Impact of Maternal-Fetal Medicine Unit Networks' publications on ACOG guidelines

Maternal-Fetal Medicine Units (MFMU) Network was created in 1986 to conduct well-designed trials. We sought to evaluate the impact of the Network’s publications on recommendations by ACOG—in obstetric practice bulletins (PB) and committee opinions (CO)—and with evaluative bibliometrics. From MFMU’s website we identified all publications related to their projects. From the ACOG website we searched each PB and CO to ascertain if the publication was referenced and if it led to recommendations. Google scholar was searched for each publication to determine how often it had been cited from publication to June 2021. Binomial logistic regression was performed using months since publication, journal of publication and number of citations as independent variables and link to ACOG recommendation as outcome. Over 333 months (Oct 1993-Feb 2021), the Network published 364 articles, with 54 (15%) linked to a guideline. As of April 2021, ACOG had 101 guidelines with 6,314 references and 763 recommendations. Network publications represented 0.9% of all references but contributed to 7.1% of the recommendations. MFMU influenced 18% of all level A recommendations, 14% of level B, and 10% of level C. Network publications were more likely to be linked to a recommendation if they were randomized clinical trial (RCT), were positive, and had a high number of citations (P < 0.05 for all comparison; Table 1). There was also an association with the journal in which the results were published (Table 1). The average time from publication to linked recommendation was 122 months. Link to ACOG guideline increased with citation count (OR 1.004; 95% CI 1.002-1.006) after controlling for journal of publication and time since publication. MFMU publications are influential with a 7:1 ratio of citations to linked recommendations in ACOG guidelines and they account for 1 in 5 level A recommendations. The impact of MFMU Networks’ publications on ACOG guidelines are notable.