The effectiveness of health information systems in supporting early detection and referral pathways for high-risk pregnancies: A systematic review

Maternal mortality remains a major public health challenge, particularly in low and middle-income countries, where delayed detection and referral of high-risk pregnancies contribute to preventable complications. This systematic review evaluated the effectiveness of Health Information Systems (HIS) in supporting the early detection and management of high-risk pregnancies through improved referral processes, monitoring, and clinical decision-making. The review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420250641958). PubMed, Scopus, Web of Science, and ScienceDirect were searched for peer-reviewed English-language empirical studies published between January 2015 and March 2025. Eligible studies evaluated HIS interventions for maternal health or detection and reported outcomes related to early detection, referral effectiveness, clinical decision support or maternal health improvement. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools. Findings from 19 eligible studies were synthesized narratively according to HIS type. HIS interventions improved early detection accuracy, antenatal follow-up, screening compliance, and clinical decision support. mHealth improved antenatal care adherence, while telemedicine and telemonitoring supported remote monitoring and reduced unnecessary hospitalization. EHR and e-Registries enhanced risk classification, and artificial intelligence models demonstrated promising predictive performance for preeclampsia and other maternal complications. However, the evidence base was limited by heterogeneous study designs, limited direct mortality outcomes, infrastructure constraints, digital literacy gaps, and interoperability challenges. Direct evidence demonstrating reductions in maternal mortality remains limited. HIS can strengthen maternal surveillance, referral pathways, and clinical decision support for high-risk pregnancies. Sustainable impact requires integrated infrastructure, workforce training, effective data governance, and standardized outcome evaluation.