{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T07:04:02Z","timestamp":1780556642531,"version":"3.54.1"},"reference-count":42,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,4,24]],"date-time":"2023-04-24T00:00:00Z","timestamp":1682294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1017337"],"award-info":[{"award-number":["OPP1017337"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To inform digital health design by evaluating diagnostic test properties of antenatal blood pressure (BP) outputs and levels to identify women at risk of adverse outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Planned secondary analysis of cluster randomised trials.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>India, Pakistan, Mozambique.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women with in\u2010community BP measurements and known pregnancy outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Blood pressure was defined by its outputs (systolic and\/or diastolic, systolic only, diastolic only or mean arterial pressure [calculated]) and level: normotension\u20101 (&lt;135\/85\u2009mmHg), normotension\u20102 (135\u2013139\/85\u201389\u2009mmHg), non\u2010severe hypertension (140\u2013149\/90\u201399\u2009mmHg; 150\u2013154\/100\u2013104\u2009mmHg; 155\u2013159\/105\u2013109\u2009mmHg) and severe hypertension (\u2265160\/110\u2009mmHg). Dose\u2013response (adjusted risk ratio [aRR]) and diagnostic test properties (negative [\u2212LR] and positive [+LR] likelihood ratios) were estimated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>Maternal\/perinatal composites of mortality\/morbidity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 21\u2009069 pregnancies, different BP outputs had similar aRR, \u2212LR, and +LR for adverse outcomes. No BP level (even normotension\u20101) was associated with low risk (all \u2212LR \u22650.20). Across outcomes, risks rose progressively with higher BP levels above normotension\u20101. For each of maternal central nervous system events and stillbirth, BP \u2265155\/105\u2009mmHg showed at least good diagnostic test performance (+LR \u22655.0) and BP \u2265135\/85\u2009mmHg at least fair performance, similar to BP \u2265140\/90\u2009mmHg (+LR 2.0\u20134.99).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In the community, normal BP values do not provide reassurance about subsequent adverse outcomes. Given the similar performance of BP cut\u2010offs of 135\/85 and 140\/90\u2009mmHg for hypertension, and 155\/105 and 160\/110\u2009mmHg for severe hypertension, digital decision support for women in the community should consider using these lower thresholds.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17465","type":"journal-article","created":{"date-parts":[[2023,4,24]],"date-time":"2023-04-24T07:44:15Z","timestamp":1682322255000},"page":"1275-1285","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Choosing blood pressure thresholds to inform pregnancy care in the community: An analysis of cluster trials"],"prefix":"10.1111","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4136-3070","authenticated-orcid":false,"given":"Peter","family":"von Dadelszen","sequence":"first","affiliation":[{"name":"Institute of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine King's College London  London UK"},{"name":"Department of Obstetrics and Gynaecology and BC Children's Hospital Research Institute University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7704-1677","authenticated-orcid":false,"given":"Jeffrey N.","family":"Bone","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology and BC Children's Hospital Research Institute University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akshdeep","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology and BC Children's Hospital Research Institute University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Mark","family":"Ansermino","sequence":"additional","affiliation":[{"name":"Centre for International Child Health, BC Children's Hospital Research Institute University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahat N.","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Division of Woman and Child Health, Centre of Excellence Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charfudin","family":"Sacoor","sequence":"additional","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a  Manhi\u00e7a Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esperan\u00e7a","family":"Sevene","sequence":"additional","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a  Manhi\u00e7a Mozambique"},{"name":"Department of Physiological Sciences, Clinical Pharmacology, 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