Essay on Does the Teaching of Self-Measured Blood Pressure Monitoring (SMBP) Lead to an Earlier Diagnosis of Gestational Hypertension in the Prenatal Period As Compared to Standard Care

High blood pressure in pregnancy is one of the leading causes of maternal and fetal morbidity across the world. High blood pressure can develop between antenatal appointments and can be asymptomatic until an advanced stage and blood pressure self-monitoring creates room for early detection and improved management of pregnancy hypertension. The selection of literature is based on academic articles which on self-monitoring blood pressure by expectant women. Selecting such articles was helpful in shading light to the issue of high blood pressure and expectancy. The technique used for searching for the articles was by looking at medical journals because of credibility. The search terms utilized were pregnant women, self-measured blood pressure monitoring, gestational hypertension, prenatal period, and standard care. The research question helps assess the impact of self-measured blood pressure monitoring in the diagnosis of gestational hypertension in early pregnancy in the prenatal period when compared to standard care. The PICOT question is “In pregnant women, does the teaching of self-measured blood pressure monitoring (SMBP) lead to an earlier diagnosis of gestational hypertension in the prenatal period as compared to standard care?”

Lavalle et al. (2018) carried out research to encourage expectant women to monitor their blood pressure at home as an effective way of overcoming the issue of hypertension. The authors used explanatory research and secondary data to explain how women monitoring their blood pressure at home are effective in overcoming hypertension, a cost-effective way of empowering women in their care. The instruments used are valid and reliable considering the research studies used were carried out by other researchers. Lavalle et al. (2018) used researches already carried out to explain the importance and potential benefits of self-monitoring blood pressure while expectant. The analysis of data is effective in that the authors ensured they cited all researches used in the explanations. The results of the articles confirm that early detection of high blood pressure through self-monitoring by expectant women is an effective tool for improving outcomes in hypersensitivity during pregnancy. Maternal and neonatal health can lead to a better outcome when blood pressure is checked regularly to detect pre-eclampsia (Lavallee et al., 2018). A limitation in the research is that the authors did not explain a summarized finding of all the used articles to bring about a better understanding.

The focus of a study carried out by Muijsers et al. (2020) was on strategies that can be better at detecting and preventing hypertension in women after being diagnosed with PE/ HELLP on time. The participants were 200 women aged between forty and sixty with a history of PE/HELLP. The participants were recruited from the obstetrics/gynecology centers. The instruments are valid and reliable considering the researcher used a randomized study design for comparing usual care with self-management of monitoring blood pressure. The consistency of data collection and procedures was in randomizing participants into an intervention and control group to carry out an effective comparison. The participants were requested to fill structured online questionnaires on different occasions during the research. Statistical analysis using SPSS was carried out to easily and effectively understand the results. The outcome of the research indicates that HBPM is a way that is not only easy but also acceptable for checking blood pressure regularly. A limitation of the study is on putting an age limit on the participants instead of including all expectant women.

A research carried out by Nash et al. (2019) aimed at quantifying the risk of HDP after maternal deployment in the post- 9/11/2001 era. Nash et al. (2019) confirm that after a mother is diagnosed with a hypertension disorder in her pregnancy, she’s now at an increased risk for later in life developing cardiovascular disease. The research utilized a database from the U.S. Department of Defense which included all active-duty women who gave birth to their first, love-born singleton infant utilizing Tricare. The reliability and validity of the instruments are on using records for maternal/infant birth hospitalizations and deployment. Nash et al. (2019) used a retrospective cohort study in evaluating the risk of HDP related to different deployment measures. The consistency of data collection and procedures is on using Tricare data from 1st January 2004 to 31st December 2008. Statistical analyses were carried out using SAS version 9.4 to explore descriptive statistics for the main deployment exposures and covariates. The outcomes show there is no increased risk of HDP for deployed mothers when compared to non-deployed mothers but cumulative deployment for more than a year was identified as a potential risk factor for HDP. A limitation of the study is that did not possess strength because of focusing on military women.

Tucker et al. (2018) carried out a study to systematically review the existing evidence for differences between self-monitored and clinic blood pressure during pregnancy. The research utilized 2654 studies that used self-monitoring of blood pressure during pregnancy. 121 articles were assessed in full and 21 included SMBP during pregnancy in a sample of man women. The reliability and validity of instruments are on selecting studies from MEDLINE and other electronic databases. Data was gotten from the third party and database searches run from 2016 by using a combination of a title and abstract keywords together with subject headings. There was no limitation on the publication date and all primary researches of any study design which involved SMEP during pregnancy in a sample of many women were involved. Two independent reviewers were used to identify articles that were relevant to the research. Consistency of data collection and procedures was achieved by looking at each of the titles and abstracts to determine the eligibility of the articles. Tucker et al. (2018) analyzed data by calculating the differences in blood pressure between clinic and self-measurement in all researches and periods depending on the gestation period. The results of the research show that after the 20th week of pregnancy, hypertension is known as gestational hypertension and can be a complication in 2%-8% of all pregnancies (Tucker et al., 2018). The research showed no clinical difference throughout pregnancy. One of the limitations of the study is that out of the 21 articles selected for the research, 11 may have had additional data on readings that are clinical and self-monitored not provided.

