Self-testing for pregnancy: a systematic review and meta-analysis

Abstract

Objectives: Urine pregnancy tests are often inaccessible in low-income settings. Expanded provision of home pregnancy testing could support self-care options for sexual and reproductive health and rights. We conducted a systematic review of pregnancy self-testing effectiveness, values and preferences and cost.

Design: Systematic review and meta-analysis using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.

Data sources: PubMed, CINAHL, LILACS and EMBASE and four trial registries were searched through 2 November 2020.

Eligibility criteria for selecting studies: We included trials and observational studies that compared urine self-testing for pregnancy to health worker-led pregnancy testing on effectiveness outcomes; quantitative and qualitative studies describing values and preferences of end users and health workers and costs of pregnancy self-testing.

Data extraction and synthesis: Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Cochrane Collaboration and Evidence Project tools. Meta-analysis was conducted using random effects models. Findings were summarised in GRADE evidence profiles and synthesised qualitatively.

Results: For effectiveness, four randomised trials following 5493 individuals after medical abortion showed no difference or improvements in loss to follow-up with home pregnancy self-testing compared with return clinic visits. One additional trial of community health workers offering home pregnancy tests showed a significant increase in pregnancy knowledge and antenatal counselling among 506 clients. Eighteen diverse values and preferences studies found support for pregnancy self-testing because of quick results, convenience, confidentiality/privacy, cost and accuracy. Most individuals receiving pregnancy self-tests for postabortion home management preferred this option. No studies reported cost data.

Conclusion: Pregnancy self-testing is acceptable and valued by end users. Effectiveness data come mostly from articles on postabortion care, and cost data are lacking. Greater availability of pregnancy self-tests, including in postabortion care and CHW programs, may lead to improved health outcomes.

Prospero registration number: CRD42021231656.

Keywords: maternal medicine; organisation of health services; protocols & guidelines; public health.

Figure 1

PRISMA flowchart showing disposition of citations through the search and screening process. PICO, population–intervention–comparison–outcome; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; VP, values and preferences.

Figure 2

Meta-analysis of loss to follow-up (LTFU) among clients following medical abortion, comparing those receiving follow-up at home vs a return clinic visit.