Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Medicine
Published in: BMC Medicine 1/2007

Open Access 01-12-2007 | Research article

A review of the methodological features of systematic reviews in maternal medicine

Authors: Lumaan Sheikh, Shelley Johnston, Shakila Thangaratinam, Mark D Kilby, Khalid S Khan

Published in: BMC Medicine | Issue 1/2007

Login to get access

Abstract

Background

In maternal medicine, research evidence is scattered making it difficult to access information for clinical decision making. Systematic reviews of good methodological quality are essential to provide valid inferences and to produce usable evidence summaries to guide management. This review assesses the methodological features of existing systematic reviews in maternal medicine, comparing Cochrane and non-Cochrane reviews in maternal medicine.

Methods

Medline, Embase, Database of Reviews of Effectiveness (DARE) and Cochrane Database of Systematic Reviews (CDSR) were searched for relevant reviews published between 2001 and 2006. We selected those reviews in which a minimum of two databases were searched and the primary outcome was related to the maternal condition. The selected reviews were assessed for information on framing of question, literature search and methods of review.

Results

Out of 2846 citations, 68 reviews were selected. Among these, 39 (57%) were Cochrane reviews. Most of the reviews (50/68, 74%) evaluated therapeutic interventions. Overall, 54/68 (79%) addressed a focussed question. Although 64/68 (94%) reviews had a detailed search description, only 17/68 (25%) searched without language restriction. 32/68 (47%) attempted to include unpublished data and 11/68 (16%) assessed for the risk of missing studies quantitatively. The reviews had deficiencies in the assessment of validity of studies and exploration for heterogeneity. When compared to Cochrane reviews, other reviews were significantly inferior in specifying questions (OR 20.3, 95% CI 1.1–381.3, p = 0.04), framing focussed questions (OR 30.9, 95% CI 3.7- 256.2, p = 0.001), use of unpublished data (OR 5.6, 95% CI 1.9–16.4, p = 0.002), assessment for heterogeneity (OR 38.1, 95%CI 2.1, 688.2, p = 0.01) and use of meta-analyses (OR 3.7, 95% CI 1.3–10.8, p = 0.02).

