Dynamics of Mycobacterium tuberculosis-Specific and Nonspecific Immune Responses in Women with Tuberculosis Infection during Pregnancy

Tesfaye, Fregenet; Sturegård, Erik; Walles, John; Bekele, Bayissa; Bobosha, Kidist; Björkman, Per; Jansson, Marianne

doi:10.1128/spectrum.01178-22

Cited by 3 publications

(2 citation statements)

References 48 publications

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“…The elevated incidence of TB disease in connection to pregnancy observed in low-endemic countries is likely to be due to pregnancy-induced progression of TBI [ 13 , 14 ]. Furthermore, we and other researchers have found altered M. tuberculosis –specific immune responses during pregnancy [ 17 , 20 , 30 , 31 ], suggesting that the host–pathogen interaction changes during pregnancy [ 17 , 20 ].This register-based study was not designed to investigate mechanisms involved in these phenomena. Yet, we speculate that low-grade inflammation triggered by TBI during pregnancy might be involved in the association between TBI and pregnancy complications observed in our study population [ 26 , 27 , 32 ].…”

Section: Discussionmentioning

confidence: 70%

Pregnancy Outcomes in Women Screened for Tuberculosis Infection in Swedish Antenatal Care

Walles

Winqvist²,

Hansson

et al. 2023

Clinical Infectious Diseases

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Background Tuberculosis (TB) disease has been associated with pregnancy complications. However, the potential impact of TB infection (TBI) on pregnancy outcome is unknown. To investigate this, we conducted a register-based study in immigrant women screened with QuantiFERON assays for TBI in antenatal care in Sweden. Methods Women with history of immigration from TB-endemic countries were eligible for inclusion if national identification numbers and available QuantiFERON results obtained during pregnancy 2014-2018 were available. QuantiFERON results were linked to data on maternal characteristics and pregnancy outcomes from the national Pregnancy and Patient Registers. TBI was defined as nil-corrected QuantiFERON result ≥0.35 IU/ml, in the absence of TB disease. Pregnancies in women with TB disease or HIV infection were excluded, as well as multiplex pregnancies, pregnancies resulting in miscarriage, and pregnancies occurring >10 years after immigration. Odds of defined adverse pregnancy outcomes were compared by maternal TBI status using mixed effects logistic regression with adjustment for maternal age and region of origin. Results In total, 7,408 women with 12,443 pregnancies were included. In multivariable analysis, stillbirth (adjusted Odds ratio [AOR] 1.90, 95% confidence interval [CI] 1.13-3.21, p=0.016), severe preeclampsia (AOR 1.62, 95% CI 1.03-2.56, p=0.036), low birthweight (<2500 grams; AOR 1.38, 95% CI 1.01-1.88, p=0.041) and emergency Caesarean section (AOR 1.28, 95% CI 1.02-1.63, p=0.033) were significantly associated with TBI. Conclusion Among immigrant women seeking antenatal care in Sweden, TBI was independently associated with adverse pregnancy outcomes. Further studies are needed to corroborate these findings and to explore mechanisms involved.

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Section: Discussionmentioning

confidence: 70%

Pregnancy Outcomes in Women Screened for Tuberculosis Infection in Swedish Antenatal Care

Walles

Winqvist²,

Hansson

et al. 2023

Clinical Infectious Diseases

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“…Interestingly, most TB cases in previous studies were reported postpartum [ 11 , 12 ], whereas the majority of people with TB disease in our study had been diagnosed during pregnancy. Pregnancy confers physiological immune changes, which may increase the risk of progression of TBI [ 32 , 33 ]. These immune modifications are restored shortly after delivery.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis Infection and Disease Among Pregnant People Living in Sweden With Origin in Tuberculosis-Endemic Countries

