Maternal Recommender System Systematic Literature Review: State of the Art and Future Studies
Authors: Priambodo Rinto , Wuri Handayani Putu , Fathoni Aji Rizal 
Published: November 2023

Aim/Purpose: This paper illustrates the potential of health recommender systems (HRS) to support and enhance maternal care. The study aims to explore the recent implementations of maternal HRS and to discover the challenges of the implementations.

Background: The sustainable development goals (SDG) aim to reduce maternal mortality to less than 70 per 100,000 live births by 2030. However, progress is uneven between countries, with primary causes being severe bleeding, infections, high blood pressure, and failed abortions. Regular antenatal care (ANC) visits are crucial for detecting and managing complications, such as hypertensive illnesses, anemia, and gestational diabetes mellitus. Utilizing maternal evaluations during ANC visits can help identify and treat problems early, lowering morbidity and death rates for both mothers and fetuses. Technology-enabled daily health recording can help monitor pregnancy by providing actionable guides to patients and health workers based on patient status.

Methodology: A systematic literature review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to identify maternal HRS reported in studies between November 2022 and December 2022. Information was subsequently extracted to understand the potential benefits of maternal HRS. Titles and abstracts of 1,851 studies were screened for the full-text screening, in which two reviewers independently selected articles and systematically extracted data using a predefined extraction form.

Contribution: This study adds to the explorations of the challenges of implementing HRS for maternal care. This study also emphasizes the significance of explainability, data-driven methodologies, automation, and the necessity for integration and interoperability in the creation and deployment of health recommendation systems for maternity care.

Findings: The majority of maternal HRS use a knowledge-based (constraint-based) ap-proach with more than half of the studies generating recommendations based on rules defined by experts or available guidelines. We also derived four types of interfaces that can be used for delivering recommendations. Moreover, patient health records as data sources can hold data from patients’ or health workers’ input or directly from the measurement devices. Finally, the number of studies in the pilot or demonstration stage is twice that in the sustained stages.

We also discovered crucial challenges where the explainability of the methods was needed to ensure trustworthiness, comprehensibility, and effective enhancement of the decision-making process. Automatic data collection was also required to avoid complexity and reduce workload. Other obstacles were also identified where data integration between systems should be established and decent connectivity must be provided so that complete services can be admin-istered. Lastly, sustainable operations would depend on the availability of standards for integration and interoperability as well as sufficient financial sup-port.

Recommendations for Practitioners: Developers of maternal HRS should consider including the system in the main healthcare system, providing connectivity, and automation to deliver better service and prevent maternal risks. Regulations should also be established to support the scale-up.

Recommendation for Researchers: Further research is needed to do a thorough comparison of the recommendation techniques used in maternal HRS. Researchers are also recommended to explore more on this topic by adding more research questions.

Impact on Society: This study highlights the lack of sustainability studies, the potential for scaling up, and the necessity for a comprehensive strategy to integrate the maternal recommender system into the larger maternal healthcare system. Researchers can enhance and improve health recommendation systems for maternity care by focusing on these areas, which will ultimately increase their efficacy and facilitate clinical practice integration.

Future Research: Additional research can concentrate on creating and assessing methods to increase the explainability and interpretability of data-driven health recommender systems and integrating automatic measurement into the traditional health recommender system to enhance the anticipated outcome of antenatal care. Comparative research can also be done to assess how well various models or algorithms utilized in these systems function. Future research can also examine creative solutions to address resource, infrastructure, and technological constraints, such as connectivity and automation to help address the shortage of medical personnel in remote areas, as well as define tactics for long-term sustainability and integration into current healthcare systems.