Implementation and Impacts of Maternal and Perinatal Quality Collaboratives across U.S. States: A Scoping Review

Maternal and Perinatal Quality Care Collaboratives (M/PQCs) are voluntary state-based initiatives that leverage shared data systems, evidence-based toolkits, and quality improvement science to reduce preventable maternal and infant harm.

A scoping review of academic and grey literature was conducted following PRISMA-ScR guidelines, and registered in Open Science Framework. Seven databases were searched for U.S.-based M/PQC studies published between January 2000 - November 2024, analyzed in 2025. Two independent reviewers screened 456 deduplicated records; 31 met eligibility criteria. Quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Findings were synthesized narratively, organized by implementation theme and intervention topic.

Thirty-one studies spanning 16 states and one national analysis were included. Five themes were identified across two domains. Implementation approaches included: (A) building statewide governance infrastructure; (B) translating evidence into practice through standardized toolkits; and (C) strengthening communication, teamwork, and process outcomes. Impacts included: (D) demonstrated reductions in maternal and birth morbidity, including 45-95% reductions in early elective deliveries, 76-87% improvements in timely hypertension treatment, and national-level reductions in eclampsia and intensive care unit admissions; and (E) expansion of the collaborative mission toward contraceptive access, opioid use disorder care, and racial health equity.

M/PQCs function as a form of primary and secondary prevention, institutionalizing evidence-based protocols before obstetric emergencies occur. M/PQCs' evolution from clinical safety bundles toward equity, access, and social determinants signals an expanding mandate. Future initiatives should prioritize disaggregated outcome reporting, health equity frameworks, and inclusion of community birth and outpatient settings to ensure M/PQC gains are equitably distributed.