Båtshake,

Walles,

Winqvist

et al. 2023

Open Forum Infectious Diseases

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Background Pregnancy has been associated with elevated incidence of tuberculosis disease. Since 2014, people living in Sweden with origin in tuberculosis-endemic countries are offered screening for tuberculosis infection in antenatal care (ANC) using Quantiferon-TB assays. We assessed factors associated with tuberculosis infection in this population, and determined the incidence of tuberculosis disease during pregnancy and postpartum periods with regard to ANC Quantiferon-TB results. Methods Quantiferon-TB results obtained during ANC in Sweden 2014-2018 were linked to data from national registers (Pregnancy Register, Patient Register and Tuberculosis Register). Factors associated with tuberculosis infection (defined as Quantiferon-TB ≥0.35 IU/ml) were identified using logistic regression analysis. Incidence of tuberculosis disease was determined with regard to pregnancy, post-partum and subsequent periods, and ANC Quantiferon-TB results. Results Among 7,638 screened individuals, 1,424 (18.6%) had tuberculosis infection. Tuberculosis infection was independently associated with higher age at immigration (adjusted odds ratio 1.04, 95% confidence interval 1.03–1.05; p < 0.001), and was more common among people originating from Africa compared to other world regions (845/3,088 [27.4%] vs. 579/4,550 [12.7%]; p < 0.001). In total, 16 participants were diagnosed with tuberculosis disease (10 during pregnancy, 4 < 6 months after delivery, 2 > 6 months after delivery); among these, all diagnosed during pregnancy/postpartum had positive ANC Quantiferon-TB results (constituting 14/1,424 [1%] of people with tuberculosis infection). Conclusions Among pregnant people screened in Swedish ANC, tuberculosis infection was associated with higher age and African origin. All cases of tuberculosis disease reported in persons with tuberculosis infection at ANC screening occurred during pregnancy or postpartum.

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A case report on tuberculosis in pregnancy revealing the need for an effective multidisciplinary approach and the importance of tailored therapy

Gandavaram,

Rajalekshmi M

2024

IJOGR

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Tuberculosis (TB) during pregnancy, especially with central nervous system (CNS) involvement, poses significant risks to maternal and fetal health. This case report explores the diagnostic and therapeutic challenges of managing new-onset seizures in a pregnant patient with CNS-TB.A 23-year-old primigravida presented at 36 weeks gestation with new-onset seizures. The diagnostic workup, complicated by the pregnancy, revealed a left frontal tuberculoma. The patient was started on a standard antitubercular therapy (ATT) regimen of 2HRZE followed by 4HR, taking into account the drugs’ teratogenic potential and fetal safety. Despite the development of mild atonic postpartum hemorrhage (PPH), the patient gave birth to a preterm but viable infant with satisfactory APGAR scores.The interdisciplinary team provided comprehensive care, including seizure management with Levetiracetam and postpartum follow-up for both mother and child. The patient showed neurological improvement and, alongside the newborn, had a favorable outcome. This case underlines the importance of a tailored, multidisciplinary approach to managing TB in pregnancy. It also emphasizes the need for vigilant monitoring and treatment adherence to navigate the complexities of TB with CNS involvement and concurrent pregnancy.Enhanced prenatal screening for TB, interdisciplinary protocols, research on TB medications during pregnancy, and long-term follow-up studies are recommended to improve outcomes for similar future cases.

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Dynamics of Mycobacterium tuberculosis-Specific and Nonspecific Immune Responses in Women with Tuberculosis Infection during Pregnancy

Abstract: Tuberculosis (TB) is globally one of the most common causes of death, and a quarter of the world's population is estimated to have TB infection. The risk of active TB is increased in connection to pregnancy, a phenomenon that could be due to physiological immune changes.

Cited by 3 publications

References 48 publications

Pregnancy Outcomes in Women Screened for Tuberculosis Infection in Swedish Antenatal Care

Pregnancy Outcomes in Women Screened for Tuberculosis Infection in Swedish Antenatal Care

Tuberculosis Infection and Disease Among Pregnant People Living in Sweden With Origin in Tuberculosis-Endemic Countries

A case report on tuberculosis in pregnancy revealing the need for an effective multidisciplinary approach and the importance of tailored therapy

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