Tuberculosis clinical presentation and treatment outcomes in pregnancy: a prospective cohort study

Abstract

Background There is limited research to guide TB treatment specifically in pregnant women and few studies have described the presentation of TB in pregnant women. We aimed to understand TB presentation and treatment outcomes in pregnant women in a low HIV burden setting. We describe a cohort of women of childbearing age treated for TB disease in Lima, Peru, and compare clinical presentation and treatment outcomes among pregnant and non-pregnant women between 2009 and 2012, including 36 pregnant women. Methods This is a prospective cohort study. Subjects were recruited from across 106 public health centers in Lima, Peru. Baseline demographic, medical history, and drug-susceptibility test results were collected. We used descriptive statistics to describe demographic and clinical characteristics of the women using Pearson chi-squared, Fisher’s exact tests, or Kruskal-Wallis. Results Among 4500 individuals with pulmonary TB disease, 1334 women were included in analysis with 36 (2.69%) pregnant women. Pregnant women had similar demographics, past medical histories, and clinical presentation to non-pregnant women, except being more likely to be married (p = 0.01) and have cardiac disease (p = 0.04) and less likely to have weight loss (p = 0.05). Twenty (71.4%) pregnant women had pan-susceptible TB compared with 616 (63.1%) non-pregnant women; four (14.3%) pregnant women had mono-resistant TB compared with 154 (15.8%) non-pregnant women; and four (14.3%) pregnant women had multi-drug-resistant TB compared with 140 (14.3%) of non-pregnant women (p = 0.53). Twenty-eight (96.6%) pregnant women had a successful outcome (cure, completed treatment, treatment ended early by clinical team) while one (3.4%) had an unsuccessful outcome (treatment failed) and 1074 (97.3%) non-pregnant women had a successful outcome while 30 (2.7%) had an unsuccessful outcome (p = 0.56). Conclusion In this cohort with low HIV co-infection, we found high TB treatment success rates in both pregnant and non-pregnant women, irrespective of drug-susceptibility profiles. If treated appropriately, pregnant women with TB disease can have successful outcomes.

Treatment and Pregnancy Outcomes of Pregnant Women Exposed to Second-line Anti-tuberculosis Drugs in South Africa

“…The reported preterm births in our cohort were also higher than what was found in the KwaZulu-Natal cohort and a cohort of pregnant women treated for MDR/RR-TB in Lima, Peru between 1996 and 2005 (13,20). Most concerning is that the preterm births in our cohort was also higher than in HIV and general populations in South Africa (13,(20)(21)(22)(23)(24). Almost all of the adverse birth outcomes were among HIV-positive women in our cohort.…”

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 ).…”

Pregnancy With Atypical Pulmonary Tuberculosis in COVID-19 Outbreak:A Case Report

“…Pregnancy with tuberculosis means that a woman develops tuberculosis during pregnancy or a woman of childbearing age becomes pregnant when tuberculosis is not cured, or is diagnosed with tuberculosis within three months after delivery. It is estimated that more than three million women in the world are infected with tuberculosis and are in the incubation period [3]. About 700,000 women die of tuberculosis each year, and about 26 % of all preventable deaths in pregnancy worldwide are directly attributable to tuberculosis [4].…”