The United States (U.S.) has the highest maternal mortality rate among high-income countries, with 32.9 deaths per 100,000 live births in 2021 [1]. Severe maternal morbidity has steadily increased over the last three decades as pregnant women have become older, more obese, and more likely to have pre-existing medical conditions [2], [3]. The most common causes of preventable maternal death in the U.S. are severe hypertension, hemorrhage, and venous thromboembolism [4], [5]. Hypertensive disorders of pregnancy (HDP), defined as pre-pregnancy chronic hypertension and pregnancy-associated hypertension (preeclampsia, eclampsia, gestational hypertension, and chronic hypertension with super-imposed preeclampsia), are a major cause of maternal morbidity and mortality, and have been steadily increasing, affecting about 15.9 % pregnancies in 2019, compared to 5.9 % of pregnancies in 2003 [3], [6], [7], [8]. Maternal mortality rates in the U.S. are rising, and Black women have nearly three times higher mortality rates than White women [1]. Racial and sociodemographic disparities are present, with HDP prevalence highest among Black women (20.9 %), low-income women, and those living in the South [3], [9].

Kaiser Permanente of Georgia (KPGA) is a large, multispecialty integrated health care system serving over 320,000 members in the Atlanta metropolitan area. Our patient population is 43 % Black, 30 % White, 5 % Asian, 4 % Hispanic and 18 % unknown/other [10]. Georgia has one of the highest maternal mortality rates — with an MMR of 28.8 (2018–2020) [11], and one of the highest hypertension mortality rates in the country [12]. We developed an innovative perinatal patient safety program (PPSP) in 2019 to improve our obstetric and perinatal outcomes and decrease maternal and perinatal morbidity and mortality by improving the quality of care for pregnant women [13].

We implemented a remote patient monitoring program for hypertension (RPM HTN) to improve care for obstetric patients within our PPSP. To our knowledge, a large-scale remote blood pressure (BP) monitoring program in obstetric patients diagnosed with HDP that follows patients from the antepartum through the postpartum period has not previously been reported in the U.S. This study describes the RPM HTN program’s interventions and reports on outcomes in the first 24 months after implementation.