Development of a smartphone-based device to detect fluid overload among postpartum women with hypertensive disorders of pregnancy

项目摘要 妊娠期高血压疾病在孕产妇发病率中占很大比例 和死亡率，是产后再入院的最常见原因。而当 高血压的治疗是产后管理的基石，新的证据 建议实施稳健的远程血压监测和治疗 仅靠方案并不能减少孕产妇发病率或与以下疾病相关的重新住院 产后液体过多和心力衰竭症状。能够预测哪些女性会 发展这些并发症，并寻求更积极的利尿治疗之前 住院或产后第一周出院是有限的。这条线路的总体目标是 研究是开发和实现一种方便的家用拥堵预测设备 在产后人群中结合家庭血压监测 妊娠高血压疾病。在此应用程序中，目标是开发和测试 基于智能手机的设备通过三个月预测先兆子痫患者的液体超负荷 具体目标：1)构建多个基于智能手机的设备，通过 先兆子痫患者产后充血预测指标的建立 使用设备训练数据，优化其在评估量状态时的准确性，并确定 并创建最终实时设备，以及3)作为响应，前瞻性地验证最终设备 一组患有先兆子痫的产后妇女的已知体液变化。这个 本申请中提出的研究在其对循证证据的新颖改编方面具有创新性 心力衰竭患者产后体液评估方法探讨 有严重发病率的人群，其使用智能手机的外形因素以及设计和 建议测试多个设备，以优化有效性和便利性。这项建议是 由于它将提供一个机会来开发和评估智能手机的可行性，因此意义重大- 基于产后子痫前期妇女体液状况的评估。有效 改善产后高血压护理的干预措施与创新的远程 战略对改善孕产妇发病率和减少性别差异具有广泛的影响。 关心。我们的发现将提供一个有价值的框架，为未来的随机试验提供信息 产后液体状况的远程评估和管理。成功 这项研究的完成将代表着产后管理的转变 对患有先兆子痫的妇女有直接影响，对改善高血压和 与心血管相关的孕产妇发病率和死亡率。

PROJECT ABSTRACT Hypertensive disorders of pregnancy contribute to a significant proportion of maternal morbidity and mortality and are the most common reason for hospital readmission postpartum. While treatment of hypertension is the cornerstone of postpartum management, emerging evidence suggests that implementation of robust remote blood pressure monitoring and treatment programs alone do not reduce maternal morbidity or hospital readmissions related to postpartum fluid overload and heart failure symptoms. The ability to predict which women will develop these complications and pursue more aggressive treatment with diuresis prior to hospital discharge or in the first week postpartum is limited. The overall goal of this line of research is to develop and implement a convenient congestion prediction device for home use in conjunction with home blood pressure monitoring in a postpartum population following a hypertensive disorder of pregnancy. In this application, the objective is to develop and test a smartphone-based device to predict fluid overload in patients with preeclampsia through three specific aims: 1) to build multiple smartphone-based devices to assess volume status via a congestion prediction index in postpartum women with preeclampsia, 2) to collect patient training data with the devices, optimize their accuracy in assessing volume status, and identify and create the final real-time device and 3) to validate the final device prospectively in response to known fluid changes among a new cohort of postpartum women with preeclampsia. The research proposed in this application is innovative in its novel adaptation of evidence-based approaches to fluid assessment in heart failure patients to an understudied postpartum population with significant morbidity, its use of a smartphone form factor and the design and the proposed testing of multiple devices to optimize effectiveness and convenience. This proposal is significant as it will provide an opportunity to develop and assess the feasibility of smartphone- based assessment of fluid status among postpartum women with preeclampsia. Effective interventions to improve postpartum hypertension care coupled with innovative remote strategies have broad implications for improving maternal morbidity and reducing disparities in care. Our findings will provide a valuable framework to inform a future randomized trial of remote assessment and management of fluid status in the postpartum period. Successful completion of this line of research would represent a transformation in postpartum management of women with preeclampsia and have a direct impact to improve hypertension and cardiovascular-related maternal morbidity and mortality.