Table 3.
Pooled relative risk and mean likelihood ratios for other main and secondary outcomes according to BP cutoffs at <20 weeks gestation based on ACC-AHA BP categories
| Outcome |
Ref |
Number of studies |
Number of women |
RR (95% CI); I2 (95% PI) |
−LR (95% CI) |
+LR (95% CI) |
|---|---|---|---|---|---|---|
| Diagnostic threshold: sBP 120 mmHg (with dBP <80 mmHg) | ||||||
| Serious maternal complications | 6a | 51,095 | 1.2 (0.9–1.8); I2=50%, (0.4–3.7) | 0.97 (0.89–1.04) | 1.19 (0.86–1.62) | |
| Preterm birth | 8 | 100,663 | 1.2 (1.0–1.5); I2=94%, (0.6–2.5) | 0.94 (0.89–1.00) | 1.21 (1.01–1.43) | |
| Perinatal death | 5 | 51,699 | 1.4 (1.2–1.6); I2=11%, (1.1–1.7) | 0.94 (0.87–0.97) | 1.34 (1.17–1.54) | |
| Stillbirth | 6 | 51,095 | 1.2 (0.9–1.8); I2=51%, (0.4–3.7) | 0.97 (0.89–1.04) | 1.18 (0.86–1.62) | |
| Newborn death | 5 | 50,410 | 1.4 (1.2–1.7); I2=0%, (1.0–1.9) | 0.94 (0.88–0.98) | 1.35 (1.14–1.59) | |
| SGA | 5 | 68,908 | 1.0 (0.9–1.1); I2=79%, (0.7–1.5) | 1.00 (0.96–1.04) | 1.00 (0.91–1.09) | |
| NICU admission | 3 | 34,401 | 1.5 (1.2–1.8); I2=45%, (0.2–10.15) | 0.87 (0.82–0.92) | 1.36 (1.21–1.52) | |
| Eclampsia | 4 | 38,586 | 2.2 (0.8–6.5); I2=40%, (UTD) | 0.89 (0.62–1.00) | 1.72 (0.97–2.60) | |
| Stroke | 3 | 19,387 | 2.1 (0.7–6.2); I2=63%, (UTD) | 0.88 (0.65–1.03) | 2.08 (0.74–4.39) | |
| Maternal ICU admission | 4 | 38,187 | 1.5 (1.1–2.0); I2=0%, (0.8–2.9) | 0.86 (0.79–0.92) | 2.02 (1.31–3.06) | |
| Placental abruption | 4 | 37,379 | 1.1 (0.9–1.3); I2=0%, (0.7–1.6) | 0.98 (0.93–1.03) | 1.05 (0.90–1.22) | |
| Cesarean | 4 | 19,752 | 1.3 (1.2–1.4); I2=0%, (1.0–1.6), | 0.96 (0.93–0.98) | 1.27 (1.13–1.45) | |
| Diagnostic threshold: sBP 130 mmHg or dBP 80 mmHg | ||||||
| Serious mat complications | 8 | 357,659 | 1.6 (1.3–1.9); I2=29%, (1.1–2.2) | 0.93 (0.89–0.96) | 1.47 (1.18–1.69) | |
| Preterm birth | 13 | 514,632 | 1.5 (1.3–1.8); I2=98%, (0.7–3.3) | 0.92 (0.84–0.96) | 1.49 (1.24–1.77 | |
| Perinatal death | 5 | 51,699 | 1.6 (1.4–1.9); I2=0%, (1.2–2.1) | 0.95 (0.92–0.97) | 1.59 (1.29–1.94) | |
| Stillbirth | 8 | 357,659 | 1.6 (1.3–1.9); I2=29%, (1.1–2.2) | 0.93 (0.89–0.96) | 1.47 (1.28–1.69) | |
| Newborn death | 5 | 50,410 | 1.6 (1.3–2.1); I2=14%, (1.0–2.7) | 0.96 (0.93–0.98) | 1.57 (1.19–2.05) | |
| SGA | 10 | 497,236 | 1.1 (1.0–1.2); I2=78%, (0.8–1.4) | 0.99 (0.96–1.00) | 1.06 (0.99–1.14) | |
| NICU admission | 6 | 462,080 | 1.4 (1.2–1.7); I2=96%, (1.1–1.8) | 0.92 (0.86–0.97) | 1.39 (1.11–1.72) | |
| Eclampsia | 5 | 342,275 | 2.5 (1.1–5.4); I2=66%, (0.1–48.6) | 0.85 (0.67–0.96) | 2.47 (1.39–4.32) | |
