Tailoring systematic reviews to meet critical priorities in maternal health: Issues of scope, methods and outcomes

Background. Health care practitioners and researchers commonly call for greater reliance on evidence as a means to achieve quality-improvement. Systematic reviews provide a means to accelerate the use of evidence-based clinical interventions and public health practices. The extent to which these time- and resource-intensive systematic reviews currently address critical maternal health priorities is unclear at this time.

Objective. This analysis summarizes key maternal health and research priorities, maps these priorities to existing reviews, identifies gaps in the literature that can be addressed with systematic reviews, and highlights key methodological concerns in conducting systematic reviews.

Methods. We draw on published data on maternal morbidities, web searches of organizational research priorities, and a systematic review of 488 reviews in Medline in the past five years using the MeSH term “"Delivery, Obstetric," to make links between health priorities, research priorities, existing evidence, and missing evidence.

Results. Key causes of morbidity during labor and delivery in the United States continue to be hemorrhage, pre-eclampsia and eclampsia, obstetric trauma, and infection. Organizational research priorities typically focus on broader issues of disparities in health outcomes and access to care. Systematic reviews, however, generally tend to focus on narrow clinical interventions rather than public health interventions, are frequently limited to randomized designs, and do not explicitly record adverse events.

Discussion. Our results suggest that advances in evidence-based care in maternal health require that systematic reviews move to a broader scope, include a larger variety of study designs, and pay closer attention to adverse events and health disparities.