Turning text messages into a lifeline

High blood pressure from preeclampsia puts mothers at an increased risk of rare but serious complications including seizure, stroke, organ damage, and death. Women are most susceptible to these risks during the first week after delivery, but about 70 percent of women do not make it to their first follow-up appointment after delivery, which can lead to worsening hypertension and increased readmissions.

Instead of asking mothers to come into the office to check their blood pressure a few days after discharge, in 2017, doctors at the Hospital of the University of Pennsylvania (HUP) launched the Heart Safe Motherhood program. Developed by Adi Hirshberg, MD, an associate professor of Clinical Obstetrics and Gynecology and director of obstetrical services at HUP, and Sindhu K. Srinivas, MD, MSCE,a professor and vice chair for quality and safety in Obstetrics and Gynecology, this first-of-its-kind text message-based program allows mothers to track their blood pressure from the comfort of their home and communicate with their care team without visiting a doctor’s office.

As part of the program, patients are given blood pressure monitoring cuffs before leaving the hospital. Once home, they receive text messages reminding them to measure and record their blood pressure via text message two times per day for ten days. Once submitted, patients receive a response informing them if their blood pressure is normal or high, and what to do next. Patients reporting higher blood pressures may be asked to take additional readings. The patient’s doctor is also notified of elevated values. The reporting allows the care team to intervene and treat potentially life-threatening high blood pressure without a visit to the office.

Scaled up for impact across the health system, region, and beyond

The program is now the standard of care for all at-risk obstetric patients in all five of Penn Medicine’s birthing hospitals in the region spanning central Pennsylvania to central New Jersey.

After several years of operation, research bears out the effectiveness of Heart Safe Motherhood in protecting of participants’ health over the year following childbirth. Multiple conditions tied to high blood pressure occurred less frequently in those who participated in Heart Safe Motherhood compared to a similar group of patients who did not. Additionally, the Heart Safe Motherhood patients had fewer emergency room visits, hospitalizations, and total health care costs, averaging a savings of about $100 per patient.

Tens of thousands of patients enrolled for postpartum remote blood-pressure monitoring

From the launch of the program at Penn Medicine in 2017 through 2023, more than 27,400 patients have enrolled in Heart Safe Motherhood, including:

• 18,800+ Penn Medicine patients
• 8,600+ hospital patients at two other Philadelphia birthing hospitals, an academic hospital in the Midwest, and a California health care institution

Monitoring blood pressure is key to keeping mothers safe

To date, 250,000+ blood pressures have been reported through the program by Penn Medicine patients.

Dramatically reducing readmissions

Penn Medicine patients had a 50% reduction in readmissions due to blood-pressure-related conditions for six months.

Improving health and eliminating disparities

Before the Heart Safe Motherhood Program:

• 70% of non-Black women completed a post-discharge blood pressure reading
• 33% of Black women completed a post-discharge blood pressure reading

After the Heart Safe Motherhood Program:

• 93% of non-Black women completed the reading
• 91% of Black women completed the reading

Editor's note: An earlier version of this article was first published in February 2020. Data and description were most recently updated in December 2023.