Conclusion

This study identifies areas which have a strong influence on maternal morbidity and mortality but lack good quality systematic reviews. Overall quality of the existing systematic reviews was variable. Cochrane reviews were of better quality as compared to other reviews. There is a need for good quality systematic reviews to inform practice in maternal medicine.
Appendix
Available only for authorised users
Literature
1.
2.
Oxman AD, Cook DJ, Guyatt GH: Users' guides to the medical literature. VI. How to use an overview. Evidence-Based Medicine Working Group. JAMA. 1994, 272: 1367-1371. 10.1001/jama.272.17.1367.CrossRefPubMed
3.
Sacks HS, Reitman D, Pagano D: Meta-analysis: an update. Mt Sinai J Med. 1996, 63: 216-224.PubMed
4.
5.
6.
Jadad AR, Cook DJ, Jones A, et al: Methodology and reports of systematic reviews and meta-analyses: a comparison of Cochrane reviews with articles published in paper-based journals. JAMA. 1998, 280: 278-280. 10.1001/jama.280.3.278.CrossRefPubMed
7.
Oxman AD, Guyatt GH: Validation of an index of the quality of review articles. J Clin Epidemiol. 1991, 44: 1271-1278. 10.1016/0895-4356(91)90160-B.CrossRefPubMed
8.
Abalos E, Duley L, Steyn DW, Henderson-Smart D: Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database of Systematic Reviews. 2001, CD002252-2
9.
Adab N, Tudur SC, Vinten J, Williamson P, Winterbottom J: Common antiepileptic drugs in pregnancy in women with epilepsy. Cochrane Database of Systematic Reviews. 2004, CD004848-3
10.
Atallah AN, Hofmeyr GJ, Duley L: Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database of Systematic Reviews. 2002, CD001059-1
11.
Bergel E, Carroli G, Althabe F: Ambulatory versus conventional methods for monitoring blood pressure during pregnancy. Cochrane Database of Systematic Reviews. 2002, CD001231-2
12.
Boulvain M, Stan C, Irion O: Elective delivery in diabetic pregnant women. Cochrane Database of Systematic Reviews. 2001, CD001997-2
13.
Brocklehurst P: Antibiotics for gonorrhoea in pregnancy. Cochrane Database of Systematic Reviews. 2002, CD000098-2
14.
Cuervo LG, Mahomed K: Treatment for iron deficiency anaemia in pregnancy. Cochrane Database of Systematic Reviews. 2001, CD003094-2
15.
Dennis CL, Creedy D: Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database of Systematic Reviews. 2004, CD001134-4
16.
Burrows RF, Clavisi O, Burrows E: Interventions for treating cholestasis in pregnancy. Cochrane Database of Systematic Reviews. 2001, CD000493-4
17.
Churchill D, Duley L: Interventionist versus expectant care for severe pre-eclampsia before term. Cochrane Database of Systematic Reviews. 2002, CD003106-3
18.
Dodd J, Dare MR, Middleton P: Treatment for women with postpartum iron deficiency anaemia. Cochrane Database of Systematic Reviews. 2004, CD004222-4
19.
Duley L, Henderson-Smart DJ: Drugs for treatment of very high blood pressure during pregnancy. Cochrane Database of Systematic Reviews. 2002, CD001449-4
20.
Duley L, Henderson-Smart D: Magnesium sulphate versus phenytoin for eclampsia. Cochrane Database of Systematic Reviews. 2003, CD000128-4
21.
Duley L, Henderson-Smart D: Magnesium sulphate versus diazepam for eclampsia. Cochrane Database of Systematic Reviews. 2003, CD000127-4
22.
Duley L, Gulmezoglu AM, Henderson-Smart DJ: Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database of Systematic Reviews. 2003, CD000025-2
23.
Duley L, Henderson-Smart D, Meher S: Altered dietary salt for preventing pre-eclampsia, and its complications. Cochrane Database of Systematic Reviews. 2005, CD005548-4
24.
French L, Smaill F: Antibiotic regimens for endometritis after delivery. Cochrane Database of Systematic Reviews. 2004, CD001067-4
25.
Garner P, Gulmezoglu A: Drugs for preventing malaria-related illness in pregnant women and death in the newborn. Cochrane Database of Systematic Reviews. 2002, CD000169-4
26.
Gates S, Brocklehurst P, Davis LJ: Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period. Cochrane Database of Systematic Reviews. 2002, CD001689-2
27.
Howard LM, Hoffbrand S, Henshaw C, Boath L, Bradley E: Antidepressant prevention of postnatal depression. Cochrane Database of Systematic Reviews. 2005, CD004363-2
28.
Jewell D, Young G: Interventions for nausea and vomiting in early pregnancy. Cochrane Database of Systematic Reviews. 2002, CD000145-1
29.
Jewell D, Young G: Interventions for treating constipation in pregnancy. Cochrane Database of Systematic Reviews. 2001, CD001142-2
30.
Kroner C, Turnbull D, Wilkinson C: Antenatal day care units versus hospital admission for women with complicated pregnancy. Cochrane Database of Systematic Reviews. 2001, CD001803-4
31.
Magee L, Sadeghi S: Prevention and treatment of postpartum hypertension. Cochrane Database of Systematic Reviews. 2005, CD004351-1
