Treatment and pregnancy outcomes of pregnant women exposed to second-line anti-tuberculosis drugs in South Africa

Abstract

Background Multi-drug resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) in pregnant women is a cause for concern globally; few data have described the safety of second-line anti-TB medications during pregnancy. We aim to describe TB treatment and pregnancy outcomes among pregnant women receiving second-line anti-tuberculosis treatment for MDR/RR-TB in Johannesburg, South Africa. Methods We conducted a retrospective record review of pregnant women (≥ 18 years) who received treatment for MDR/RR-TB between 01/2010–08/2016 at three outpatient treatment sites in Johannesburg, South Africa. Demographic, treatment and pregnancy outcome data were collected from available medical records. Preterm birth (< 37 weeks), and miscarriage were categorized as adverse pregnancy outcomes. Results Out of 720 women of child-bearing age who received MDR/RR-TB treatment at the three study sites, 35 (4.4%) pregnancies were identified. Overall, 68.7% (24/35) were HIV infected, 83.3% (20/24) were on antiretroviral therapy (ART). Most women, 88.6% (31/35), were pregnant at the time of MDR/RR-TB diagnosis and four women became pregnant during treatment. Pregnancy outcomes were available for 20/35 (57.1%) women, which included 15 live births (11 occurred prior to 37 weeks), 1 neonatal death, 1 miscarriage and 3 pregnancy terminations. Overall, 13/20 (65.0%) women with known pregnancy outcomes had an adverse pregnancy outcome. Of the 28 women with known TB treatment outcomes 17 (60.7%) completed treatment successfully (4 were cured and 13 completed treatment), 3 (10.7%) died and 8 (28.6%) were lost-to-follow-up. Conclusions Pregnant women with MDR/RR-TB suffer from high rates of adverse pregnancy outcomes and about 60% achieve a successful TB treatment outcome. These vulnerable patients require close monitoring and coordinated obstetric, HIV and TB care.

Examining family planning and adverse pregnancy outcomes for women with active tuberculosis disease: a systematic review

“…Similarly, another study found 91% (10/11) of preterm labour were among those with TB-HIV coinfection compared with those with TB only. 42 One study found no statistical significance in association between TB-HIV coinfection and maternal or fetal outcome. 62 …”

“… 22 26 27 44 45 TB outcomes for newborns with congenital TB include: resolution or improvement of TB at follow-up, loss to follow-up, died without TB treatment or unknown. 22 26 28 40 44–46 Other reported poor fetal outcomes included stillbirth (case reports n=1, case series n=2, cohort studies n=3), 30 47 48 spontaneous abortions/fetal demise (case reports n=3, case series n=6, cohort study n=1) 19 29 49–55 or induced abortions (case reports n=4, series n=1, cohort study n=2, other n=1) 42 49 55–60 and fetal growth restriction/retardation (case series n=1, case-control n=1). 41 61 One case series reported stillbirth, spontaneous abortions/fetal demise and induced abortions, 49 and one cohort study reported spontaneous and induced abortions.…”

“… 33 Four studies reported successful treatment outcome (complete or cure) for the majority of their samples (83.3%, 61%, 65.4% and 88%) and lost to follow-up (11.1%, 28.6%, 26.9% and 12%). 42 62 82 84 The remaining studies, three case reports 57 72 78 and a case series, 19 provide conflicting results on maternal and fetal outcomes: two case studies reported good outcome for mother and baby, one case study reported treatment failure with induced abortion, while the case series noted maternal and fetal/newborn complications and deaths in their descriptive analysis. The validity and generalisability of these studies are limited by their study design and sample size.…”

Treatment Outcomes Among Pregnant Patients With Multidrug-Resistant Tuberculosis

“…Our electronic database searches identified 487 records. After removal of duplicates, excluding studies by title and abstract screening and full-text review (eTable 5 in the Supplement ), 10 studies 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 were included in the meta-analysis, which included 288 pregnant patients with MDR-TB ( Figure 1 ).…”

“…The studies were conducted in 5 different countries, and the data were collected from 1996 to 2019 (eTable 6 in the Supplement ). Among the included studies, 9 were published in English, 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 and 1 was in Spanish. 23 Treatment outcomes were reported for all 10 studies, which included 275 of the 288 pregnant patients with MDR-TB ( Table 1 ).…”