What are the key areas of research in maternal health?

From the Guidelines

The key areas of research in maternal health should focus on addressing the neglected medium-term and long-term consequences of labour and childbirth, including conditions such as depression, urinary and anal incontinence, and sexual dysfunction, as highlighted in the most recent study published in 2024 1. To effectively address these issues, research should prioritize the following areas:

• Medium-term and long-term complications that can arise from the processes of labour and childbirth, such as obstetric fistula, which has benefited from dedicated stakeholder community efforts, but other common complications are often overlooked 1
• The interplay between human evolution, maternal physiology, and inherent predisposition to these complications, which can inform the development of prevention and treatment strategies 1
• Epidemiological data on these conditions, which is currently scarce and impairs their visibility to key stakeholders, making it essential to systematically search for and summarize high-quality clinical guidelines on their prevention, identification, and treatment 1
• Implications for women living in low-income and middle-income countries (LMICs), where these conditions can have lifelong social, economic, and health consequences, and resources are often limited 1 In contrast to the 2021 study published in the American Journal of Obstetrics and Gynecology 1, which focuses on assessing the risk of maternal morbidity and mortality, the 2024 study published in The Lancet Global Health 1 provides a more comprehensive and up-to-date overview of the key areas of research in maternal health, highlighting the need to address the neglected medium-term and long-term consequences of labour and childbirth. Therefore, research in maternal health should prioritize the prevention, identification, and treatment of medium-term and long-term complications, with a focus on LMICs, to improve maternal health outcomes and reduce morbidity and mortality.

From the FDA Drug Label

WARNINGS FETAL HARM: Continuous administration of magnesium sulfate beyond 5 to 7 days to pregnant women can lead to hypocalcemia and bone abnormalities in the developing fetus. Folic acid requirements are markedly increased during pregnancy, and deficiency will result in fetal damage

The key areas of research in maternal health include:

• Fetal harm associated with prolonged administration of magnesium sulfate
• Folic acid deficiency and its effects on fetal development
• Pregnancy-related complications, such as preterm labor and eclampsia 2
• Nutritional requirements during pregnancy, including folic acid supplementation 3

From the Research

Key Areas of Research in Maternal Health

The key areas of research in maternal health include:

• Improving data quality and measurement to better understand maternal mortality and morbidity 4
• Understanding the populations affected by maternal mortality and morbidity, as well as the numerous etiologies 4
• Clinical research to confirm preventive and interventional strategies to reduce maternal mortality and morbidity 4
• Engagement of community participation in research to reduce maternal mortality and morbidity 4
• Improving women's health before, during, and beyond pregnancy 5
• Improving the quality and safety of maternity care 5
• Improving systems of maternity care, including both clinical and public health systems 5
• Improving public awareness and education on maternal health 5
• Improving surveillance and research on maternal health 5

Implementation Research Priorities

Implementation research priorities for addressing the maternal health crisis in the USA include:

• Practices to prioritize for broader implementation, such as improved postpartum care and perinatal and postpartum mood disorder screening and management 6
• Practices to prioritize for de-implementation, such as cesarean delivery for low-risk patients and routine discontinuation of all psychiatric medications during pregnancy 6
• Research questions about implementation determinants, such as the role of social determinants and disparities in maternal health 6
• Research questions about implementation strategies, such as the use of health information technology to reduce racial disparities in maternal morbidity and mortality 7
• Research questions about methods/measures, such as the development of approaches for involving patients in implementation research 6

Community-Based Intervention Packages

Community-based intervention packages have been shown to be effective in reducing maternal and neonatal morbidity and mortality, and improving neonatal outcomes, particularly in low- and middle-income countries 8. These packages can include a range of interventions, such as:

• Tetanus immunization for mothers
• Clean and skilled care at delivery
• Newborn resuscitation
• Exclusive breastfeeding
• Clean umbilical cord care
• Management of infections in newborns
• Use of clean delivery kits
• Institutional deliveries
• Early breastfeeding
• Healthcare seeking for neonatal morbidities
• Iron/folic acid supplementation during pregnancy