to be at a ‘natural’ level. The readings were then sent by text to the study manager (via a system called ‘Florence’ or ‘FLO’) and/or written down by the participant in a booklet. Participants could sign up for text reminders, which some said were really helpful. Some found the reminders annoying, especially if they had already sent their blood pressure readings in but the study’s recording system hadn’t logged it yet.
Getting involved in a study about self-monitoring blood pressure in pregnancy
 
Most women in the BuMP study had been told about it during an early routine check-up (usually in the first trimester/12 weeks). A few had heard about the study elsewhere - Vicki saw it advertised in a newsletter. Women invited to join the study usually had one or more ‘risk factors’ for developing pre-eclampsia.
 
Women started in the study by first meeting with the research midwife/nurse. Most women said this was helpful, especially for those who hadn’t been given much information when the study was first mentioned to them. The meeting covered a lot of information and was an opportunity to ask questions. Women were also given written information they could look at afterwards. Elaine found it helpful to be given an A4 folder so that “all the information was in there together”. Taking part or not was entirely voluntary. Some talked to their partners about taking part, but most said they felt it was an easy decision to make and their partners were supportive of their choice.
Reasons for taking part in the BuMP study
 
Some people had taken part in health research before; for others, this was their first experience. Women gave several different reasons for taking part. 
  • To help build medical knowledge and to help other people with their pregnancies in the future. Some felt comfortable doing the study because it seemed “simple” and “non-invasive”. 
  • To manage worries and anxieties about their own pregnancy. Being able to check their own blood pressure was reassuring for some and many felt it was better to know sooner rather than later if there was a problem. If there was any cause for concern, they could go see a medical professional and often felt more confident about doing so.
  • Women said it was more convenient to check their own blood pressure if they had any worries, rather than making an appointment with their GP or hospital. Some women disliked having their blood pressure checked by doctors or nurses and thought it gave them higher readings (known as white coat hypertension), so they preferred to monitor themselves.
  • Women liked the extra support from the research midwife/nurse who they could get in touch with if they had any worries, concerns or questions.
There were sometimes challenges in reality. You can read more about the practicalities and emotional impacts of self-monitoring blood pressure (as part of a research study or for other reasons) here.
 
Support from research midwives/nurses
 
Women participating in the BuMP study saw a research midwife/nurse several times for appointments (in addition to their routine antenatal care). Most people had contact with just one research midwife/nurse each time, though a few people had seen several. Helen Y saw a different research midwife after the original person went on sick leave. The research midwives/nurses were friendly and helpful. Komal said her research midwife gave her extra support which she otherwise wouldn’t have had from the doctors and midwives she saw as part of ‘routine’ antenatal care. Elaine found it useful to be able to ask her research midwife a question she had forgotten to talk to her community midwife about earlier in the day. Research midwives/nurses sometimes gave emotional support as well as practical advice – Abigail said “it just gave me a huge amount of reassurance to know that she [research midwife] was there if I needed her”.
Having extra meetings with the research midwife/nurse on top of ‘routine’ antenatal appointments could mean more time off work and extra travel arrangements. This could be a struggle, though most people said it wasn’t too bad. Sometimes research midwives/nurses visited the woman at home. This was particularly appreciated by those who would have struggled with travelling (for example, if they didn’t drive or after a caesarean section). 
 
Some women combined appointments (having the research midwife/nurse sit in on the routine appointment as well) or scheduled the appointments one after the other. Whilst this worked well for most women who tried it, there could be downsides. Helen Y was told she could cancel a routine appointment around 16 weeks with her community midwife and instead have the meeting with her research midwife. She thought this was a good idea as it would save her making two trips. However, Helen Y didn’t feel she received the same level of care or information at the combined appointment with her research midwife as she would have had with the two separate appointments. She wasn’t given her Bounty pack or the chance to hear her baby’s heartbeat by Doppler (a machine used to estimate blood flow). 
 
Some found the other medical professionals involved in their care were unaware of the BuMP study or didn’t trust the self-monitoring readings. Also, some women found that readings considered ‘high’ in the study were different to those considered high by their hospital. Vicki said if she had a self-monitored blood pressure reading of 140/90 or more then she would be contacted as part of the study and encouraged to seek medical help, but her hospital were only concerned if they took her blood pressure and the reading was 150/100 or higher.
Technical problems and uncertainties in the study
 
Some had difficulties working the blood pressure monitor or texting their readings to the BuMP study manager. Others found the equipment quite easy to use, especially if they had taken their own blood pressure before or had done it as part of their job. A few people noticed gaps where more information could be provided about the BuMP study. For example, Amy placed the arm cuff too low the first time she tried to take her blood pressure and suggested that a diagram or written explanation would have been helpful. 
 
Sometimes the batteries in the monitor needed to be replaced. Helen Y also had an experience when the machine went “a bit crackers”. Vicki had been unsure about carrying her monitor in hand luggage for a flight and so took the batteries out, but worried it might lose the data stored on it. Samantha Y hadn’t been aware that the blood pressure monitor recorded all the readings until the end of the BuMP study and she felt bad that she had let some friends use it when they asked.

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