Applications and Challenges of Retrieval-Augmented Generation (RAG) in Maternal Health: A Multi-Axial Review of the State of the Art in Biomedical QA with LLMs

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Abstract

The emergence of large language models (LLMs) has redefined the potential of artificial intelligence in clinical domains. In this context, retrieval-augmented generation (RAG) systems provide a promising approach to enhance traceability, timeliness, and accuracy in tasks such as biomedical question answering (QA). This article presents a narrative and thematic review of the evolution of these technologies in maternal health, structured across five axes: technical foundations of RAG, advancements in biomedical LLMs, conversational agents in healthcare, clinical validation frameworks, and specific applications in obstetric telehealth. Through a systematic search in scientific databases covering the period from 2022 to 2025, 148 relevant studies were identified. Notable developments include architectures such as BiomedRAG and MedGraphRAG, which integrate semantic retrieval with controlled generation, achieving up to 18% improvement in accuracy compared to pure generative models. The review also highlights domain-specific models like PMC-LLaMA and Med-PaLM 2, while addressing persistent challenges in bias mitigation, hallucination reduction, and clinical validation. In the maternal care context, the review outlines applications in prenatal monitoring, the automatic generation of clinically validated QA pairs, and low-resource deployment using techniques such as QLoRA. The article concludes with a proposed research agenda emphasizing federated evaluation, participatory co-design with patients and healthcare professionals, and the ethical design of adaptable systems for diverse clinical settings.