Grant: Project Grant

Pakistan has one of the highest rates of maternal deaths in the world, with one-third of maternal deaths in hospitals due to preeclampsia and eclampsia (PE/E). Preeclampsia is when pregnant individuals have high blood pressure and protein in the urine. It can lead to maternal death, preterm birth, pregnancy loss, and stillbirth. In severe cases, preeclampsia can lead to eclampsia which is the presence of seizures. High maternal death from PE/E results from the lack of early risk detection, diagnosis, and treatment of individuals at high risk for pre-eclampsia (HRPE). Individuals at HRPE should have frequent clinic visits, but this can be hard due to socio-cultural and financial factors. However, even with regular visits, individuals at HRPE can have life-threatening spikes in their blood pressure. A potential tool to support individuals at HRPE is telemonitoring (TM), which is when home blood pressure readings and symptoms are sent to their providers in real-time. This project will explore how feasible it is to implement a mobile phone-based TM program for individuals at HRPE at a public hospital in Karachi, the largest city in Pakistan, where many people with very low-income live. The feasibility study will include 50 pregnant individuals at HRPE. The participants will take home blood pressure measurements and enter symptoms through the app, and will receive self-care instructions based on the entered data. A nurse will be the central point person to communicate with the high-risk pregnant individuals and their care team, and will respond to the automated alerts generated by the TM system. This will be the first study to explore the feasibility of having pregnant individuals at HRPE in Pakistan take their own home blood pressure readings through a TM system. The goal is to use the findings from this study to conduct a future larger trial to determine the effectiveness of the TM program to reduce the number of pregnant individuals and babies who die from PE/E.