A systematic review of maternal and perinatal health outcomes in the context of epidemic threats: towards the development of a core outcome set.

Abstract

Objective To systematically identify and classify maternal and perinatal health outcomes reported in research conducted in the epidemic and pandemic context. Study design and Setting We conducted a systematic review following Cochrane Methods. We searched MEDLINE, EMBASE, LILACS, SCI-EXPANDED, CINAHL, Cochrane Central Register of Controlled Trials, PsycINFO, AMED, ClinicalTrials.gov and ICTRP, between January 2015 and March 2023. Experimental, quasi-experimental, observational studies, phase IV trials, and post-marketing studies, published protocols and ongoing registered studies reporting maternal and perinatal health outcomes were included. Studies only reporting coverage of interventions, access to routine health services, clinical presentation of infectious diseases, and reviews were excluded. A sampling strategy was used for COVID-19 studies, due to their very high numbers. Outcome verbatims were extracted and categorized in unique outcome, and further classified into domains and subdomains. Frequency of outcome reporting was calculated. Results 94 maternal and pregnancy and 47 unique neonatal outcomes were identified, from a total of 917 and 657 verbatims, respectively, reported across 440 included studies. At least 20% of included studies reported maternal and pregnancy outcomes of mode of delivery (56.1%), stillbirth (33.0%), preterm birth (28.6%), hypertensive disorders of pregnancy (26.6%), and maternal death (20.7%). These outcomes were identified across all three types of studies identified (epidemiological, product development or post-authorization surveillance). Gestational age at birth (29.8%), congenital malformations of the nervous system (26.1%), birth weight (23.4%), neonatal admission to intensive care unit (23.2%), and neonatal death (19.1%) were the most frequently reported neonatal outcomes. Conclusions Our study provides the basis for developing a core outcome set to measure maternal and perinatal health during outbreaks, which would help improve data collection of harmonized data, data synthesis, and timely development of informed public health guidance and clinical care responding to the needs of pregnant women. .