# Evaluating a Smartphone App to Monitor Blood Pressure in Normotensive Pregnancies, High-Risk Pregnancies, and Women With Preeclampsia: Prospective Longitudinal Feasibility Study

## TL;DR

A smartphone app for blood pressure monitoring in pregnant women shows promise but needs improvement for high-risk cases.

## Contribution

The study evaluates the Anura app's accuracy and user experience for blood pressure monitoring in normotensive, high-risk, and preeclamptic pregnancies.

## Key findings

- Anura showed acceptable agreement with manual measurements in normotensive pregnancies but lower accuracy in high-risk and preeclamptic groups.
- User feedback was predominantly positive, with women feeling more empowered and in control of their health.
- Bland-Altman analysis revealed increasing variability in high-risk pregnancies, suggesting the need for improved accuracy.

## Abstract

Antenatal care has been crucial in reducing maternal mortality. Currently, screening programs of pregnant women include blood pressure (BP) measurements, urine protein tests, and the identification of risk factors. Home monitoring can enhance the early detection and management of pregnancy-related hypertension, while also empowering women to take an active role in their own health care.

This study aimed to evaluate the reliability and accuracy of contactless BP monitoring using the Anura smartphone app and to compare it to conventional manual cuff measurements. This was done in normotensive and high-risk pregnancies, as well as in women diagnosed with preeclampsia. A secondary objective was to assess women’s experience using the Anura app.

Pregnant women with normotensive or high-risk pregnancies were enrolled from pregnancy weeks 8‐14, and women with preeclampsia were enrolled at the time of diagnosis. The 3 study groups consisted of 132 women with normotensive pregnancies, 40 women with high-risk pregnancies, and 87 women with preeclampsia. They were instructed to use the Anura smartphone app and perform a 30-second facial scan, alongside manual BP measurements, throughout pregnancy. Differences between the 2 methods were analyzed with linear mixed models accounting for repeated measures, reporting beta coefficients with 95% CIs, stratified by patient group and trimester. Outliers were detected visually in the Bland-Altman plots. A digital survey was answered in the Anura app at gestational weeks 37‐39, about their experiences using the Anura app.

A total of 4932 BP measurements were recorded with Anura, of which 539 had corresponding manual measurements. In normotensive pregnancies, Anura consistently showed slightly higher diastolic values (approximately 5‐7 mm Hg) and lower systolic values, with significant differences in the second and third trimesters. In high-risk pregnancies, both the systolic and diastolic BP were generally lower with Anura, especially in the second and third trimesters, while women with preeclampsia showed the largest differences, with Anura clearly showing lower systolic and diastolic values. Bland-Altman analyses confirmed these patterns and showed increasing variability and wider limits of agreement in the high-risk pregnancies with preeclampsia. Of 172 women with normotensive and high-risk pregnancies, 56 (32.5%) evaluated their experiences that were predominantly positive, with high perceived safety, better control, and a feeling of increased responsibility for their own health. Some experienced the measurement as somewhat uncomfortable.

The Anura app is well accepted by pregnant women and supported them to take an active role in their own health care. Agreement with manual BP measurements was acceptable in normotensive pregnancies but lower in high-risk and preeclamptic pregnancies. These findings indicate potential for Anura as a complementary self-monitoring tool. Further development is needed to improve the app’s accuracy in high-risk groups before broader implementation can be recommended.