(938) Perinatal outcomes following implementation of a remote patient monitoring program for hypertensive disorders in pregnancy

Telehealth and remote patient monitoring programs (RPM) are used increasingly in obstetrics to improve care and decrease hospital admissions. Our goal was to evaluate the impact on perinatal outcomes of an RPM for management of antepartum hypertensive disorders of pregnancy (HDP).

Study Design: Retrospective cohort study of singleton gestations with HDP < 37 weeks expectantly managed before and after implementation of an RPM for HDP (controls 6/2020-5/2022, RPM 6/2022-4/2024). Patients were excluded if they had severe features or an indication for immediate delivery. RPM management was outpatient and included remote vital signs, nurse phone visits, and fetal surveillance. Control group management was both inpatient and outpatient at the discretion of the obstetrician. Primary outcome was gestational age (GA) at delivery. Secondary outcomes were readmission rates and select perinatal outcomes.

Results: 162 patients were identified: 66 RPM and 96 controls (Table 1). Median GA at enrollment and duration in RPM was 32.9 wks (IQR 29.9-34.6) and 20.0 days (IQR 9-31), respectively. RPM patients were more likely to have underlying chronic hypertension (cHTN); demographics were otherwise similar. Controls were more likely to deliver during the index hospitalization and develop severe features; RPM were more likely to be readmitted. RPM participants had a longer latency period between HDP diagnosis and delivery (27.5 vs 14.0 days, p=0.0036), delivered at a later GA (35.9 vs 35.4 wks, p=0.0051), and were more likely to have a planned delivery at 37 wks (31.8% vs 0%, p< 0.0001). NICU admission rate was higher in the control group (78.1% vs 57.6%, p=0.0051), primarily due to prematurity. After adjusting for cHTN, preeclampsia history and BMI, RPM was associated with pregnancy prolongation of 0.949 wks (95% CI 0.188, 1.710), an 83% reduction in development of severe features [AOR 0.169 (95% CI 0.073, 0.391), p< 0.0001] and a 60% reduction in NICU admission [AOR 0.398 (95% CI 0.191, 0.833), p=0.0144).

Conclusion: Use of RPM for outpatient management of preterm HDP is safe and may improve select perinatal outcomes.