32.
Magee LA, Duley L: Oral beta-blockers for mild to moderate hypertension during pregnancy. Cochrane Database of Systematic Reviews. 2003, CD002863-3
33.
Matchaba P, Moodley J: Corticosteroids for HELLP syndrome in pregnancy. Cochrane Database of Systematic Reviews. 2004, CD002076-1
34.
Meher S, Abalos E, Carroli G: Bed rest with or without hospitalisation for hypertension during pregnancy. Cochrane Database of Systematic Reviews. 2005, CD003514-4
35.
Orton L, Garner P: Drugs for treating uncomplicated malaria in pregnant women. Cochrane Database of Systematic Reviews. 2005, CD004912-3
36.
Quijano CE, Abalos E: Conservative management of symptomatic and/or complicated haemorrhoids in pregnancy and the puerperium. Cochrane Database of Systematic Reviews. 2005, CD004077-3
37.
Rumbold A, Duley L, Crowther C, Haslam R: Antioxidants for preventing pre-eclampsia. Cochrane Database of Systematic Reviews. 2005, CD004227-4
38.
Smaill F: Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database of Systematic Reviews. 2001, CD000490-2
39.
Tuffnell DJ, West J, Walkinshaw SA: Treatments for gestational diabetes and impaired glucose tolerance in pregnancy. Cochrane Database of Systematic Reviews. 2003, CD003395-3
40.
Vazquez JC, Villar J: Treatments for symptomatic urinary tract infections during pregnancy. Cochrane Database of Systematic Reviews. 2003, CD002256-4
41.
Walker GJ: Antibiotics for syphilis diagnosed during pregnancy. Cochrane Database of Systematic Reviews. 2001, CD001143-3
42.
Walker MC, Ferguson SE, Allen VM: Heparin for pregnant women with acquired or inherited thrombophilias. Cochrane Database of Systematic Reviews. 2003, CD003580-2
43.
Webb RT, Howard L, Abel KM: Antipsychotic drugs for non-affective psychosis during pregnancy and postpartum. Cochrane Database of Systematic Reviews. 2004, CD004411-2
44.
Young G, Jewell D: Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database of Systematic Reviews. 2002, CD001139-1
45.
Young G, Jewell D: Topical treatment for vaginal candidiasis (thrush) in pregnancy. Cochrane Database of Systematic Reviews. 2001, CD000225-4
46.
Young G, Jewell D: Interventions for leg cramps in pregnancy. Cochrane Database of Systematic Reviews. 2002, CD000121-1
47.
Boath E, Bradley E, Henshaw C, Boath E: The prevention of postnatal depression: a narrative systematic review. Journal of Psychosomatic Obstetrics & Gynecology. 2005, 26 (3): 185-192. 10.1080/01674820400028431.CrossRef
48.
Brien T, Ray JG, Chan WS: Maternal body mass index and the risk of pre eclampsia: a systematic overview. Epidemiology. 2003, 14 (3): 368-374. 10.1097/00001648-200305000-00020.CrossRef
49.
Brody SC, Harris R, Lohr K: Screening for gestational diabetes: a summary of the evidence for the U.S. Preventive Services Task Force. Obstetrics & Gynecology. 2003, 101 (2): 380-392. 10.1016/S0029-7844(02)03057-0.
50.
Beck CT: Predictors of postpartum depression: an update. Nursing Research. 2001, 50 (5): 275-285. 10.1097/00006199-200109000-00004.CrossRefPubMed
51.
Austin MP, Priest SR: Clinical issues in perinatal mental health: new developments in the detection and treatment of perinatal mood and anxiety disorders. Acta Psychiatrica Scandinavica. 2005, 112 (2): 97-104. 10.1111/j.1600-0447.2005.00549.x.CrossRefPubMed
52.
Beck CT: Postpartum depression: a metasynthesis. Qualitative Health Research. 2002, 12 (4): 453-472. 10.1177/104973202129120016.CrossRefPubMed
53.
Coomarasamy A, Papaioannou S, Gee H, Khan KS: Aspirin for the prevention of preeclampsia in women with abnormal uterine artery Doppler: a meta-analysis. Obstetrics & Gynecology. 2001, 98 (5 Pt 1): 861-866. 10.1016/S0029-7844(01)01569-1.
54.
Coomarasamy A, Honest H, Papaioannou S, Gee H, Khan KS: Aspirin for prevention of preeclampsia in women with historical risk factors: a systematic review. Obstetrics & Gynecology. 2003, 101 (6): 1319-1332. 10.1016/S0029-7844(03)00169-8.
55.
Conde-Agudelo A, Villar J, Lindhmeimer M: World health organization syustematic review of screening tests for pre eclampsia. Obstetrics & Gynecology. 2004, 104: 1367-1391.CrossRef
56.
Dennis CL: Preventing postpartum depression part II: A critical review of nonbiological interventions. Canadian Journal of Psychiatry – Revue Canadienne de Psychiatrie. 2004, 49 (8): 526-538.PubMed
57.
Dennis CL: Preventing postpartum depression part I: a review of biological interventions. Canadian Journal of Psychiatry – Revue Canadienne de Psychiatrie. 2004, 49 (7): 467-475.PubMed
58.
Duckitt K, Harrington D: Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ. 2005, 330 (7491): 565-10.1136/bmj.38380.674340.E0.CrossRefPubMedPubMedCentral
59.
