Examining family planning and adverse pregnancy outcomes for women with active tuberculosis disease: a systematic review.
Examining family planning and adverse pregnancy outcomes for women with active tuberculosis disease: a systematic review.
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DOI：
10.1136/bmjopen-2021-054833
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发表时间：
2022-03-28
期刊：
影响因子：
2.9
通讯作者：
Warren N
中科院分区：
文献类型：
--
作者：
Nguyen Y;McNabb KC;Farley JE;Warren N
(1)总结和评估结核病（TB）相关妊娠结局的现有证据，（2）评估结核病治疗期间计划生育科学的状况，（3）提供建议，以改善结核病期间的护理和结局。使用系统性综述和荟萃分析（PRISMA）指南的首选报告项目进行系统性综述。检索了PubMed、Embase、CINAHL、科克伦、Web of Science和Scopus，检索时间为2009年9月至2021年11月。如果研究评估了患有活动性结核病、耐药结核病（DR-TB）或结核病/艾滋病毒合并感染的孕妇，并检查了妊娠、孕产妇、胎儿/分娩和结核病或结核病/艾滋病毒合并感染的结局，则纳入研究。如果研究对开始结核病治疗的妇女的计划生育服务进行了审查，也将纳入研究。两位独立的评审员使用PRISMA指南提取数据，并使用Joanna-Briggs研究所的关键评估工具进行质量评估。使用约翰霍普金斯循证实践指南报告证据等级。69篇研究纳入本综述。病例报告、病例系列、病例对照、队列研究、二级数据分析和在26个国家进行的服务提供改进项目构成了证据的全部。大多数研究报告了母亲的妊娠并发症（贫血、产后出血、死亡）和胎儿或新生儿的妊娠并发症（出生体重低、早产、自然流产或人工流产）。很少有研究讨论提供计划生育以防止不良妊娠结局的价值。一项研究审查了提供者培训对避孕药具使用的影响，据报告，避孕药具的使用有所增加。将计划生育服务纳入结核病治疗方案对于减少结核病相关的母婴不良后果至关重要。尽管不良妊娠结局已得到公认，但很少关注计划生育以防止结核病/耐药结核病妇女不良妊娠结局。为临床医生，结核病规划和研究人员提供的建议，并反映在这次审查的证据。
(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. Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed, Embase, CINAHL, Cochrane, Web of Science and Scopus were searched from September 2009 to November 2021. Studies 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. Two 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. 69 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. Integrating 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.
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