King's College London

The Royal College of Obstetricians and Gynaecologists produces evidence-based recommendations for Green-top Guidelines (GTGs). However, given disparities in pregnancy outcomes, such as the fact that Asian and Black women experience higher maternal mortality rates than White women, it is important to understand how inclusive and generalisable these GTGs are. In a recent study, Anangsha Kumar, Lisa Story and colleagues show that 24.3% of GTGs have no Grade A recommendations (which are recommendations underpinned by the highest quality evidence). They go on to explore Grade A recommendations in more detail, developing a novel tool to assign them a health equity score. This score is based on a number of parameters that have previously been shown to be associated with increased risk of maternal mortality, including age, race/ethnicity and culture, disability, and socioeconomic status. The authors find that most studies underpinning Grade A recommendations only address one or two health equity parameters, and no study reports more than four. While most studies consider women’s age and body mass index (BMI), few studies consider race/ethnicity, socioeconomic status, disability, or language barriers. The authors also use an existing framework to score the Grade A GTGs according to their generalisability.

While GTGs are a positive step forwards in improving obstetrics care, Anangsha’s work shows that there are still improvements to be made in their inclusivity and generalisability. “Our findings suggest that, alongside methodological quality, greater attention should also be paid to equity and generalisability when developing and appraising guideline evidence,” Anangsha said. “Hopefully this encourages more inclusive research and ultimately more applicable guidance for diverse patient populations.”

While completing this work, Anangsha was funded by a Pre-doctoral Clinical Research Excellence Fellowship from the King’s Health Partners Centre for Translational Medicine. “The fellowship was incredibly important in giving me protected time, mentorship and supervision from Dr Lisa Story, and research training with senior academics,” Anangsha said. “It allowed me to contribute to projects like this and to further develop my doctoral fellowship applications. During my PhD, I hope to combine clinical obstetrics with research in maternal and foetal health. Ultimately, I aspire to pursue a clinical academic role in foetal medicine.”

‘Assessment of Grades of Recommendations and Applicability of Royal College of Obstetricians and Gynaecologists Green-Top Guidelines: A Cross-Sectional Study’ (Kumar et al.) (DOI: 10.1111/1471-0528.70230) was published in BJOG).