Table S1.
Details of QUADAS-2 tool for risk-of-bias assessment of for included studies
| Paper | QUADAS domain |
Overall | ||||
|---|---|---|---|---|---|---|
| 1A | 1B | 2 | 3 | 4 | ||
| 29 | Low | Low | Low - thorough description, trained staff, semi-automated machine | Low | Low | Low |
| 30 | Low – singleton only, excluded only if no BP <20 weeks or medical comorbidity requiring antihypertensive use for indication other than lowering BP | Low | Unclear – no description of measurement | Unclear | Low | Unclear |
| 8 | Low – excluded lost to follow up and women given aspirin | Low | Low – single measurement, 5 mins rest, trained staff, automated sphygmomanometer, appropriately sized cuff | Low | Low | Low |
| 31 | Low - excluded <18 years old or fewer than 2 antenatal visits before 20 weeks of gestation | Low | Unclear – no description of measurement | Unclear | High | High |
| 32 | High - excluded chronic diseases including thrombophilia, heart disease, neuropathy, neurodegenerative disease, cancer or autoimmune disease, ART, fetal anomaly or aneuploidy, or delivery at different institution | Low | Unclear –aneroid machine but no other description of measurements | Unclear | Low | High |
| 9 | High – excluded maternal comorbidities – SLE, pre-existing diabetes, lack of maternal weight recorded or gestational weight gain, initiation of antihypertensive medication < 20 weeks without diagnosis of HDP | Low | Unclear – no description of measurement | Unclear | Low | High |
| 33 | High – nulliparous only. Excluded history of 3 or more spontaneous abortions, current pregnancy complicated by aneuploidy or fetal malformation, assisted reproduction with a donor oocyte, multifetal reduction or plans to terminate the pregnancy |
Low | Low – aneroid sphygmomanometer, trained staff, sized cuff, rested and seated, repeated x 3 | Low | Low | High |
| 10 | High – chronic hypertension, multiple pregnancy Included only those with pre-existing diabetes or history of previous PET |
Low | Low – mercury sphygmomanometer, seated 10 mins, trained study staff, cuff to size | Low | Low | High |
| 52 | High – excluded multiple pregnancy, multiparous women, chronic hypertension, missing variables – large proportion excluded | Low | Unclear – booking visit, right arm but no other specifications | Unclear | Low | High |
| 11 | High – excluded PET late pregnancy, birth defects, tobacco and alcohol use, chronic hypertension based on criteria <20 weeks, missing covariates and those who delivered more than once in the study period | Low | Low – seated, automated sphygmomanometer, repeated and averaged | Low | High | High |
| 35 | High – excluded those with missing BP data or chronic hypertension | Low | Low – mercury sphygmomanometer, trained staff, seated, resting, multiple measurements averaged | Low | Low | High |
| 36 | High – excluded multiple pregnancy, stillbirth, diabetes mellitus, thyroid disease, renal disease, chronic hypertension, PCOS, incomplete records | Low | Low – trained staff, mercury sphygmomanometer, upright, right arm, repeated and averaged | Low | Low | High |
| 37 | Low – excluded multiples, anomalies and lost to follow up <20 weeks | Low | Low – manual device, described technique 15 mins seated rest | Low | High – 1933 women met inclusion criteria but only 252 included overall∗ | High |
| 38 | High – excluded multiple pregnancy, miscarriage, stillbirth, chronic hypertension, missing data | Low | Low – automated device, described measurement technique arm at heart level | Low | Low | High |
| 39 | Low | Low | Low - thorough description, trained staff, semi-automated machine | Low | Low | Low |
| 13 | Low – multiple pregnancy, fetal anomalies and no BP measurements in specified gestations | Low | Unclear – trained staff, doesn’t specify which type of sphygmomanometer | Unclear | Low | Unclear |
| 3 | Low – excluded only multiple pregnancy and those entering care >12 weeks | Low | Unclear – BP left arm seated position but no other comments | Unclear | Low | Unclear |
| 14 | Low - excluded multiples, delivery <20 weeks, missing prenatal records or BP data | Low | Unclear – not described | Unclear | Low | Unclear |
| 41 | Low | Low | Low - thorough description, trained staff, semi-automated machine | Low | Low | Low |
| 43 | Low – excluded multiple pregnancy, incomplete records, second delivery in study period or miscarriage | Low | High – records from multiple practices, not regulated by research protocol | High | Low | High |
| 42 | High – cut off was 135/85, excluded chronic hypertension above that, renal disease, diabetes or anyone with proteinuria on dipstick | Low | Low – mercury sphygmomanometer, study staff, seated and rested | Low | Low | High |
| 44 | High – excluded multiples, renal disease, stillbirth, hypertension, diabetes, thyroid dysfunction in early pregnancy | Low | Low – trained nurses, mercury sphygmomanometer, comfortable seat, 2 measurements | Low | Low | High |
| 45 | High – excluded <2 BP measurements <20 weeks, chronic hypertension, cardiovascular or hepatic disease, diabetes, autoimmune disease, multiple gestation or fetal anomaly | Low | Low – automatic sphygmomanometer, at least 2 measurements, seated position, left arm, resting | Low | Low | High |
ACC (American College of Cardiology), AHA (American Heart Association), ART (assisted reproductive technologies), BP (blood pressure), HDP – hypertensive disorder of pregnancy, PCOS (polycystic ovarian syndrome), PET (preeclampsia), SLE (systemic lupus erythematosus)
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.
∗
For every patient placed into either the ACC-AHA group or the ACOG group, the next patient with normal blood pressures was placed in the control group.