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Effect of Maternal Blood Pressure Self-Monitoring on Early Detection of Pregnancy-Induced Hypertension in Nigeria

Abstract

Pregnancy-induced hypertension is an important maternal health concern and may contribute to serious complications for pregnant women and their babies if not identified and managed promptly. Early detection of elevated blood pressure during pregnancy provides an opportunity for timely clinical assessment, appropriate management, referral, and monitoring. However, reliance solely on routine facility-based blood pressure assessments may result in delayed identification of abnormal blood pressure between antenatal visits, particularly among women who experience barriers to frequent healthcare attendance. Maternal blood pressure self-monitoring provides an opportunity for pregnant women to measure their blood pressure at home using validated digital blood pressure devices and report abnormal readings to healthcare professionals. This approach may support more frequent monitoring and earlier recognition of pregnancy-induced hypertension. However, limited access to reliable devices, inadequate training, incorrect measurement techniques, poor understanding of blood pressure readings, cost, and weak communication or referral systems may affect its effectiveness. Against this background, this study investigates the effect of maternal blood pressure self-monitoring on early detection of pregnancy-induced hypertension in Nigeria. The study will be anchored on the Health Belief Model, Self-Efficacy Theory, and Health Promotion Model. The Health Belief Model explains how pregnant women's perceptions of susceptibility to hypertension, perceived severity of complications, perceived benefits of blood pressure self-monitoring, perceived barriers, and cues to action may influence their participation in home blood pressure monitoring. Self-Efficacy Theory emphasizes women's confidence and ability to correctly measure, interpret, record, and communicate their blood pressure readings. The Health Promotion Model emphasizes individual experiences, perceived benefits and barriers, interpersonal influences, and behavioural factors that influence participation in preventive health practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how maternal blood pressure self-monitoring may influence early detection of pregnancy-induced hypertension in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise pregnant women attending selected antenatal care facilities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, antenatal clinics, and eligible pregnant women. Maternal blood pressure self-monitoring will be assessed using indicators such as availability of validated home blood pressure devices, training received, frequency of blood pressure measurement, adherence to recommended measurement procedures, accuracy of measurement technique, maintenance of monitoring records, interpretation of readings, communication of abnormal readings to healthcare providers, and referral or follow-up arrangements. Early detection of pregnancy-induced hypertension will be assessed using indicators such as identification of elevated blood pressure readings, timing of first abnormal reading, confirmation of hypertension by healthcare professionals, gestational age at detection, referral for clinical assessment, and initiation of appropriate management. Data will be collected using structured questionnaires, home blood pressure monitoring records, antenatal clinic records, blood pressure measurement logs, clinical records, and referral documents. Descriptive statistics will be used to summarize participants' characteristics, monitoring practices, blood pressure readings, and detection patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of maternal blood pressure self-monitoring on early detection of pregnancy-induced hypertension. Where a quasi-experimental design is adopted, detection rates and gestational age at identification before and after introduction of a structured home blood pressure self-monitoring programme may be compared, while relevant demographic, obstetric, socioeconomic, and healthcare-access factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that maternal blood pressure self-monitoring has a significant positive effect on the early detection of pregnancy-induced hypertension in Nigeria. Pregnant women who regularly monitor their blood pressure at home and appropriately communicate abnormal readings to healthcare providers are expected to have pregnancy-induced hypertension identified earlier than women who rely exclusively on routine facility-based assessments. Frequent monitoring may identify changes in blood pressure between antenatal visits and create opportunities for prompt clinical confirmation, counselling, treatment, and referral. Training may also improve women's confidence and accuracy in measuring and recording their blood pressure. However, inadequate access to validated blood pressure devices, poor measurement technique, incorrect interpretation of readings, financial constraints, limited digital or health literacy, and weak communication and referral systems may reduce the effectiveness of home monitoring. The study therefore expects appropriately supervised, accessible, and well-integrated maternal blood pressure self-monitoring programmes to contribute significantly to earlier detection of pregnancy-induced hypertension in Nigeria. The study is expected to contribute to the literature on maternal blood pressure self-monitoring, pregnancy-induced hypertension, antenatal care, maternal health, hypertension detection, home-based healthcare, digital and remote health monitoring, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, primary healthcare centres, antenatal care providers, midwives, obstetricians, community health workers, maternal health programmes, development partners, and policymakers regarding strategies for strengthening hypertension detection during pregnancy. The study will also provide evidence-based recommendations for expanding supervised home blood pressure monitoring, improving access to validated monitoring devices, strengthening maternal education, training pregnant women in correct measurement techniques, establishing clear thresholds and communication pathways for abnormal readings, improving referral and follow-up systems, and integrating home blood pressure monitoring into appropriate antenatal care programmes across Nigeria.

Keywords: Maternal blood pressure self-monitoring, pregnancy-induced hypertension, early detection, pregnant women, home blood pressure monitoring, antenatal care, maternal health, hypertension, pregnancy, Nigeria, public health.