I always rely on a variety of medical journals and scientific literature when making clinical assessments and recommendations. My goal here is to help you translate that often difficult-to-read medical jargon into useful information that can help answer a good number of your questions about pregnancy.
Prior to meeting with me for a consultation, many women have already scoured the internet looking for information to answer their questions. There are quite a few helpful websites about pregnancy that are written for an everyday audience. However, keep in mind that they are often not detailed, may not refer to the medical literature, and are unlikely to focus on mental health and emotional wellbeing.
I have found that some women, after hearing my explanations during a visit, want to go back to the original scientific articles and read it for themselves. This is great, and here are five tips to help you evaluate medical literature more critically to get the most out of it.
#1 – Think about the “when” and “where.”
Take a look at the date the article you are interested in was published. Reproductive psychiatry is a fairly newer field and only in recent years have articles come out that are large enough to answer questions with more certainty. Then take a look at where the scientists are writing from, as information from a different country might not apply to you.
#2 – What is statistically significant might not be clinically significant.
One example is a study that might state a particular medication leads to preterm delivery. This statement is based on the fact that women in their study taking the medication delivered at 38 weeks and 3 days on average, while other women delivered 9 days later at 39 weeks 5 days on average. If the study is large enough, this difference will be statistically significant. But both groups of women are delivering term babies and the 9 days may not make much clinical difference.
#3 – Think about the complexity of your question.
For easier questions there will be a lot of data and for more complicated ones much less. A prime example of this range is medication safety in pregnancy. When we think about medication safety in pregnancy, we look at three categories:
- First, the risk of birth defects. This is the easiest question to answer because it is easily observable and an answer is available within 9 months. Therefore, for any medication, you will find the most information on this question.
- Second, the potential for complications at birth or immediately after delivery. Often, this means whether or not the medication might lead to preterm deliveries or could lead to withdrawal symptoms after delivery. This question is more difficult to answer because many factors can lead to similar outcomes and it can sometimes be a challenge to know exactly what the culprit is to a complication. Similarly, it may be difficult to tell, especially with mild withdrawal, if an infant just has a difficult temperament or is actually withdrawing from a medication.
- Finally, long-term consequences. This is the most difficult question to answer. To know whether a medication exposure in pregnancy can lead to problems for the child at 2 years, 5 years, or 10 years requires researchers and participants to invest very long lengths of time in the research study. Therefore, there is very little data that answers these long-term questions.
#4 – Look at the type of study you are reading.
Did it ask women to answer questions after the fact (called retrospectively) or did it follow a group of women over time to answer a question (prospectively). The former can often be a source of bias and usually prospective studies, if available, are a better bet.
#5 – Take note at whether or not the article takes everything into account that might affect the result.
Scientifically speaking, this means accounting for confounding factors. A prime example would be a study that attempts to answer the question of whether or not a medication for depression leads to adverse consequences in babies. However, the study does not take into account the severity of a woman’s depression as a complicating factor that might also lead to adverse consequences. Another example is an investigation that concludes a treatment for insomnia causes problems for the mother postpartum, without taking into account the impact of the sleepless nights themselves.
There are, of course, other elements in critically reading a scientific paper (understanding differences in study design, being familiar with statistics, knowing about scientific limitations, for example), but I hope these will provide a good foundation should you choose to review yourself the articles I mention at the end of my posts or others you come across.
Whenever you have more specific questions, do not hesitate to take the article to your primary clinician and have them review it with you.
Want to learn more about reading medical journals and related topics?
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