Zhao et al. (2020) carried out a study to investigate the expression and functions of CLDN3 in pregnancy-induced hypertension. A total of fifty-one expectant women where twenty-five were diagnosed with pregnancy-induced hypertension, eleven with mild pre-eclampsia, fifteen patients who had severe pre-eclampsia, and thirty normal pregnant women took part in the research. The reliability and validity of the instrument were achieved by participants and the collected sample. The use of different instruments such as lentiviral vector, cell counting kit-8, and western blot analysis confirms the validity and reliability of the research as a whole. The mRNA expression levels of CLDN3 in the placental tissue and peripheral blood of patients with pregnancy-induced hypertension were measured using reverse transcription-quantitative PCR. Lentiviral vector was used in human trophoblast HTR8/Svneo cells overexpressing CLDN3. Statistical analysis was done using SPSS where pairwise comparison was performed using the t-test, and one-way ANOVA followed by Dunnett’s test was utilized for multiple group comparisons. The study confirms that CLDN3 can promote human trophoblast cell proliferation, migration, and invasion with an underlying mechanism. A limitation of the research is that it utilized one trophoblast cell line.

The articles used in his paper explain that self-monitoring of high blood pressure during pregnancy assists in enhancing care, self-efficacy, and empowerment among women. Through self-monitoring of blood pressure, expectant women are deciding their health and that of their unborn baby. All the studies support the use of self-monitoring for blood pressure when a woman is expectant. However, there are gaps and inconsistencies in some of the researches. Lavalle et al. (2018) used articles with either primary or secondary data to carry out the analysis. It could have been beer if the researchers had focused on one type of article for consistency to be achieved. Muijsers et al. (2020) focused on general strategies in detecting and preventing hypertension in women after being diagnosed with PE/ HELLP. The explanation and analysis could have been more intense if the focus could have been on only one strategy such as self-monitoring blood pressure. Nash et al. (2019) focused on military women and the results could have been more effective if a comparison could have been made with women who are not in the military.

The researches carried out also has strengths and weaknesses. For instance, Zhao et al. (2020) used a small sample size, and maybe the results could not have been the same if the population was bigger. Tucker et al. (2018) did not put a time limit on the systematic review which makes it harder to have a comparison of the effectiveness of the intervention of self-monitoring blood pressure by expectant women. The weakness of the study carried out by Nash et al. (2019) is not only focusing on women in the military but also focusing on the United States only. Apart from the weaknesses, there are strengths of the articles such as Nash et al. (2019) did a comparison of deployed and nondeployed women to bring a better understanding of self-monitoring blood pressure. Muijsers et al. (2020) grouped the participants into a control and intervention group to carry out a comparison of the effect of expectant women using self-monitoring blood pressure and the usual care. It will be much easier for a reader to carry out a comparison of the two and determine which one is more effective when compared to only using one strategy of care.

There are both similarities and differences in the articles. The main similarity is that the focus was on looking at the effectiveness of self-monitoring blood pressure among expectant women. The main difference is on the population utilized in the studies, and data collection methods. Lavalle et al. (2018) used existing research to explain the importance of expectant women self-monitoring their blood pressure. The participants used by Muijsers et al. (2020) were 200 women aged between forty and sixty with a history of PE/HELLP and a randomized study design was utilized. Nash et al. (2019) utilized a database from the United States Department of Defense while Tucker et al. (2018) systematically reviewed existing evidence from research already carried out. Lastly, Zhao et al. (2020) utilized fifty-one expectant women in their research. Even though the researches aimed at looking at the effectiveness of using self-monitoring blood pressure while a woman is expectant, the population type, size, and data collection methods were not the same. Considering the results of the studies confirm the effectiveness of using self-monitoring blood pressure while expectant, it confirms the reliability of the strategy.

References

Lavallee, L., Tucker, K., & McManus, R. (2018). Pregnant women are doing it for themselves: Self-monitoring of blood pressure in pregnancy. British Journal of Midwifery, 26(7), 451–454. https://doi.org/10.12968/bjom.2018.26.7.451

Muijsers, H. E., van der Heijden, O. W., de Boer, K., van Bijsterveldt, C., Buijs, C., Pagels, J., Tönnies, P., Heiden, S., Roeleveld, N., & Maas, A. H. (2020). Blood pressure after PREECLAMPSIA/HELLP by self monitoring (bp-preself): Rationale and design of a multicenter randomized controlled trial. BMC Women’s Health, 20(1). https://doi.org/10.1186/s12905-020-00910-0

Nash, M. C., Kip, K., Wang, W., Custer, M., & O’Rourke, K. (2019). Deployment Among Active-Duty Military Women and Pregnancy-Related Hypertensive Disorders. Military Medicine, 184(5/6), e278–e283. https://doi.org/10.1093/milmed/usy228

Tucker, K. L., Bankhead, C., Hodgkinson, J., Roberts, N., Stevens, R., Heneghan, C., Rey, É., Lo, C., Chandiramani, M., Taylor, R. S., North, R. A., Khalil, A., Marko, K., Waugh, J., Brown, M., Crawford, C., Taylor, K. S., Mackillop, L., & McManus, R. J. (2018). How do home and clinic blood pressure readings compare in pregnancy? Hypertension, 72(3), 686–694. https://doi.org/10.1161/hypertensionaha.118.10917

Zhao, A., Qi, Y., & Liu, K. (2020). CLDN3 expression and function in pregnancy‑induced hypertension. Experimental and Therapeutic Medicine, 20(4), 3798-3806. https://doi.org/10.3892/etm.2020.9084