Current state of blood pressure measurement in pregnant people in Canada: A national, inter-disciplinary survey.

Objective

Hypertension impacts 26 900 pregnancies in Canada per year. Accurate blood pressure (BP) measurement is recognized as crucial to hypertension care outside pregnancy but has gained less attention in pregnancy. Canadian guidelines recommend measuring maternal BP with a manual auscultatory device, or an automated device validated in pregnancy. National adherence to this recommendation is unknown.

Methods

We developed a 15-question survey to understand how health care professionals (HCPs) measure BP in pregnancy. We distributed it through Hypertension Canada's mailing list and the Snowball method.

Results

86 HCPs from 7 provinces and various specialties (including 63% from internal medicine and 21% from obstetrics) responded. For clinic BP in pregnant people, respondents frequently use an appropriate cuff size (n = 82, 95%), take multiple readings (n = 77, 90%), and have patients sit with arm/back support (n = 72, 84%). HCPs often use automated clinic devices for pregnant people but are uncertain of their validation in pregnancy (n = 53, 62%). Respondents frequently recommended home BP measurement (n = 81, 94%) and asked patients to bring home devices in to compare against clinic devices (n = 61, 71%) but most did not recommend a specific home device nor specify one that is validated in pregnancy.

Conclusions

We identified four strengths of BP measurement in pregnancy: appropriate cuff size, taking multiple readings, recommending home measurement, and attempting calibration of home devices. The most concerning finding is failure to use (in clinic) and recommend (at home) devices validated for pregnant people, due at least in part, to the limited number of devices validated for this population.