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

BackgroundSelf-testing for proteinuria may help identify preeclampsia risk during pregnancy, increase end-user empowerment, and reduce burden on health systems. We conducted this systematic review of the impact of proteinuria self-testing during pregnancy to expand the evidence base for the World Health Organization consolidated guideline on self-care interventions. MethodsWe comprehensively searched for articles comparing the effect of proteinuria self-testing with clinic-based testing among pregnant individuals receiving antenatal care on the following outcomes: maternal mortality or near-miss; adverse pregnancy outcomes; eclampsia or pre-eclampsia; long-term diseases; follow-up care and appropriate management; self-efficacy, self-determination, autonomy, and empowerment; mental health and well-being; adverse events and social harms; device-related issues; intra-uterine growth restriction; preterm birth; and stillbirth or perinatal death. After abstract screening and full-text review, we systematically extracted data using standardized forms and summarized the relative risks of outcomes between self-testing and clinic-based testing for proteinuria. We also assessed values and preferences and costs of self-testing. ResultsThree publications were identified for the effectiveness review; two for values/preferences, and none for the cost review, mostly from high-income countries. Overall, there was no statistically significant difference between self-testing and inpatient care for proteinuria among women with hypertension for any of the outcomes with data available. In general, both women and providers were supportive of proteinuria self-testing because it allows a greater role in self-care and fewer clinic visits, though some emphasized the need to train end-users for proper testing and appropriate follow-up actions. ConclusionsVery limited evidence suggests that self-testing for proteinuria results in comparable maternal and fetal outcomes as provider-testing for hypertensive pregnant individuals, and is generally acceptable to end-users and providers despite some concerns. No evidence of effectiveness was available for the general pregnant population. This evidence base supports its feasibility as an additional option for identifying individuals at risk of preeclampsia. Systematic review registration numberPROSPERO CRD42021233845