Risk of drug use during pregnancy: master protocol for living systematic reviews and meta-analyses performed in the metaPreg project

Abstract Background Knowledge about the risks of drugs during pregnancy are continuously evolving due to the frequent publication of a large number of epidemiological studies. Systematic reviews and meta-analyses therefore need to be regularly updated to reflect these advances. To improve dissemination of this updated information we developed an initiative of real time full-scale living meta-analyses relying on an open online dissemination platform ( www.metapreg.org ). Method All living meta-analysis performed in this project will be conducted in accordance with this master protocol after adaptation of the search strategy. A systematic literature search of Pubmed and Embase will be performed. All analytical studies (e.g., cohort, case control, randomized studies) reporting original empirical findings on the association between in-utero exposure to drugs and adverse pregnancy outcomes will be included. Study screening and data extraction will be performed in a semi-automation way supervised by a biocurator. Risk of bias will be assessed using the ROBINS-I tools. All clinically relevant pregnancy adverse outcomes (malformations, stillbirths, neuro-developmental disorders, pre-eclampsia, etc.) available in the included studies will be pooled through random-effects meta-analysis. Heterogeneity will be evaluated by I2 statistics. Discussion Our living systematic reviews and subsequent updates will inform the medical, regulatory and health policy communities as the news results evolve to guide decisions on the proper use of drugs during the pregnancy. Systematic review registration Open science framework (OSF) Registries ( https://osf.io/u4gva )