Summary

Introduction Pregnant women and their offspring are often at increased direct and indirect risks of adverse outcomes during epidemics and pandemics. A coordinated research response is paramount to ensure that this group is offered at least the same level of disease prevention, diagnosis, treatment, and care as the general population. We conducted a landscape analysis and held expert consultations to identify research efforts relevant to pregnant women affected by disease outbreaks, highlight gaps and challenges, and propose solutions to addressing them in a coordinated manner.

Methods Literature searches were conducted from 1 January 2015 to 22 March 2022 using Web of Science, Google Scholar, and PubMed augmented by key informant interviews. Findings were reviewed and Quid analysis was performed to identify clusters and connectors across research networks followed by two expert consultations.

Results Ninety-four relevant research efforts were identified. Although well-suited to generating epidemiological data, the entire infrastructure to support a robust research response remains insufficient, particularly for use of medical products in pregnancy. Limitations in global governance, coordination, funding, and data-gathering systems have slowed down research responses.

Conclusion Leveraging current research efforts while engaging multinational and regional networks may be the most effective way to scale up maternal and perinatal research preparedness and response. The findings of this landscape analysis and proposed operational framework will pave the way for developing a roadmap to guide coordination efforts, facilitate collaboration, and ultimately promote rapid access to countermeasures and clinical care for pregnant women and their offspring in the future.

Funding UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, and Bill and Melinda Gates Foundation.

Evidence before this study Previous epidemics and pandemics highlighted the dearth of preparedness and response for maternal and perinatal health, resulting in access to countermeasures being delayed for this group, despite pregnant women and their offspring often being identified as at increased risk of severe disease outcomes. Based on this experience, we first searched PubMed from 1 January 2015 to 22 March 2022 with no language restrictions to identify any landscape analyses evaluating research efforts pertaining to pregnant women facing ongoing and emerging epidemic threats. Those efforts were defined as persistent data generation or aggregation exercises, including single studies, networks, and collaborations. As many of them struggled to secure and sustain baseline funding, it could be potentially beneficial to have them covered by some form of a global coordination mechanism to help improve their coherence.

Multiple commentary articles discussing the need for harmonization of research and preparedness planning to avoid maternal and perinatal exclusion from potential preventative and treatment interventions in future epidemics/pandemics were identified, with most focusing on the lessons that can be learned from the COVID-19 pandemic. Evaluation of existing literature and scoping reviews identified studies which have evaluated gaps in approaches for alleviating gender inequality in future public health emergencies and the impacts of the COVID-19 pandemic on maternal and perinatal health services. None of them, however, have specifically focused on current research efforts in maternal and perinatal health that can be utilised in context of emerging and ongoing epidemic threats, or have proposed a framework for harmonizing future research efforts.

Added value of this study This study provides a comprehensive overview of existing research efforts relevant to maternal and perinatal health in future outbreak, epidemic or pandemic situations. We summarise the key areas of focus of research efforts, identifying current gaps and areas in which the existing infrastructure is insufficient, and proposing an operational framework for improving conduct of maternal and perinatal heath research related to emerging and ongoing epidemic threats.

Implications of all the available evidence The available evidence indicates that while current research efforts are well-suited to collecting maternal and perinatal epidemiological data, some gaps remain. They include limitations in global governance, coordination, funding, and data-gathering systems. The proposed operational framework developed based on the findings of this study will allow for development of a roadmap for guiding efforts and coordinating research to maximise access to countermeasures and clinical care for pregnant women and their offspring in during emerging and ongoing epidemic threats future outbreak, epidemic, and pandemic situations.

Competing Interest Statement

Beate Kampmann was former member of Scientific Advisory Board of Pfizer, a member of Data Safety Monitoring Board of J&J, and employer received a grant from Pfizer. Marian Knight has received grants to the institution from the National Institute for Health Research Healthcare Quality Improvement Programme. Flor Munoz has received grants to the institution from Pfizer for COVID 19 vaccines, Gilead for remdesivir, NIH & CDC for COVID 19 vaccines and respiratory viruses epidemiology, she receives royalties for authorship and conducting reviews, and consulting fees from Sanofi, AZ, Merck, Moderna for prevention of viral respiratory infections, she participates on a Data Safety Monitoring Board or Advisory Board of Dynavax (plague vaccines) and Pfizer and Meissa (RSV vaccines). Andy Stergachis has received grants to the institutions from USAID and BMGF, receives consulting fees from CEPI and PATH, participates on a Data Safety Monitoring Board or Advisory Board IMPROVE (malaria chemoprevention) Trials and INTREPiD (malaria testing); both non compensated, participates in Safety Platform for Emergency Vaccines (SPEAC) Executive Board and Scientific Advisory Board, Vivli AMR Register. Cristiana Toscano receives support from Harvard School of Public Health, Yale School of Public Health, and the Pan American Health Organization. All other authors declare no competing interests.

Funding Statement

Funding UNDP UNFPA UNICEF WHO World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, and Bill and Melinda Gates Foundation.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors

AbbreviationsHIChigh income countryHRPHuman Reproduction ProgrammeLMIClow- and middle-income countryMERSMiddle East Respiratory SyndromeSARSSevere Acute Respiratory SyndromeWHOWorld Health Organization