Evaluation of fetal growth restriction guidelines using the AGREE II, STAR, and RIGHT tools

To comprehensively evaluate the quality of guidelines related to fetal growth restriction (FGR) and provide recommendations for the development of high-quality guidelines. The CNKI, Wanfang, PubMed, Embase, Web of Science, and other databases were searched for FGR guidelines published from database inception to September 2024. The Appraisal of Guidelines for Research and Evaluation II (AGREE II), Reporting Items for Practice Guidelines in Healthcare (RIGHT), and Scientific, Transparent and Applicable Rankings (STAR) tools were used for quality assessment. Interrater reliability was assessed using the intraclass correlation coefficient (ICC). Ten guidelines, including nine English-language clinical practice guidelines (CPGs) and one Chinese-language CPG, were included. Based on the AGREE II assessment, two guidelines were classified as “recommended” and eight as “recommended with modification”. The STAR domain scores were highest for “recommendations” (88.66%) and lowest for “registry” and “protocol” (both 0%), with the remaining domain scores ranging from 18.49% to 70.00%. RIGHT reporting rates ranged from 40.00% (“funding and declaration and management of interests”) to 76.67% (“basic information”), with most domains exceeding 60%. The three tools showed good interrater reliability (ICC > 0.80). The quality of FGR guidelines requires further improvement. Standardized development and reporting are essential to ensure that future FGR guidelines are methodologically rigorous, clinically applicable, and trustworthy for decision-making. Future guideline development and updates should focus on clearly defining the target population and settings in which the guidelines are intended to be used. Guideline authors should involve experts in statistics and guideline methodology to enhance the quality of the evidence supporting their recommendations. In addition, factors influencing the dissemination of guidelines into clinical practice and their practical implementation in clinical settings should be considered more comprehensively. The independence of guideline development, including the management of conflicts of interest and funding, also requires greater attention. The quality of internationally published FGR guidelines varies considerably. High-quality guidelines can effectively inform clinical practice, whereas low-quality guidelines may lead to inappropriate recommendations and potentially compromise patient health. The guidelines were assessed using the AGREE II, STAR, and RIGHT tools. Among the 10 included guidelines, two were classified as “recommended”, and the results were generally consistent across the three evaluation tools. The quality of FGR guidelines requires improvement, particularly with respect to defining target populations and settings for guideline use, applicability, and editorial independence.