Artificial Intelligence in Improving Adverse Pregnancy Outcomes - A Scoping Review and Ethical Issues

Abstract

Abstract: Background/Objectives: Adverse pregnancy outcomes (APOs), which include hypertensive disorders of pregnancy (gestational hypertension, preeclampsia and related disorders), gestational diabetes, preterm birth, fetal growth restriction, low birth weight, small for gestational age newborn, placental abruption and stillbirth are health risks for pregnant women that can have a fatal outcome. The aim is to investigate the usefulness of artificial intelligence (AI) in improving these outcomes and includes the change in the utilization of ultrasound, continuous monitoring and an earlier prediction of complications, as well as being able to individualize processes and support clinical decision-making. This study evaluates the use of AI in improving at least one APO. Methods: PubMed, Web of Science, and Scopus databases were searched and limited to the English language, humans and between 2020 and 2024. This scoping review included peer-reviewed articles across any study design. However, systematic reviews, meta-analyses, unpublished studies and grey literature sources (e.g., reports and conference abstracts) were excluded. Studies were eligible for inclusion if they described the use of AI in improving APOs and the associated ethical issues. Results: Five studies met the inclusion criteria and were included in this scoping review. The findings demonstrate the positive impact of AI on APOs such as preterm birth, hypertensive disorders of pregnancy and gestational diabetes. However, none of the studies specifically addressed placental abruption or stillbirth. The studies primarily utilized machine learning models, including eXtreme Gradient Boosting (XGBoost) and Random Forest (RF), showing promising results in enhancing prenatal care and supporting clinical decision- making. Ethical considerations, including algorithmic bias, transparency and the need for regulatory oversight, were highlighted as critical challenges to be addressed. Conclusions: The application of these tools can improve prenatal care by predicting obstetric complications, but ethics and transparency are pivotal. Empathy and humanization in healthcare must remain fundamental and flexible training mechanisms are needed to keep up with rapid innovation. AI offers an opportunity to support, not replace, the doctor-patient relationship and must be subject to strict legislation if it is to be used safely and fairly.