This study was planned using a cross-sectional design. Video scanning was performed on February 2, 2026. The study involved searching on YouTube using the keywords “rheumatology pregnancy”, “rheumatic diseases pregnancy”, “rheumatism pregnancy”, and “arthritis pregnancy”. Because YouTube provides personalized results based on user behavior, searches were performed in incognito mode after clearing browser cookies and browsing history to minimize personalization bias and obtain standardized results. This approach aimed to reduce the influence of user-specific algorithmic guidance, thereby providing a more objective video selection.

Search results were obtained using the “Relevance” option that mirrors the standard user experience and constitutes the platform’s default ranking configuration [11, 12]. Prior research indicates that online users often scrutinize only a limited subset of search results and predominantly engage with information at higher ranks/traffic. Consequently, the first 50 videos for each search keyword were assessed to accurately represent actual user activity [13, 14]. On the stated date, 200 video URLs were documented, and key video parameters were collected simultaneously.

The exclusion criteria were established in advance. Videos in languages other than English, duplicate materials, unrelated videos, and content with substantial technical faults in audio or image quality were excluded from the analysis. Furthermore, videos under one minute were excluded from the analysis because they were considered insufficient to convey substantive information.

During the video assessment procedure, two independent researchers conducted separate evaluations of the videos, remaining unaware of each other’s scores. Following the initial assessments, the researchers’ scores were compared, and videos with divergent ratings were identified. Videos exhibiting inconsistencies in the evaluation results were subsequently reviewed by a third researcher, who determined the final decision. The concordance between the researchers’ evaluations was quantified using Cohen’s kappa coefficient, thereby indicating the reliability of the evaluation process [15].

Video metrics include total views, likes, and comments; the video’s length in seconds; and the number of days between the upload date and the access date. Daily engagement metrics (daily views, daily likes, and daily comments) are computed by dividing the cumulative totals by the number of days since the video’s upload date. Furthermore, videos are classified into five established categories based on their content presentation format: (a) Narrative-oriented videos feature speaker-focused content, typically with few visual aids, in which a physician or healthcare professional communicates directly to the camera, conveying information verbally; these films are generally presented in a “doctor speaking” manner, with some organized as question-and-answer sessions; (b) Slide-based presentations convey information through visual elements, such as PowerPoint; they may include bullet points, tables, diagrams, guideline summaries, and statistical data, and are frequently scholarly in character; (c) Animated visual explanatory videos elucidate intricate clinical procedures through animation, graphics, diagrams, or visual metaphors; this category encompasses visually intense contents, including animations depicting fetal development, schematics illustrating the immune system, risk ratio presentations accompanied by graphs, and animated infographics; (d) Patient experience-based videos feature unique experiences, typically conveyed in a patient-centered, personal narrative format; in such materials, therapeutic contents may be subordinate, with the story primarily rooted in an emotional or personal perspective; (e) The panel-webinar format often consists of multiple speakers, discussions, or question-and-answer sessions and is offered as expert panels, moderated webinars, or conference recordings; this category often encompasses organized presentations that highlight multidisciplinary viewpoints.

Videos are categorized by source, the content developer’s professional identity, and the institutional framework to which they are affiliated. The physician category encompasses videos that are either directly created by a specialized physician or formally published under a physician’s name. The nonphysician healthcare professional category encompasses materials created by nurses, physiotherapists, dietitians, or other healthcare practitioners. The category of academic medical centers encompasses videos generated within university hospitals or academic healthcare facilities. Non-academic healthcare facilities encompass materials disseminated by private hospitals, clinics, or health centers. TV channels or news media category covers content delivered through health-themed programs or news formats; the nonprofit charities or foundationscategory comprises content from civil society organizations involved in patient advocacy, awareness, and education; the pharmaceutical or commercial company category refers to content disseminated by pharmaceutical firms or commercial healthcare entities; and the independent user category consists of videos uploaded by individual content creators whose corporate affiliation is not clearly identified.

A prominent method for assessing online educational materials is the Global Quality Scale (GQS). The GQS is designed to assess the informativeness and educational value of digital health materials on a five-point scale (1–5). A score of 1 indicates that the material is deficient, inconsistent, contains substantial information gaps, and offers minimal value to the user; a score of 5 denotes that the content is exceptionally consistent, complete, and highly beneficial from an educational standpoint [16].

In this study, videos were assessed with their GQS scores and grouped into quality categories. Those with scores of 4 or 5 were labeled “high quality”, 3 “intermediate quality”, and 1 or 2 “low quality.” This approach, which uses GQS categories, has been favored in previous studies because it provides a more objective and comparable means of evaluating content quality [17].

To evaluate the reliability of video content, a modified DISCERN tool, commonly used to assess online health and educational materials, was employed. This tool systematically reviews criteria, including the clarity and comprehensibility of information, content neutrality, potential for bias, and the use of references and supplementary data. The scale comprises five questions, answered ‘yes’ or ‘no’; each positive answer is worth 1 point, and each negative answer is worth 0 point. The total score ranges from 0 to 5, with higher scores indicating greater reliability of the video information [18].

A topic classification approach tailored to rheumatic diseases and pregnancy was developed to assess the distribution of themes in video content. Given that videos may encompass multiple topics, each video was meticulously analyzed, and all topics discussed were recorded. The topic classification was organized into nine main categories. The first category is ‘Preconception - Family Planning,’ which encompasses topics including pregnancy timing, contraceptive advice, pre-pregnancy counseling, and the importance of a multidisciplinary approach. The second category centers on ‘Disease Activity - Management During Pregnancy’ assessing how disease activity progresses during pregnancy, the risk of flare-ups, management strategies for each trimester, and how pregnancy influences the disease. The third category addresses the ‘Safety of Anti-Rheumatic Drugs’ and reviews conventional DMARDs, biologics, corticosteroids, nonsteroidal anti-inflammatory drugs, and medications that should be discontinued before pregnancy. The fourth category covers ‘Pregnancy Outcomes in Rheumatic Diseases’ which includes maternal and fetal outcomes, preterm birth, miscarriage or stillbirth, and mode of delivery. The fifth category addresses ‘Disease - Specific Considerations’; pregnancy management is evaluated in the context of systemic lupus erythematosus, rheumatoid arthritis, antiphospholipid syndrome, Sjögren’s syndrome, vasculitis, and spondyloarthritis, among others. The sixth category focuses on the ‘Postpartum Period - Breastfeeding’, covering postpartum exacerbation, drug safety during breastfeeding, and postpartum treatment approaches. The seventh category is ‘Patient Education - Counseling’; within this framework, patient information, frequently asked questions, lifestyle recommendations, and psychosocial support are examined. The eighth category focuses on ‘Guidelines - Evidence-Based Information’, where EULAR/ACR guidelines, scientific evidence, and other recommendations are assessed. The ninth category includes ‘Misconceptions - Risk Communication’; incomplete or inaccurate information and narratives that can create fear are analyzed within this scope.

Statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS) version 20.0 (SPSS Inc., Chicago, IL, USA). Before analysis, the Shapiro–Wilk test was used to assess the distribution of continuous variables; the test indicated that the distributions did not meet the normality assumption. Consequently, findings were presented as median (minimum–maximum), number (n), and percentage (%), using nonparametric statistical techniques. Videos were classified into three distinct quality categories: low, intermediate, and high. The Kruskal–Wallis test was used to compare these groups. Spearman’s rank correlation coefficient was applied to assess the correlations between variables. The inter-rater agreement during the video assessment process was assessed using Cohen’s kappa coefficient. A p-value below 0.05 was deemed statistically significant.