Proficiency, Clarity, and Objectivity of Large Language Models Versus Specialists’ Knowledge on COVID-19's Impacts in Pregnancy: Cross-Sectional Pilot Study
Authors: Bragazzi Nicola Luigi , Buchinger Michèle , Atwan Hisham , Tuma Ruba , Chirico Francesco , Szarpak Lukasz , Farah Raymond , Khamisy-Farah Rola 
Published: January 2025

Background
The COVID-19 pandemic has significantly strained health care systems globally, leading to an overwhelming influx of patients and exacerbating resource limitations. Concurrently, an “infodemic” of misinformation, particularly prevalent in women’s health, has emerged. This challenge has been pivotal for health care providers, especially gynecologists and obstetricians, in managing pregnant women’s health. The pandemic heightened risks for pregnant women from COVID-19, necessitating balanced advice from specialists on vaccine safety versus known risks. In addition, the advent of generative artificial intelligence (AI), such as large language models (LLMs), offers promising support in health care. However, they necessitate rigorous testing.

Objective
This study aimed to assess LLMs’ proficiency, clarity, and objectivity regarding COVID-19’s impacts on pregnancy.

Methods
This study evaluates 4 major AI prototypes (ChatGPT-3.5, ChatGPT-4, Microsoft Copilot, and Google Bard) using zero-shot prompts in a questionnaire validated among 159 Israeli gynecologists and obstetricians. The questionnaire assesses proficiency in providing accurate information on COVID-19 in relation to pregnancy. Text-mining, sentiment analysis, and readability (Flesch-Kincaid grade level and Flesch Reading Ease Score) were also conducted.

Results
In terms of LLMs’ knowledge, ChatGPT-4 and Microsoft Copilot each scored 97% (32/33), Google Bard 94% (31/33), and ChatGPT-3.5 82% (27/33). ChatGPT-4 incorrectly stated an increased risk of miscarriage due to COVID-19. Google Bard and Microsoft Copilot had minor inaccuracies concerning COVID-19 transmission and complications. In the sentiment analysis, Microsoft Copilot achieved the least negative score (–4), followed by ChatGPT-4 (–6) and Google Bard (–7), while ChatGPT-3.5 obtained the most negative score (–12). Finally, concerning the readability analysis, Flesch-Kincaid Grade Level and Flesch Reading Ease Score showed that Microsoft Copilot was the most accessible at 9.9 and 49, followed by ChatGPT-4 at 12.4 and 37.1, while ChatGPT-3.5 (12.9 and 35.6) and Google Bard (12.9 and 35.8) generated particularly complex responses.

Conclusions
The study highlights varying knowledge levels of LLMs in relation to COVID-19 and pregnancy. ChatGPT-3.5 showed the least knowledge and alignment with scientific evidence. Readability and complexity analyses suggest that each AI’s approach was tailored to specific audiences, with ChatGPT versions being more suitable for specialized readers and Microsoft Copilot for the general public. Sentiment analysis revealed notable variations in the way LLMs communicated critical information, underscoring the essential role of neutral and objective health care communication in ensuring that pregnant women, particularly vulnerable during the COVID-19 pandemic, receive accurate and reassuring guidance. Overall, ChatGPT-4, Microsoft Copilot, and Google Bard generally provided accurate, updated information on COVID-19 and vaccines in maternal and fetal health, aligning with health guidelines. The study demonstrated the potential role of AI in supplementing health care knowledge, with a need for continuous updating and verification of AI knowledge bases. The choice of AI tool should consider the target audience and required information detail level.