{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T07:01:02Z","timestamp":1781938862337,"version":"3.54.5"},"reference-count":36,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,8,12]],"date-time":"2019-08-12T00:00:00Z","timestamp":1565568000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/J013595\/1"],"award-info":[{"award-number":["MR\/J013595\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MC_UU_12023\/21"],"award-info":[{"award-number":["MC_UU_12023\/21"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Research Synthesis Methods"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Multivariate meta\u2010analysis (MVMA) jointly synthesizes effects for multiple correlated outcomes. The MVMA model is potentially more difficult and time\u2010consuming to apply than univariate models, so if its use makes little difference to parameter estimates, it could be argued that it is redundant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We assessed the applicability and impact of MVMA in Cochrane Pregnancy and Childbirth (CPCB) systematic reviews. We applied MVMA to CPCB reviews published between 2011 and 2013 with two or more binary outcomes with at least three studies and compared findings with results of univariate meta\u2010analyses. Univariate random effects meta\u2010analysis models were fitted using restricted maximum likelihood estimation (REML).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eighty CPCB reviews were published. MVMA could not be applied in 70 of these reviews. MVMA was not feasible in three of the remaining 10 reviews because the appropriate models failed to converge. Estimates from MVMA agreed with those of univariate analyses in most of the other seven reviews. Statistical significance changed in two reviews: In one, this was due to a very small change in <jats:italic>P<\/jats:italic> value; in the other, the MVMA result for one outcome suggested that previous univariate results may be vulnerable to small\u2010study effects and that the certainty of clinical conclusions needs consideration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>MVMA methods can be applied only in a minority of reviews of interventions in pregnancy and childbirth and can be difficult to apply because of missing correlations or lack of convergence. Nevertheless, clinical and\/or statistical conclusions from MVMA may occasionally differ from those from univariate analyses.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jrsm.1353","type":"journal-article","created":{"date-parts":[[2019,5,6]],"date-time":"2019-05-06T21:04:41Z","timestamp":1557176681000},"page":"440-451","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Empirical comparison of univariate and multivariate meta\u2010analyses in Cochrane Pregnancy and Childbirth reviews with multiple binary outcomes"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7352-3027","authenticated-orcid":false,"given":"Malcolm J.","family":"Price","sequence":"first","affiliation":[{"name":"Institute of Applied Health Research University of Birmingham  Birmingham UK"},{"name":"NIHR Birmingham Biomedical Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7856-5931","authenticated-orcid":false,"given":"Helen A.","family":"Blake","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics London School of Hygiene and Tropical Medicine  London UK"},{"name":"Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Kenyon","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian R.","family":"White","sequence":"additional","affiliation":[{"name":"MRC Clinical Trials Unit University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4963-8123","authenticated-orcid":false,"given":"Dan","family":"Jackson","sequence":"additional","affiliation":[{"name":"Statistical Innovation Group AstraZeneca  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie J.","family":"Kirkham","sequence":"additional","affiliation":[{"name":"Department of Biostatistics University of Liverpool  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James P.","family":"Neilson","sequence":"additional","affiliation":[{"name":"Cochrane Pregnancy &amp; 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