The self-management of hypertensive pregnancies

Background Hypertension occurs in between 8 to 10% of pregnancies in the UK. While there has been a decline in maternal deaths from hypertensive disorders in pregnancy, it can still cause increased cardiovascular disease risk in later life. Therefore, better management strategies for hypertensive pregnancies, such as combining blood pressure monitoring, self-testing for proteinuria, and self-titrating blood pressure medication, are needed. In the general population, self-management interventions are becoming increasingly common place in the management of chronic conditions such as hypertension and diabetes. The evidence for self-management in pregnancy, however, is thin. Methods This thesis brings together qualitative and quantitative evidence on self-management to contribute to the evidence base for self-management interventions in pregnancy. A diagnostic accuracy study was conducted to determine the accuracy of proteinuria self-testing in pregnancy, and three qualitative interview and focus group studies with pregnant people and healthcare professionals were conducted to explore their thoughts on self-testing and self-management interventions. Results The diagnostic accuracy study showed that pregnant people are able to self-test in pregnancy with a similar accuracy to healthcare professionals. Meanwhile, the qualitative work revealed that while pregnant people and healthcare professionals find self-testing and the self-monitoring of blood pressure an acceptable self-management intervention that has the potential to empower patients, there were hesitancies from healthcare professionals, and some pregnant people, around the self-titration of blood pressure medication. Finally, a pervasive discourse of paternalism was explored in healthcare professional’s attitudes towards self-testing, and how the burden of self-management may affect pregnant people’s adherence to a self-management intervention. Conclusion This thesis has found that while there is an appetite, and growing evidence, for self-management in pregnancy from both pregnant people and healthcare professionals, both have concerns over self-titration of blood pressure medication. Self-management interventions in pregnancy are made more complex by paternalism, gatekeeping, concerns for maternity safety, and the unique burden of treatment that accompanies pregnancy – considering the additional life of the baby.