29 August 2021
WHO recommendation on tuberculosis testing in pregnancy
In settings where the tuberculosis (TB) prevalence in the general population is 100/100 000 population or higher, systematic screening for active TB should be considered for pregnant women as part of antenatal care.
First published: December 2016
Updated: No update planned
Assessed as up-to-date: December 2016
–– Household contacts and other close contacts should be systematically screened for TB (strong recommendation, very low-quality evidence).
–– People living with HIV should be systematically screened for active TB at each visit to a health-care facility (strong recommendation, very low-quality evidence).
–– Systematic screening for active TB may be considered also for other subpopulations that have very poor access to health care, such as people living in urban slums, homeless people, people living in remote areas with poor access to health care, and other vulnerable or marginalized groups including some indigenous populations, migrants and refugees (conditional recommendation, very low-quality evidence).
Infants of mothers with TB have increased risks of premature birth and perinatal death; pregnant women with TB are more likely to have complications during pregnancy; initiating TB treatment is associated with better maternal and infant outcomes than late initiation. (1)
The ANC recommendations are intended to inform the development of relevant health-care policies and clinical protocols. These recommendations were developed in accordance with the methods described in the WHO handbook for guideline development (2). In summary, the process included: identification of priority questions and outcomes, retrieval of evidence, assessment and synthesis of the evidence, formulation of recommendations, and planning for the implementation, dissemination, impact evaluation and updating of the guideline.
The quality of the scientific evidence underpinning the recommendations was graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) (3) and Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) (4) approaches, for quantitative and qualitative evidence, respectively. Up-to-date systematic reviews were used to prepare evidence profiles for priority questions. The DECIDE (Developing and Evaluating Communication Strategies to support Informed Decisions and Practice based on Evidence) (5) framework, an evidence-to-decision tool that includes intervention effects, values, resources, equity, acceptability and feasibility criteria, was used to guide the formulation and approval of recommendations by the Guideline Development Group (GDG) – an international group of experts assembled for the purpose of developing this guideline – at three Technical Consultations between October 2015 and March 2016.
To ensure that each recommendation is correctly understood and applied in practice, the context of all context-specific recommendations is clearly stated within each recommendation, and the contributing experts provided additional remarks where needed.
In accordance with WHO guideline development standards, these recommendations will be reviewed and updated following the identification of new evidence, with major reviews and updates at least every five years.
Further information on procedures for developing this recommendation are available here.
For this recommendation, we aimed to answer the following question:
For pregnant women (P), does screening women for TB infection in ANC settings (I) compared with not screening for TB (C) improve health outcomes (O)?
Further information and considerations related to this recommendation can be found in the WHO guidelines, available at: http://www.who.int/entity/tb/GRADE_tables_screening.pdf
The GDG did not identify any priority question related to this recommendation
WHO recommendations on antenatal care for a positive pregnancy experience
Citation: WHO Reproductive Health Library. WHO recommendation on tuberculosis testing in pregnancy. (December 2016). The WHO Reproductive Health Library; Geneva: World Health Organization.
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