Objective
The objective of the study was to identify the external funding status of the most frequently cited obstetrical publications (citation classics) and to assess trends in funded vs nonfunded manuscripts as well as each publication’s type of external funding.
Study Design
For the first objective, the citation classics, which were reported in a previous publication, were reviewed to identify their funding status. For the second objective, all pregnancy-related and obstetrical publications from the 2 US-based leading journals, the American Journal of Obstetrics and Gynecology and Obstetrics and Gynecology , were reviewed to identify the funding status and trends between 1989 and 2012.
Results
Twenty-seven of 44 of the citation classics (61%) had external funding, whereas only 43% of the reviewed regular (non-citation classic) obstetrical publications had external funding. There was a decreasing trend in the number of obstetrical manuscripts associated with a decreasing trend in the number and proportion of nonfunded manuscripts and an increasing trend in the number and proportion of National Institutes of Health (NIH)–funded manuscripts. Relative to 1989, in 2012 there was a 34.8% decrease in the number of published obstetrical manuscripts, a 59.6% decrease in the number of nonfunded manuscripts, and a 6.8% increase in the number of funded manuscripts accompanied by an 8.2% increase in the number of NIH-funded publications. In the last 9 years (2004-2012), there was a 35.1% increase in the proportion of NIH-funded manuscripts accompanied by an 18.8% decrease in the proportion of non–NIH-funded manuscripts.
Conclusion
Our findings provide useful data regarding the importance of securing NIH-based funding for physicians contemplating academic careers in obstetrics.
Perinatal mortality is considered to be an index for measuring and interpreting the health of a nation. Perinatal health is mainly related to socioeconomic factors in a society and also to the quality and quantity of research budgeted to pregnancy and obstetrics. Clinical research, the scientific basis for evidence-based medicine, can be funded by external agencies or internal sources including clinical departments. To date, there are minimal data available regarding the sources of external funding for obstetrical research as well as any knowledge on whether funding influences research quality and chance for publication. Most importantly, the difficulty in securing external funding is a major obstacle to recruit physicians to academic medicine.
This study was undertaken to address 2 objectives. The first was to identify the external funding status of the most frequently cited obstetrical publications. The second objective was to assess the trend in number and proportion of externally funded vs nonfunded publications in obstetrics in 2 leading journals in the specialty of obstetrics and gynecology, as well as each publication’s type of funding, from 1989 to 2012.
Materials and Methods
To achieve the first objective, we reviewed the article by Brandt et al, who used the Social Sciences Citation Index database to determine the 100 most frequently cited journal articles (citation classics) in obstetrics and gynecology between 1956 and 2009. Among the 100 citation classics, 44 were related to pregnancy and obstetrics and the overwhelming majority (38 of 44, or 86%) were published in the American Journal of Obstetrics and Gynecology and Obstetrics and Gynecology . These 44 articles were reviewed to identify their funding status and, if funded, they were classified as National Institutes of Health (NIH) funded or non-NIH funded.
To accomplish the second objective, all pregnancy-related and obstetrical publications from the 2 US-based leading medical journals, the American Journal of Obstetrics and Gynecology and Obstetrics and Gynecology , were reviewed from 1989 to 2012. Manuscripts were reviewed using electronic records; because the earliest available online records of archive manuscripts from the American Journal of Obstetrics and Gynecology are from 1989, this year was chosen as the start year.
Funding was defined as total or partial external financial support provided by an agency to a study and/or an investigator listed as an author. The inclusion criteria for review were as follows: original research articles, review articles, meeting papers, clinical expert series, and clinical opinions containing a discrete Materials and Methods section. We excluded all gynecology and reproductive endocrinology publications and manuscripts of other subspecialties in obstetrics and gynecology, manuscripts in basic science that were based on nonhuman tissues, editorials, personal perspectives, commentaries, consensus development articles, letters, and case reports.