| Stroke | 4 | 323,076 | 2.1 (0.8–5.6); I2=76%, (0.0–105.9) | 0.86 (0.84–0.91) | 2.80 (1.40–5.20) | |
| Maternal ICU admission | 4 | 38,187 | 2.3 (1.7–3.1); I2=0%, (1.1–4.6) | 0.93 (0.84–0.99) | 1.78 (1.28–2.35) | |
| Placental abruption | 8 | 344,717 | 1.1 (1.0–1.2); I2=0%, (1.0–1.3) | 0.97 (0.94–0.99) | 1.10 (1.04–1.17) | |
| Cesarean delivery | 7 | 447,431 | 1.3 (1.1–1.6); I2=99%, (1.0–1.9) | 0.95 (0.90–0.97) | 1.45 (1.26–1.69) | |
| Diagnostic threshold: sBP 140 mmHg or dBP 90 mmHg | ||||||
|---|---|---|---|---|---|---|
| Serious maternal complications | 8 | 54,347 | 3.5 (2.5–4.9); I2=0%, (2.3–5.3) | 0.93 (0.86–0.97) | 3.33 (2.23–4.80) | |
| Preterm birth | 12 | 210,923 | 2.3 (2.0–2.6); I2=82%, (1.1–4.6) | 0.95 (0.89–0.98) | 2.51 (2.04–3.06) | |
| Perinatal death | 5 | 51,699 | 2.4 (1.8–3.1); I2=0%, (1.5–3.8) | 0.98 (0.95–0.99) | 2.54 (1.76–3.56) | |
| Stillbirth | 8 | 54,347 | 3.5 (2.5–4.0); I2=0%, (2.3–5.3) | 0.93 (0.86–0.97) | 3.26 (2.23–4.80) | |
| Newborn death | 5 | 50,410 | 1.9 (1.1–3.4); I2=0%, (0.4–9.4) | 0.99 (0.97–1.00) | 2.04 (1.00–3.73) | |
| SGA | 9 | 193,527 | 1.3 (1.2–1.4); I2=47%, (1.0–1.6) | 0.98 (0.96–0.99) | 1.32 (1.17–1.48) | |
| NICU admission | 6 | 158,768 | 1.8 (1.3–2.4); I2=93%, (0.4–9.0) | 0.95 (0.91–0.99) | 1.91 (1.18–3.15) | |
| Eclampsia | 4 | 38,586 | 7.3 (3.8–14.3); I2=0%, (0.1–560.9) | 0.89 (0.69–0.96) | 7.46 (4.16–13.3) | |
| Stroke | 3 | 19,387 | 8.6 (1.5–50.2); I2=0%, (UTD) | 0.90 (0.77–0.98) | 12.7 (2.11–41.10) | |
| Maternal ICU admission | 4 | 38,187 | 4.0 (2.8–5.6); I2=0%, (1.9–8.4) | 0.91 (0.84–0.96) | 6.34 (3.55–10.50) | |
| Placental abruption | 6 | 40,631 | 1.4 (1.0–1.9); I2=0%, (0.8–2.3) | 0.97 (0.91–1.00) | 1.40 (1.04–1.85) | |
| Cesarean delivery | 7 | 144,119 | 1.7 (1.6–1.8); I2=27%, (1.5–1.9) | 0.97 (0.93–0.98) | 2.30 (2.06–2.55) | |
ACC-AHA, American College of Cardiology-American Heart Association; BP, blood pressure; CI, confidence interval; dBP, diastolic blood pressure; ICU, intensive care unit; NICU, neonatal intensive care unit; PI, prediction interval; PPH, postpartum hemorrhage; sBP, systolic blood pressure; SGA, small for gestational age; UTD, unable to determine.
Slade. The diagnostic accuracy of American College of Cardiology-American Heart Association blood pressure categories for identification of women and babies at risk. Am J Obstet Gynecol 2023.
One additional study was not included, because complications such as gestational diabetes mellitus, cesarean delivery, and all forms of pregnancy hypertension were part of the composite.39