What is a PRISMA Systematic Review – and Why Should Pregnant Women Care?

By: Sarah Ghantiwala

I am working with a group of students, under the Principal Investigator (PI), Dr. Stephanie Waggel, to write a systematic review of the safety of analgesic medications during pregnancy. Dr. Waggel is a mother and physician, so for her, pregnancy and analgesics are not just prevalent in the office, but also in her personal life. Analgesic medications are among the most commonly used drugs during pregnancy, including both opioid and non-opioid agents, yet evidence regarding their safety remains fragmented across drug classes, indications, and outcome domains. Existing studies vary widely in design, exposure definitions, and reported maternal, fetal, and neonatal outcomes, making interpretation and clinical counseling challenging. This systematic review aimed to synthesize the available evidence on analgesic exposure during pregnancy to provide a comprehensive, transparent assessment of the associated maternal, fetal, and neonatal outcomes.

This systematic review used PRISMA, which stands for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PRISMA is extremely important in writing a review, as it works to ensure reproducibility, transparency, and accurate reporting of a systematic review or meta-analysis. PRISMA uses a 27-item checklist and a 4-phase flow chart to allow researchers to document their selections and analysis process. The 4 phases of PRISMA are split into identification, which essentially searches for citations and sources; screening, which removes duplicates and looks for eligibility based on the systematic review’s requirements; full-text screening, which identifies full-text to screen based on the eligibility criteria; and inclusion, which finalizes the studies to be included in the systematic review. This lengthy process is vital to reducing bias and improving the quality of a systematic review.

Next, the systematic review also utilized PROSPERO, which refers to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and its registration greatly matters in the PRISMA process. Before starting a systematic review, the researchers should submit the search strategy to PROSPERO. PROSPERO, a free international online database that fulfills the PRISMA requirements, will then adhere to the submitted search strategy and ensure credibility. For this reason, PROSPERO acts as a registry to make planned research transparent, where reviews can be cross-referenced, and PRISMA researchers should register their systematic reviews in PROSPERO to ensure their reliability.

This review was highly structured, following a rigid step-by-step process that ultimately reduced bias throughout the paper. Structured review is guided by the core values of PRISMA through enforcing a transparent, reproducible, and systematic methodology. The highly structured review minimizes subjective selection by using predetermined eligibility criteria, comprehensive literature searches, and rigorous screening to ensure an unbiased review. Most importantly, the predefined protocols work in unison to ensure that the review has no bias and adheres to all the PRISMA rules.

References:

https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-has-reviewed-possible-risks-pain-medicine-use-during-pregnancy

https://www.physiology.org/publications/news/the-physiologist-magazine/2024/november/how-pregnancy-affects-a-lifetime-of-health?SSO=

https://baartprograms.com/resources/blog/what-are-synthetic-opioids

https://www.crd.york.ac.uk/prospero/

https://pmc.ncbi.nlm.nih.gov/articles/PMC8007028/