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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. [ABSTRACT FROM AUTHOR]

Objectives: Pregnancy hypertension is the third leading cause of maternal mortality in Mozambique and contributes significantly to fetal and neonatal mortality. The objective of this trial was to assess whether task-sharing care might reduce adverse pregnancy outcomes related to delays in triage, transport, and treatment.Study Design: The Mozambique Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised controlled trial (NCT01911494) recruited pregnant women in 12 administrative posts (clusters) in Maputo and Gaza Provinces. The CLIP intervention (6 clusters) consisted of community engagement, community health worker-provided mobile health-guided clinical assessment, initial treatment, and referral to facility either urgently (<4hrs) or non-urgently (<24hrs), dependent on algorithm-defined risk. Treatment effect was estimated by multi-level logistic regression modelling, adjusted for prognostically-significant baseline variables. Predefined secondary analyses included safety and evaluation of the intensity of CLIP contacts.Main Outcome Measures: 20% reduction in composite of maternal, fetal, and newborn mortality and major morbidity.Results: 15,013 women (15,123 pregnancies) were recruited in intervention (N = 7930; 2·0% loss to follow-up (LTFU)) and control (N = 7190; 2·8% LTFU) clusters. The primary outcome did not differ between intervention and control clusters (adjusted odds ratio (aOR) 1·31, 95% confidence interval (CI) [0·70, 2·48]; p = 0·40). Compared with intervention arm women without CLIP contacts, those with ≥8 contacts experienced fewer primary outcomes (aOR 0·79 (95% CI 0·63, 0·99); p = 0·041), primarily due to improved maternal outcomes (aOR 0·72 (95% CI 0·53, 0·97); p = 0·033).Interpretation: As generally implemented, the CLIP intervention did not improve pregnancy outcomes; community implementation of the WHO eight contact model may be beneficial.Funding: The University of British Columbia (PRE-EMPT), a grantee of the Bill & Melinda Gates Foundation (OPP1017337). [ABSTRACT FROM AUTHOR]