Examining family planning and adverse pregnancy outcomes for women with active tuberculosis disease: a systematic review

Abstract

Objectives(1) Summarise and evaluate the current evidence of tuberculosis (TB)-associated pregnancy outcomes, (2) evaluate the state of the science of family planning during TB treatment and (3) provide recommendations to move forward to improve care and outcomes during TB disease.DesignSystematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.Data sourcesPubMed, Embase, CINAHL, Cochrane, Web of Science and Scopus were searched from September 2009 to November 2021.Eligibility criteriaStudies were included if they assessed pregnant women with active TB, drug-resistant TB (DR-TB) or TB/HIV coinfection and examined pregnancy, maternal, fetal/birth and TB or TB/HIV coinfection outcomes. Studies were also included if they examined family planning services among women initiating TB treatment.Data extraction and synthesisTwo independent reviewers extracted data using PRISMA guidelines and conducted quality assessment using the Joanna-Briggs Institute Critical Appraisal Tools. The level of evidence was reported using the Johns Hopkins Evidence-Based Practice guidelines.Results69 studies were included in this review. Case reports, case series, case controls, cohort studies, secondary data analyses and a service delivery improvement project conducted in 26 countries made up the totality of the evidence. Most studies reported pregnancy complications for mothers (anaemia, postpartum haemorrhage, deaths) and fetuses or newborns (low birth weight, premature birth, and spontaneous or induced abortions). Few studies discussed the value of offering family planning to prevent adverse pregnancy outcomes. One study examined the effect of a provider training on contraceptive use with reported increased contraceptive use.ConclusionsIntegrating family planning services within a TB treatment programme is essential to reduce adverse TB-associated maternal-child outcomes. Despite well-established adverse pregnancy outcomes, little attention has been paid to family planning to prevent poor pregnancy outcomes for women with TB/DR-TB. Recommendations for clinicians, TB programmes and researchers are provided and reflect evidence presented in this review.

Association between tuberculosis and pregnancy outcomes: a retrospective cohort study of women in Cape Town, South Africa

“…A systematic review of 69 studies (published 2009-2021), the majority of which were from low-income and middle-income countries, reported poor pregnancy outcomes for women with TB, with most studies reporting low birth weight and/or preterm labour and/or spontaneous abortions. 29 A South African study reported 48% of women routinely treated for multi-drug resistant/rifampicin resistant TB (MDR/RR-TB) during 2013-2017, had a poor pregnancy outcome, 30 higher than our study, where the majority had drug-sensitive TB. Other South African studies with cohorts between 2011 15 and 2014 14 showed that of infants born to HIVpositive mothers with TB, between 20% and 70% had a gestation period <37 weeks and between 21% and 59% had a low birth weight.…”

“…This finding should be interpreted with caution. Offering effective contraception to women at TB treatment initiation 29 36 and screening for pregnancy at each TB-related visit, with integration of reproductive health services as part of TB care is critical. 37 Women should be made aware of their increased risk of poorer pregnancy outcomes and need for additional care if they conceive during their TB episode.…”

Tuberculosis and Sexual and Reproductive Health of Women in Four African Countries

“…Taking into account a higher rate of adverse SRH outcomes in HIV and TB co-infected women described in the literature and the elevated burden of both infections in women of reproductive age, it is important to continue strengthening proper screening, diagnosis, treatment and prevention of both conditions. Moreover, as the contraception use in this cohort was relatively low, the value of offering family planning to prevent adverse pregnancy outcomes in TB infected women has to be considered for the National TB Programs [ 25 ]. Counselling women about the risks associated with becoming pregnant while undergoing TB treatment and referring them to appropriate care if they intend to conceive is essential.…”

Case Report: Congenital disseminated tuberculosis neonate born to tuberculosis- COVID-19 mother

“…Pregnant women are at increased risk of developing TB, and this is associated with poor outcomes including premature birth, intrauterine growth retardation, and low birth weight. COVID-19 and tuberculosis co-infection in pregnancy is rare ( 1 , 8 ). In the general population, one study from China reveals the TB prevalence among COVID-19 patients ranged between 0.47 to 4.47% %.…”