Randomised trials in maternal and perinatal health in low- and middle-income countries from 2010 to 2019: A systematic scoping review

Objectives: To identify and map all trials in maternal health conducted in
low- and middle-income countries (LMIC) over the 10-year period 2010-2019,
to identify geographical and thematic trends, as well as compare to global
causes of maternal death and pre-identified priority areas. Design:
Systematic scoping review. Primary and secondary outcome measures:
Extracted data included location, study characteristics and whether trials
corresponded to causes of mortality and identified research priority
topics. Results: Our search identified 7,269 articles, 874 of which were
included for analysis. Between 2010 and 2019, maternal health trials
conducted in LMICs more than doubled (50 to 114). Trials were conducted in
61 countries – 231 trials (26.4%) were conducted in Iran. Only 225 trials
(25.7%) were aligned with a cause of maternal mortality. Within these
trials, pre-existing medical conditions, embolism, obstructed labour, and
sepsis were all under-represented when compared with number of maternal
deaths globally. Large numbers of studies were conducted on priority
topics such as labour and delivery, obstetric haemorrhage, and antenatal
care. Hypertensive disorders of pregnancy, diabetes, and health systems
and policy – despite being high-priority topics – had relatively few
trials. Conclusion: Despite trials conducted in LMICs increasing from 2010
to 2019, there were significant gaps in geographical distribution,
alignment with causes of maternal mortality, and known research priority
topics. The research gaps identified provide guidance and insight for
future research conducted in low-resource settings.