Blood pressure monitoring at home helps Minnesota moms reduce birth complications

St. Cloud Hospital is giving away blood pressure cuffs after finding that the devices convinced pregnant women to seek help when hypertension threatened their health and birth outcomes.

During a test project last year, 38 women identified rising blood pressure through daily at-home use of the free cuffs and sought hospital care. Others reported reduced anxiety because they knew their blood pressure was stable, said Kayla Waldoch, a nursing supervisor at the CentraCare hospital.

"A big part of it is just building the knowledge and confidence in women about when to seek help," she said.

The giveaway was inspired by the Minnesota Perinatal Quality Collaborative, a group of health care systems that sought in 2021 to reduce unexpected, disabling health problems in women following pregnancy and childbirth by 25%.

Hypertension is a key target because it can complicate pregnancies and raise postpartum risks of stroke and heart and kidney diseases. Some women already have chronic hypertension, while more than one in 10 experience onset during or immediately after pregnancy.

The collaborative's efforts include a campaign to increase the percentage of pregnant women in Minnesota hospitals who receive medication within 60 minutes of blood pressure spikes. The target date for the goal was February 2023, but leaders said it could be months or years before they know if they met it.

"The impact for hypertension in particular will take years to fully realize because it does not simply end with the conclusion of pregnancy," said Melissa Bray-Iverslie, a nurse clinician in St. Cloud Hospital's birthing center.

However, that same report showed an increase in preterm birth rates in several large Minnesota counties. And the Centers for Disease Control and Prevention last year reported an increase in maternal deaths.

Brittney Laudenbach had three healthy pregnancies, and thought it would be safe to have a surrogate pregnancy for friends who struggled to have children. Severe headaches early on suggested that she might be at risk for pregnancy-related hypertension, so the St. Cloud obstetrical nurse agreed to monitor her blood pressure at home.

Her blood pressure spiked at about 34 weeks gestation, and she went to the hospital reporting headaches and swelling. Doctors gave her medication to prevent the seizures that can result from extreme hypertension and recommended immediate surgical delivery for the safety of the mother and the twin babies.

"I was scared," said Laudenbach, 31. "I've seen firsthand what can happen to women going through something like that."

Laudenbach credited blood pressure monitoring at home for her quick decision to seek care. Headaches are a common indicator of hypertension, but pregnant women sometimes ignore them or write them off as a lack of caffeine.

The state Medical Assistance program for low-income Minnesotans recently expanded coverage to include digital blood pressure cuffs that are easier for pregnant women to use at home, but some private health plans don't pay for any of them, said Dr. Todd Stanhope, a North Memorial obstetrician and chairman of the state collaborative.

Minnesota lawmakers have proposed requiring health plan coverage of at-home monitoring for any patients with uncontrolled hypertension, which could include pregnant women.

Waldoch said CentraCare pays for the cuffs when insurance doesn't cover them because there is an advantage to giving the devices and training to pregnant women in hospitals or clinics. Some women might not drive to medical supply stores for pickup, while others might borrow old, ill-fitting cuffs from their parents that produce faulty readings.

Supply issues are a concern. CentraCare suspended giveaways earlier this year when it received a delivery of substandard cuffs that produced inconsistent readings. Handouts resumed this week with a new batch that is far more accurate.

Waldoch said monitoring can result in early, induced deliveries for the safety of babies and mothers. However, if monitoring shows that blood pressure levels remain stable, it can allow women to deliver closer to their due dates.