This article was originally published here
BMJ open. 2022 Mar 28;12(3):e054833. doi: 10.1136/bmjopen-2021-054833.
OBJECTIVES: (1) To summarize and appraise the current evidence of pregnancy outcomes associated with tuberculosis (TB), (2) to assess the state of the science of family planning during tuberculosis treatment, and (3) to provide recommendations to move forward to improve care and outcomes during TB disease.
DESIGN: Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
DATA SOURCES: PubMed, Embase, CINAHL, Cochrane, Web of Science and Scopus were surveyed from September 2009 to November 2021.
ELIGIBILITY CRITERIA: Studies were included if they assessed pregnant women with active TB, drug-resistant TB (DR-TB) or TB/HIV co-infection and examined pregnancy, maternal, fetus/delivery and tuberculosis or tuberculosis/HIV co-infection. Studies were also included if they examined family planning services among women starting TB treatment.
DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data using PRISMA guidelines and performed quality assessment using the Joanna-Briggs Institute critical appraisal tools. The level of evidence was reported using Johns Hopkins Evidence-Based Practice guidelines.
RESULTS: 69 studies were included in this review. Case reports, case series, case controls, cohort studies, analyzes of secondary data and a service delivery improvement project in 26 countries constituted the body of evidence. Most studies reported pregnancy complications for mothers (anaemia, postpartum haemorrhage, death) and fetuses or newborns (low birth weight, premature birth, and spontaneous or induced abortions). Few studies have discussed the value of offering family planning in preventing adverse pregnancy outcomes. One study examined the effect of provider training on contraceptive use with increased contraceptive use reported.
CONCLUSIONS: The integration of family planning services within a tuberculosis treatment program is essential to reduce the adverse mother-child effects associated with tuberculosis. Despite well-established adverse pregnancy outcomes, little attention has been paid to family planning to prevent poor pregnancy outcomes in women with TB/DR-TB. Recommendations for clinicians, TB control programs and researchers are provided and reflect the evidence presented in this review.