Metaanalysis vs large clinical trials: which should guide our management?
Received 10 May 2008; received in revised form 10 August 2008; accepted 26 September 2008. published online 25 November 2008.
Large, randomized clinical trials have long been considered the gold standard to guide clinical care. Metaanalysis is a type of analysis in which results of a number of randomized clinical trials are combined and a summary measure of effect for a given treatment is ascertained. The clinician in practice often is faced with a dilemma regarding the type of evidence that should be used to guide clinical practice; for many clinical problems, there are both randomized controlled trials and metaanalyses available. The cases of calcium and aspirin therapy for the prevention of preeclampsia afford an opportunity to explore the benefits and limitations of each type of study to guide clinical practice. We conclude that, when available, large randomized clinical trials should be used to guide clinical practice.
aDepartment of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO
bDepartment of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
cDivision of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
This research was supported in part by the Intramural Research Program of the National Institute of Child Health and Human Development, National Institutes of Health.
Authorship and contribution to the manuscript is limited to the 4 authors indicated. There was no outside funding or technical assistance with the production of this article.
Cite this article as: Scifres CM, Iams JD, Klebanoff M, Macones GA. Metaanalysis vs large clinical trials: which should guide our management? Am J Obstet Gynecol 2009;200:484.e1-484.e5.
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