Discussion
BWS
PRETERM BIRTH, PREGNANCY HYPERTENSION
This re-analysis of CHIPS trial outcomes incorporated patient views and demonstrated that integrating patient preferences for outcomes and their associated weights into trial analyses is feasible and can identify different management approaches based on the results of a single trial. Our findings suggest that while almost two-thirds of women prioritize adverse outcomes equally, as assumed in the primary CHIPS analyses, about one-quarter prioritize very preterm birth that clearly favours ‘tight’ control. A distinct minority prioritize minimizing antihypertensive medication above other adverse outcomes, making ‘less-tight’ control the most value-congruent BP management for them.Recent clinical practice guidelines have recommended ‘tight’ control of pregnancy hypertension [While integrating preferences into composites has been considered in cardiology [Limitations of our work include the use of preference weights that reflect women’s values in Canada; despite its multiethnic population, values may differ elsewhere. Preferences were identified after CHIPS was completed; consequently, different composite components may have been identified a priori. However, CHIPS evaluated the standard obstetric outcomes that cover most of the subsequently published relevant core outcome set. These results are statistically significant at the group level, but clinical significance likely depends on individual preferences. Additionally, our method of preference elicitation may have been too cognitively burdensome for some participants. BWS was chosen because it can provide cardinal importance values on an additive scale. As a result, weights can be directly compared to one another and the magnitude of the difference in the importance of outcomes is known. Alternative methods of analysis which use ranks, rather than weights, to incorporate the importance of composite components were considered [