We use the terms, funded and nonfunded, to refer to manuscripts written by authors whose work had been externally funded or not funded, respectively. Funded manuscripts were classified according to the source of funding under the following 4 categories: (1) NIH, including all branches and NIH-sponsored awards such as the Child Health Research Career Development Award and the Clinical and Translational Science K Awards ; (2) non-NIH federal agencies, including the Centers for Disease Control and Prevention, the US Department of Health and Human Services, the US Food and Drug Administration, and the Maternal and Child Health Bureau; (3) state-level agencies, including US state-level government bodies and any non-US (foreign) government bodies; and (4) other sources, including private donors, nonprofit organizations/foundations, pharmaceutical companies, and private grants. If a study was funded partially by the NIH and another funding body (for example, the Centers for Disease Control and Prevention or a private donor), it was classified as NIH funded. If a study was funded by both a non-NIH federal level body and a state-level body, it was classified as federally funded. If a study was funded by a state level body and a group included in the “other” category, it was classified as state funded. This algorithm enabled us to classify each manuscript being counted only once during the statistical analysis.
In our analysis, we also used 2 additional categories: non-NIH funded (sum of the aforementioned source categories 2-4) and funded (sum of the aforementioned source categories 1-4).
All review of the journals and abstraction and tabulation of the data were carried out by the primary author (W.S.V.). Institutional review board approval was not sought because the research did not involve human or animal subjects.
Statistical analysis
The results were expressed using descriptive statistics and percentages. The statistical analysis involved 2 types of trends: (1) the trend of the absolute number of the funded and nonfunded manuscripts as well as the type of funding sources; and (2) the trend of proportions (percentages) of the funded and nonfunded manuscripts as well as the type of funding sources from 1989 to 2012. The relative changes in the absolute numbers and proportions of the funded and nonfunded manuscripts between 1989 and 2012 as well as between the periods 1989-2003 vs 2004-12 were determined. We report the change in the absolute number and the proportions expressed per 100.
Results
With respect to the first objective, of the 44 obstetrical citation classics in the article by Brandt et al, 27 (61%) were funded. Of the total number of obstetrical citation classics, 15 of 44 (34%) were NIH funded and 12 of 44 (27%) were non-NIH funded ; 8 of the 44 (18%) were review or clinical opinion articles and the remaining were original research articles.
With respect to the second objective, a combined total of 10,175 (6016 in the American Journal of Obstetrics and Gynecology and 4159 in Obstetrics and Gynecology ) obstetrical manuscripts published between 1989 and 2012 were reviewed. For the purpose of this analysis, the results are presented combined from both journals. Table 1 shows the median number of the types of manuscripts published during the period 1989-2012. Of the 10,175 manuscripts, 43% (n = 4374) were funded. Of the funded manuscripts, 39% (n = 1707) were funded by the NIH, 8.5% (n = 372) were funded by non-NIH federal sources, 23.5% (n = 1028) were funded by state-level agencies, and 29% (n = 1267) were funded through other sources.
| Manuscript classifications | Manuscripts published between 1989 and 2012, n (%) | Median (range) of manuscripts per year |
|---|---|---|
| Total number of manuscripts | 10,175 (100.0) | 431 (317–491) |
| Non-Funded manuscripts | 5810 (57.0) | 257 (129–337) |
| Funded manuscripts | 4374 (43.0) | 179 (150–220) |
| NIH funded | 1707 (39.0) | 67 (41–113) |
| Non-NIH federal funded | 372 (8.5) | 16 (10–24) |
| State funded | 1028 (23.5) | 45 (29–58) |
| Other funding sources | 1267 (29.0) | 55 (33–69) |
| Total non-NIH funded | 2667 (61.0) | 109 (89–140) |
Figure 1 illustrates the temporal changes in the number of funded and nonfunded manuscripts as well as the type of funding sources. The number of obstetrical manuscripts has been declining, which is associated with a parallel decreasing trend of nonfunded manuscripts and a stable or slightly increasing trend of funded manuscripts ( Figure 1 , A). The number of NIH-funded manuscripts has been increasing since 2004 ( Figure 1 , B). In 2012, as compared with the baseline year 1989, there was a 34.8% decrease in the number of published obstetrical manuscripts, a 59.6% decrease in the number of nonfunded manuscripts, and a 6.8% increase in the number of overall funded manuscripts, associated with an 8.2% increase in the number of NIH-funded manuscripts.
