Best practices for the care of pregnant people living with TB

Abstract

BACKGROUND: Each year more than 200,000 pregnant people become sick with TB, but little is known about how to optimize their diagnosis and therapy. Although there is a need for further research in this population, it is important to recognize that much can be done to improve the services they currently receive.METHODS: Following a systematic review of the literature and the input of a global team of health professionals, a series of best practices for the diagnosis, prevention and treatment of TB during pregnancy were developed.RESULTS: Best practices were developed for each of the following areas: 1) screening and diagnosis; 2) reproductive health services and family planning; 3) treatment of drug-susceptible TB; 4) treatment of rifampicin-resistant/multidrug-resistant TB; 5) compassionate infection control practices; 6) feeding considerations; 7) counseling and support; 8) treatment of TB infection/TB preventive therapy; and 9) research considerations.CONCLUSION: Effective strategies for the care of pregnant people across the TB spectrum are readily achievable and will greatly improve the lives and health of this under-served population.

Association between tuberculosis and pregnancy outcomes: a retrospective cohort study of women in Cape Town, South Africa

“…Offering effective contraception to women at TB treatment initiation 29 36 and screening for pregnancy at each TB-related visit, with integration of reproductive health services as part of TB care is critical. 37 Women should be made aware of their increased risk of poorer pregnancy outcomes and need for additional care if they conceive during their TB episode. If adequate counselling and assessment of family planning at the start of TB treatment is being implemented as per local guidelines, and women continue to fall pregnant during their TB episode, then there could be other factors associated with this.…”

“…Pregnancy outcomes were documented in 215 (87%) women, of whom 74 (34%) had an adverse pregnancy outcome. Being older (35)(36)(37)(38)(39)(40)(41)(42)(43)(44) years vs 25-34 years (adjusted OR (aOR): 3.99; 95% CI: 1.37 to 11.57), living with HIV (aOR: 2.72; 95% CI: 0.99 to 4.63), having an unfavourable TB outcome (aOR: 2.29; 95% CI: 1.03 to 5.08) and having presented to antenatal services ≤1 month prior to delivery (aOR: 10.57; 95% CI: 4.01 to 27.89) were associated with higher odds of an adverse pregnancy outcome. Conclusions Pregnancy outcomes among women with TB were poor, irrespective of HIV status.…”

Next-Generation TB Vaccines: Progress, Challenges, and Prospects

“…The greatest risk of TB in women coincides with their childbearing age, with over 200,000 pregnant women being affected by ATB annually [ 199 , 200 ]. The prevalence of LTBI during pregnancy is 4.2% in the United States, from 19% to 34% in HIV-negative women in India, and as high as 49% in HIV-positive women in South Africa [ 201 ].…”

Perinatal tuberculosis—An approach to an under-recognized diagnosis

“…The risk of untreated TB disease to the pregnant woman and her fetus is much greater than the risks of antituberculosis treatment. Appropriate and safe regimens for both drug-susceptible and drugresistant TB treatment in pregnancy are available (15).…”