Eberhard-Gran M, Eskild A, Tambs K, Opjordsmoen S, Samuelsen SO: Review of validation studies of the Edinburgh Postnatal Depression Scale. Acta Psychiatrica Scandinavica. 2001, 104 (4): 243-249. 10.1034/j.1600-0447.2001.00187.x.CrossRefPubMed
60.
Gluck JC, Gluck PA: Asthma controller therapy during pregnancy. American Journal of Obstetrics & Gynecology. 2005, 192 (2): 369-380. 10.1016/j.ajog.2004.07.056.CrossRef
61.
Goodman JH: Postpartum depression beyond the early postpartum period. JOGNN – Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2004, 33 (4): 410-420. 10.1177/0884217504266915.CrossRef
62.
Greer IA, Nelson-Piercy C: Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood. 2005, 106 (2): 401-407. 10.1182/blood-2005-02-0626.CrossRefPubMed
63.
Kujovich JL: Thrombophilia and pregnancy complications. American Journal of Obstetrics and Gynecology. 2004, 191: 412-424. 10.1016/j.ajog.2004.03.001.CrossRefPubMed
64.
Kosmas IP, Tatsioni A, Ioannidis JP: Association of Leiden mutation in factor V gene with hypertension in pregnancy and pre-eclampsia: a meta-analysis. Journal of Hypertension. 2003, 21 (7): 1221-1228. 10.1097/00004872-200307000-00002.CrossRefPubMed
65.
Kosmas IP, Tatsioni A, Ioannidis JP: Association of C677T polymorphism in the methylenetetrahydrofolate reductase gene with hypertension in pregnancy and pre-eclampsia: a meta-analysis. Journal of Hypertension. 2004, 22 (9): 1655-1662. 10.1097/00004872-200409000-00004.CrossRefPubMed
66.
Kovalevsky G, Clarisa R, Gracia R, Jesse AB, Mary DS, Kurt TB: Evaluation of the association between hereditary thrombophilias and recurrent pregnancy loss: a meta-analysis. Archives Internal Medicine. 2004, 164: 558-562. 10.1001/archinte.164.5.558.CrossRef
67.
Kwon HL, Belanger K, Bracken MB: Effect of pregnancy and stage of pregnancy on asthma severity: a systematic review. American Journal of Obstetrics & Gynecology. 2004, 190 (5): 1201-1210. 10.1016/j.ajog.2003.09.057.CrossRef
68.
Lassere M, Empson M: Treatment of antiphospholipid syndrome in pregnancy – a systematic review of randomized therapeutic trials. Thrombosis Research. 2004, 114 (5–6): 419-426. 10.1016/j.thromres.2004.08.006.CrossRefPubMed
69.
Magee LA, Cham C, Waterman EJ, Ohlsson A, von DP: Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis. BMJ. 2003, 327 (7421): 955-960. 10.1136/bmj.327.7421.955.CrossRefPubMedPubMedCentral
70.
Magee LA, Bull SB, Koren G, Logan A: The generalizability of trial data; a comparison of β-blockers in pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2001, 94: 205-210. 10.1016/S0301-2115(00)00331-6.CrossRef
71.
Murphy VE, Clifton VL, Gibson PG: Asthma exacerbations during pregnancy: incidence and association with adverse pregnancy outcomes. Thorax. 2006, 61 (2): 169-176. 10.1136/thx.2005.049718.CrossRefPubMedPubMedCentral
72.
Rayburn WF, Bogenschutz MP: Pharmacotherapy for pregnant women with addictions. American Journal of Obstetrics & Gynecology. 2004, 191 (6): 1885-1897. 10.1016/j.ajog.2004.06.082.CrossRef
73.
Scott DA, Loveman E, McIntyre L, Waugh N: Screening for gestational diabetes: a systematic review and economic evaluation. Health Technology Assessment. 2002, 6 (11): 1-161.CrossRefPubMed
74.
Austin MP, Lumley J: Antenatal screening for postnatal depression: a systematic review. Acta Psychiatrica Scandinavica. 2003, 107 (1): 10-17. 10.1034/j.1600-0447.2003.02024.x.CrossRefPubMed
75.
Austin MP: Targeted group antenatal prevention of postnatal depression: a review. Acta Psychiatrica Scandinavica. 2003, 107 (4): 244-250. 10.1034/j.1600-0447.2003.00086.x.CrossRefPubMed
76.
Metadata
Title
A review of the methodological features of systematic reviews in maternal medicine
Authors
Lumaan Sheikh
Shelley Johnston
Shakila Thangaratinam
Mark D Kilby
Khalid S Khan
Publication date
01-12-2007
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2007
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/1741-7015-5-10

Other articles of this Issue 1/2007

BMC Medicine 1/2007 Go to the issue

Research article

Predictability and epidemic pathways in global outbreaks of infectious diseases: the SARS case study

Research article

Clinical effectiveness of usual care with or without antidepressant medication for primary care patients with minor or mild-major depression: a randomized equivalence trial

Research article

Kisspeptin and GPR54 immunoreactivity in a cohort of 518 patients defines favourable prognosis and clear cell subtype in ovarian carcinoma

Research article

Health inequalities, physician citizens and professional medical associations: an Australian case study

Research article

The effect of acetaminophen (four grams a day for three consecutive days) on hepatic tests in alcoholic patients – a multicenter randomized study

Research article

Planning an integrated disease surveillance and response system: a matrix of skills and activities