Prevalence of tuberculosis infection among pregnant women: a systematic review protocol

OBJECTIVE: This systematic review aims to investigate the global pooled prevalence of tuberculosis (TB) infection among pregnant women. INTRODUCTION: TB infection affects 25% of the global population and poses a significant public health challenge, particularly among pregnant women who are at higher risk of progressing to TB disease. ELIGIBILITY CRITERIA: Studies will include pregnant women with TB infection, as identified by a tuberculin skin test or interferon-gamma release assay, irrespective of coexisting immunocompromizing conditions. Eligible sources will comprise cross-sectional and cohort studies, and surveillance reports from any geographic setting. Studies focusing on TB disease, lacking prevalence data, or presenting mixed data that cannot be disaggregated for the target population will be excluded. METHODS: This proposed systematic review will follow the PERSyst group guidance for systematic reviews of prevalence. A 3-step search strategy will be applied, covering 2014 to 2025, with no language restrictions. Databases include CINAHL (EBSCOhost), Embase (Elsevier), Google Scholar, PubMed, LILACS, and Web of Science, while sources of gray literature will be international and professional organizations' websites. Study selection will follow a 3-step process, including critical appraisal for methodological quality. Standardized data extraction tools will be used. Two independent reviewers will handle each step, with conflicts resolved by consensus or with a third reviewer. Narrative synthesis will be conducted and, where feasible, a random-effects meta-analysis will be performed to estimate pooled TB infection prevalence with 95% CIs. Heterogeneity will be assessed using the I 2 statistic, acknowledging that substantial heterogeneity is common in prevalence meta-analyses. REVIEW REGISTRATION: PROSPERO CRD420251026181.