Quality of guidelines for the management and prevention of occupational risks during pregnancy: a systematic quality assessment using the Appraisal of Guidelines for Research and Evaluation (AGREE II).

Abstract

This review aimed to appraise the quality of existing guidelines on the management of occupational risks for employed women during pregnancy, identifying and describing their characteristics. We systematically identified guidelines in MEDLINE, Embase, CINAHL, UpToDate, GIN International Guidelines Library, ECRI Guidelines Trust and websites of institutions and scientific societies. Four reviewers independently appraised each included document using the Appraisal of Guidelines for Research and Evaluation (AGREE II), generating domain scores of 0-100% (lowest to highest quality). An overall quality score for each guideline was assigned to each document by consensus among reviewers. The study included 31 documents: only 4 (12.9%) had good methodological quality for use in clinical practice; 27 (87.1%) scored poorly in domain III (rigor of development), failing to describe literature searches and formulation of recommendations methods, relationship between scientific evidence and recommendations or updating procedures. Domain IV (clarity of presentation) scores were higher as most documents presented their recommendations clearly, and 14 (45.1%) achieved scores of >60% for ease of identification and interpretation. Guidelines were generally clearer in defining their objectives, but none provided implementation tools. Guidelines for the management and prevention of occupational risks during pregnancy lacked sufficient rigor in their development. Despite generally clear objectives and presentation, critical gaps in methodology undermine their utility and applicability. There is a clear need to improve the development process of guidelines for the management and prevention of occupational risks during pregnancy.