Protocol for Monitoring Postpartum Hypertension Outcomes via a Smartphone App (MOMitor): Ecological Momentary Assessment

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Abstract
Background: Postpartum hypertension defined as elevated blood pressure after childbirth, affects approximately 20% of women after delivery. Digital health interventions that include remote monitoring therefore, present an important opportunity to facilitate regular blood pressure assessment in this high-risk population. Objective: The primary objective is to assess within- and between-person changes in hypertension status over the first 6 weeks postpartum using a smartphone-based ecological momentary assessment protocol. The secondary objective is to characterize the trajectory of hypertension indicators across the 6-week period and to compare hypertension screening results from week one and week six within participants. Methods: This study uses a time-series design using data from prospectively enrolled patients within a large health system. Patients eligible for recruitment were women aged 18 years or older who spoke English, owned a smartphone, had a liveborn neonate, and were willing to download an app and respond to survey questions within the app. Throughout the study period, all participants received hypertension screening items that asked whether their blood pressure was greater than 140/90 mm Hg and whether they felt dizzy or lightheaded, short of breath, or had a severe headache. A subset of participants were additionally asked to report their blood pressure readings. We estimate within- and between-participant effects using a generalized linear mixed model for a positive hypertension screen during weeks one through six. The model includes both fixed and random effects, controlling for age, race, marital status, education, insurance status, mode of delivery, total number of pregnancies, and history of diabetes mellitus. Results: The study was funded July 2021 and data collection was initiated in November 2021. Data collection for this study, per protocol, was completed in June 2025, though other participants continue to be enrolled in the ongoing parent study. Data analysis is expected to be completed by Spring 2026 with publication planned for Summer 2026. Conclusions: The study findings will provide insight into trajectories of hypertension outcomes in postpartum women and the utility for smartphone app-based remote blood pressure monitoring among postpartum women whose blood pressure was regularly tracked. Findings will provide evidence to support whether widespread implementation of this digital health surveillance approach to improve outcomes in maternal health, especially in the postpartum period, is clinically warranted.

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