Key result
Antenatal blood pressure levels ≥135/85 mmHg and ≥155/105 mmHg showed fair (+LR 2.0-4.99) and good (+LR ≥5.0) diagnostic performance for maternal central nervous system events and stillbirth.
Why the study?
To inform digital health design by evaluating the diagnostic test properties of antenatal blood pressure outputs and levels to identify women at risk of adverse outcomes.
Do lower blood pressure thresholds (135/85 mmHg and 155/105 mmHg) effectively identify women at risk of adverse pregnancy outcomes in the community compared to standard thresholds?
Observational (n=21,069)
Yes
Do lower blood pressure thresholds (135/85 mmHg and 155/105 mmHg) effectively identify women at risk of adverse pregnancy outcomes in the community compared to standard thresholds?
Lower blood pressure thresholds of 135/85 mmHg and 155/105 mmHg perform similarly to standard thresholds for identifying adverse pregnancy outcomes and should be considered for community decision support.
BP measurement alone offers limited risk stratification antenatally; leaves open optimal thresholds for community digital tools in low-resource settings.
OBJECTIVE: 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. DESIGN: Planned secondary analysis of cluster randomised trials. SETTING: India, Pakistan, Mozambique. POPULATION: Women with in-community BP measurements and known pregnancy outcomes. METHODS: Blood pressure was defined by its outputs (systolic and/or diastolic, systolic only, diastolic only or mean arterial pressure [calculated]) and level: normotension-1 (<135/85 mmHg), normotension-2 (135-139/85-89 mmHg), non-severe hypertension (140-149/90-99 mmHg; 150-154/100-104 mmHg; 155-159/105-109 mmHg) and severe hypertension (≥160/110 mmHg). Dose-response (adjusted risk ratio [aRR]) and diagnostic test properties (negative [-LR] and positive [+LR] likelihood ratios) were estimated. MAIN OUTCOME MEASURES: Maternal/perinatal composites of mortality/morbidity. RESULTS: Among 21 069 pregnancies, different BP outputs had similar aRR, -LR, and +LR for adverse outcomes. No BP level (even normotension-1) was associated with low risk (all -LR ≥0.20). Across outcomes, risks rose progressively with higher BP levels above normotension-1. For each of maternal central nervous system events and stillbirth, BP ≥155/105 mmHg showed at least good diagnostic test performance (+LR ≥5.0) and BP ≥135/85 mmHg at least fair performance, similar to BP ≥140/90 mmHg (+LR 2.0-4.99). CONCLUSIONS: In the community, normal BP values do not provide reassurance about subsequent adverse outcomes. Given the similar performance of BP cut-offs of 135/85 and 140/90 mmHg for hypertension, and 155/105 and 160/110 mmHg for severe hypertension, digital decision support for women in the community should consider using these lower thresholds.
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Dadelszen et al. (2023) conducted an observational in Pregnancy (n=21,069). Antenatal blood pressure levels vs. Normotension-1 (<135/85 mmHg) was evaluated on Maternal/perinatal composites of mortality/morbidity. Antenatal blood pressure levels ≥135/85 mmHg and ≥155/105 mmHg showed fair (+LR 2.0-4.99) and good (+LR ≥5.0) diagnostic performance for maternal central nervous system events and stillbirth.
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