Abstract Body: Introduction
Hypertensive disorders of pregnancy account for about 7% of pregnancy-related maternal deaths and contribute significantly to preterm birth, neonatal intensive care unit (NICU) admissions, and long-term CVD risks for mothers. Timely detection and management of hypertension during pregnancy and the postpartum period are critical to improving maternal and infant outcomes. Self-measured blood pressure (SMBP) monitoring enables more frequent measurements and potentially earlier detection of hypertension (HTN).
Methods
We constructed a two-part decision-analytic model to simulate impacts for pregnant Medicaid beneficiaries from mid-pregnancy (20 weeks of gestation) through the postpartum period, comparing health and economic outcomes under two strategies: clinic-based blood pressure measurement (CBPM), i.e., usual care and SMBP. Two patient cohorts are examined: non-chronic HTN pregnancies and chronic HTN pregnancies. We used the 30-year cardiovascular disease (CVD) risk from the Framingham study to predict 1-year probabilities of Myocardial Infarction, stroke and other CVDs from the current age until they leave Medicaid or die.
Results
For non-chronic HTN pregnancies, SMBP produces savings of $62 - $112 per woman during pregnancy through postpartum. These are mostly driven by savings in diagnostic of HTN and improved treatment of HTN. With SMBP for women with chronic HTN, large savings, $3,116 per mother-infant pair on average, occur during pregnancies from reductions in infant healthcare costs attributable to avoided NICU days from prolonged gestation. Postpartum savings, however, are between -$31 and -$217.
Conclusion
Overall, during pregnancy and postpartum, SMBP yields substantial economic benefits among Medicaid beneficiaries, particularly among women with chronic HTN. The benefits are derived from early detection of elevated BP among pregnant women with chronic HTN prompting obstetricians to adjust medications sooner and potentially delay delivery. In our model, these early detected cases have on average one additional week of gestation before delivery, resulting in infants having higher birth weights and shorter NICU stays.

Total savings will vary with cohort sizes, with the largest savings accruing to the largest states, e.g., Texas, California, and New York, which currently have Medicaid coverage for SMBP devices. Other states without coverage, e.g., Florida, and many of the stroke belt states, might reconsider revising that policy decision.