Trends in adherence with a home blood pressure monitoring intervention among pregnant women in Ghana: A prospective cohort study

OBJECTIVE: This study evaluates trends in adherence with home blood pressure (BP) monitoring in a cohort of Ghanaian pregnant women. METHODS: In this prospective cohort study, participants were pregnant women receiving antenatal care at a tertiary hospital in Ghana. Participants were recruited at their initial antenatal visit and trained to use an automatic BP monitor. Until delivery, participants were instructed to check their BP daily, record values, and call a study nurse's phone line for clinical advice for elevated BPs. Home monitoring data were extracted from logs and analyzed over time. RESULTS: The mean age of pregnant participants (n = 133) was 32 years; 28.6% were nulliparous, 8.3% had chronic hypertension, and 18.9% had a prior pregnancy complicated by a hypertensive disorder. From enrollment to delivery (mean 11.7 weeks), mean daily adherence with home BP monitoring was 73.7%, with a range from 0% to 100%. On average across all participants, the proportion of weeks with every day logged was 48.5%, the proportion of weeks with at least half of days logged was 74.1%, and the proportion of weeks with at least one day logged was 87.3%. Monitoring dropped off slowly over time, with over 50% of participants logging at least 1 day per week through delivery. Higher adherence was significantly associated with stillbirth in a prior pregnancy and a higher overall risk of a hypertensive disorder in the current pregnancy. CONCLUSION: Among pregnant women in Ghana, mean adherence with home BP monitoring is high, especially among women who have experienced a stillbirth.