TY - JOUR
T1 - Relevance of individual participant data meta-analysis for studies in obstetrics
T2 - Delivery versus expectant monitoring for hypertensive disorders of pregnancy
AU - Broekhuijsen, Kim
AU - Bernardes, Thomas
AU - Van Baaren, Gert Jan
AU - Tajik, Parvin
AU - Novikova, Natalia
AU - Thangaratinam, Shakila
AU - Boers, Kim
AU - Koopmans, Corine M.
AU - Wallace, Kedra
AU - Shennan, Andrew H.
AU - Langenveld, Josje
AU - Groen, Henk
AU - Van Den Berg, Paul P.
AU - Mol, Ben Willem J.
AU - Franssen, Maureen T.M.
PY - 2015/8
Y1 - 2015/8
N2 - Like many other research subjects in obstetrics, research on immediate delivery versus expectant monitoring for women with hypertensive disorders of pregnancy faces certain challenges when it comes to interpretation and generalisation of the results; relatively rare outcomes are studied, in a clinically heterogeneous population, while the clinical practice in some countries has dictated that studies in term pregnancy were completed before earlier gestational ages could be studied. This has resulted in multiple smaller studies, some studying surrogate outcome measures, with different in- and exclusion criteria, and without enough power for reliable subgroup analyses. All this complicates the generation of definitive answers and implementation of the results into clinical practice. Performing multiple studies and subsequently pooling their results in a meta-analysis can be a way to overcome the difficulties of studying relatively rare outcomes and subgroups with enough power, as well as a solution to reach a final answer on questions involving an uncertain and possibly harmful intervention. However, in the case of the current studies on delivery versus expectant monitoring in women with hypertensive disorders of pregnancy, differences regarding eligibility criteria, outcome measures and subgroup definitions make it difficult to pool their results in an aggregate meta-analysis. Individual patient data meta-analysis (IPDMA) has the potential to overcome these challenges, because it allows for flexibility regarding the choice of endpoints and standardisation of inclusion and exclusion criteria across studies. In addition, it has more statistical power for informative subgroup analyses. We therefore propose an IPDMA on immediate delivery versus expectant monitoring for hypertensive disorders of pregnancy, and advocate the use of IPDMA for research questions in obstetrics that face similar challenges.
AB - Like many other research subjects in obstetrics, research on immediate delivery versus expectant monitoring for women with hypertensive disorders of pregnancy faces certain challenges when it comes to interpretation and generalisation of the results; relatively rare outcomes are studied, in a clinically heterogeneous population, while the clinical practice in some countries has dictated that studies in term pregnancy were completed before earlier gestational ages could be studied. This has resulted in multiple smaller studies, some studying surrogate outcome measures, with different in- and exclusion criteria, and without enough power for reliable subgroup analyses. All this complicates the generation of definitive answers and implementation of the results into clinical practice. Performing multiple studies and subsequently pooling their results in a meta-analysis can be a way to overcome the difficulties of studying relatively rare outcomes and subgroups with enough power, as well as a solution to reach a final answer on questions involving an uncertain and possibly harmful intervention. However, in the case of the current studies on delivery versus expectant monitoring in women with hypertensive disorders of pregnancy, differences regarding eligibility criteria, outcome measures and subgroup definitions make it difficult to pool their results in an aggregate meta-analysis. Individual patient data meta-analysis (IPDMA) has the potential to overcome these challenges, because it allows for flexibility regarding the choice of endpoints and standardisation of inclusion and exclusion criteria across studies. In addition, it has more statistical power for informative subgroup analyses. We therefore propose an IPDMA on immediate delivery versus expectant monitoring for hypertensive disorders of pregnancy, and advocate the use of IPDMA for research questions in obstetrics that face similar challenges.
KW - Hypertensive disorders of pregnancy
KW - Individual patient data meta-analysis
KW - Maternal morbidity/mortality
KW - Perinatal morbidity/mortality
KW - Preterm birth
UR - http://www.scopus.com/inward/record.url?scp=84942823748&partnerID=8YFLogxK
U2 - 10.1016/j.ejogrb.2015.05.023
DO - 10.1016/j.ejogrb.2015.05.023
M3 - Review article
C2 - 26094180
AN - SCOPUS:84942823748
SN - 0301-2115
VL - 191
SP - 80
EP - 83
JO - European Journal of Obstetrics and Gynecology and Reproductive Biology
JF - European Journal of Obstetrics and Gynecology and Reproductive Biology
ER -