PURPOSE:
The PREMOM II study investigates the added value of remote monitoring (RM) in the prenatal follow-up of pregnant women at increased risk of developing hypertensive disorders of pregnancy (HDP). While earlier observational data from the PREMOM I study were promising, a randomized controlled trial (RCT) was needed to confirm the clinical, economic, and experiential benefits of RM.

DISCUSSION:
RM may improve the detection and management of HDP, but concerns remain about healthcare overuse, cost-effectiveness, and potential overtreatment. This study also explores whether patient self-monitoring (PSM) offers a lower-intensity alternative with similar outcomes, and how different follow-up models affect maternal satisfaction and perceived competence in the maternal role.

EVIDENCE WHERE RELEVANT:
In this multicenter RCT, 1,095 pregnant women (≥18 years, HDP risk ≥1/100) were randomized to RM (n=366), PSM (n=365), or standard care (CG, n=366). The RM group underwent more ultrasounds (8.06 vs. 7.49 [CG] and 7.33 [PSM]; p=0.011) and cardiotocographies (2.73 vs. 2.33 [CG] and 2.24 [PSM]; p=0.04), and had more gestational hypertension diagnoses (23.75% vs. 17.97% [CG] and 15.87% [PSM]; p=0.023). However, no significant differences emerged in labor onset or delivery mode. PSM was linked to less favorable perinatal outcomes, with a lower gestational age at birth (p=0.010). PROMs showed higher postpartum satisfaction and maternal confidence in the RM group (p<0.05); PSM participants reported lower satisfaction during pregnancy.

KEY MESSAGE:
RM does not significantly improve gestational outcomes when risk selection and aspirin prophylaxis are initiated early. However, it enhances patient satisfaction and confidence. Personalized, midwife-supported prenatal care remains essential. Further research should explore contextual factors and the role of advanced practice midwives in optimizing outcomes for women at risk of HDP. Complications - hypertension