Figure 2 illustrates the trend of the proportions (percentages) of funded and nonfunded manuscripts as well as the type of funding sources. Figure 2 , A shows an increasing trend of the proportion of funded manuscripts. Prior to 2004, the proportion of nonfunded publications was greater than the proportion of funded manuscripts, with this trend being reversed after 2004. Figure 2 , B shows an increasing trend of the proportion of NIH-funded manuscripts starting in 2004.
Because 2004 was a pivotal year to the change in proportion of funded vs nonfunded publications, the time periods before and after 2004 (1989-2003 and 2004-2012) were compared ( Table 2 ). In comparing the average number of manuscripts per year, there was a 16.1% decrease in the number of manuscripts, associated with a parallel 35.1% decrease in the number of nonfunded manuscripts, a 24.4% decrease in the number of funded manuscripts, and a 55.5% increase in the number of NIH-funded manuscripts from 2004 to 2012 as compared from 1989 to 2003. In comparing proportions, there was a 20.1% decrease in nonfunded manuscripts, a 30.7% increase in funded manuscripts, and a 35.1% increase in NIH-funded manuscripts, accompanied by a 30.3% decrease in other funding sources, leading to a decrease of 18.8% in total non-NIH funding sources from 2004 to 2012 as compared from 1989 to 2003.
| Manuscript classifications | Number of manuscripts (averaged per year) | Proportion of manuscripts | ||||
|---|---|---|---|---|---|---|
| 1989-2003, n | 2004-2012, n | Change 1989-2003 to 2004-2012, % | 1989-2003, % | 2004-2012, % | Change 1989-2003 to 2004-2012, % (95% CI) | |
| Number of manuscripts | 451 | 379 | −16.1 | – | – | – |
| Non-funded manuscripts | 279 | 181 | −35.1 | 60.7 | 48.7 | −20.1 (−23.3 to −16.8) |
| Funded manuscripts | 173 | 131 | −24.4 | 39.3 | 51.3 | 30.7 (24.9−36.7) |
| NIH funded | 59 | 92 | 55.5 | 34.1 | 47.2 | 35.1 (25.6−45.4) |
| Non-NIH federal funded | 15 | 16 | 5.3 | 8.8 | 8.2 | −9.7 (−26.5 to 10.8) |
| State funded | 42 | 45 | 7.5 | 24.1 | 22.3 | −6.9 (−16.8 to 4.3) |
| Other funding sources | 54 | 45 | −15.8 | 33.2 | 22.6 | −30.3 (−37.3 to −22.6) |
| Total non-NIH funded | 114 | 106 | −7.2 | 66.2 | 53.0 | −18.8 (−23.0 to −14.3) |
Results
With respect to the first objective, of the 44 obstetrical citation classics in the article by Brandt et al, 27 (61%) were funded. Of the total number of obstetrical citation classics, 15 of 44 (34%) were NIH funded and 12 of 44 (27%) were non-NIH funded ; 8 of the 44 (18%) were review or clinical opinion articles and the remaining were original research articles.
With respect to the second objective, a combined total of 10,175 (6016 in the American Journal of Obstetrics and Gynecology and 4159 in Obstetrics and Gynecology ) obstetrical manuscripts published between 1989 and 2012 were reviewed. For the purpose of this analysis, the results are presented combined from both journals. Table 1 shows the median number of the types of manuscripts published during the period 1989-2012. Of the 10,175 manuscripts, 43% (n = 4374) were funded. Of the funded manuscripts, 39% (n = 1707) were funded by the NIH, 8.5% (n = 372) were funded by non-NIH federal sources, 23.5% (n = 1028) were funded by state-level agencies, and 29% (n = 1267) were funded through other sources.
