Drug‐Resistant Tuberculosis and Pregnancy: Treatment Outcomes of 38 Cases in Lima, Peru

Abstract

Background Multidrug-resistant tuberculosis (MDR-TB) disproportionately affects young adults, including women of childbearing age; however, treatment of MDR-TB during pregnancy is still controversial. This study looks at the treatment and pregnancy outcomes of a ten-year cohort of women who were treated for MDR-TB during pregnancy. Methods A retrospective case series was performed using a standardized data collection form and data from three ranked sources of patient records. All 38 participants were treated with individualized regimes which included second-line tuberculosis medications during pregnancy. We examined the frequency of favorable and adverse outcomes in terms of disease and pregnancy. Results Upon completion of MDR-TB treatment, 61% of the women were cured, 13% died, 13% defaulted, 5% remain in treatment, and 5% failed. Four of the women experienced clinical deterioration of TB during pregnancy. Five of the pregnancies terminated in spontaneous abortions and one child was stillborn. Among the live births, 3 were born with low birth weight, one was premature, and one had fetal distress. Conclusions The rates of success in treating MDR-TB in our cohort are comparable to those of other MDR-TB treatment programs in Peru. The birth outcomes of our cohort are similar to data on the general Peru population. Therefore, we advocate that a woman should be given the option to continue treatment of MDR-TB rather than termination of pregnancy or discontinuation of MDR-TB treatment.

Congenital Transmission of Multidrug-Resistant Tuberculosis

“…The study concluded by advocating continuation of treatment of MDR-TB throughout pregnancy. 25 In the case presented above, if the mother had been diagnosed and treated for MDR-TB during pregnancy, she may not have experienced systemic dissemination and complications from her TB, and the baby would have had a better chance of survival.…”

“…Drobac and others 24 found no significant evidence of toxicity in six children, with an average age of 3.7 years, who had been exposed to second-line agents in utero. In a 10-year retrospective cohort of 38 women treated for MDR-TB, 25 61% of the mothers were cured, 13% of the mothers died, 5% of the mothers had treatment failure, 13% of the mothers discontinued treatment, and 5% of the mothers remained on treatment. Clinical deterioration of TB during pregnancy occurred in four women, five pregnancies ended in spontaneous abortion, and one child was stillborn; among the live births, three children were born with low birth weight, one child was born pre-maturely, and one child suffered fetal distress.…”

Caracterização da tuberculose multidroga resistente durante a gravidez, em Campinas, Estado de São Paulo, Brasil, no período de 1995 a 2007

“…Estudos sobre TB-MDR na gravidez estão limitados a 64 casos [2][3][4][5][6][7][8][9] . O enfoque dado pelos autores é essencialmente clínico e apenas em Palácios cols 8 , no Peru, em uma coorte de 10 anos, as 38 pacientes foram caracterizadas em relação ao desfecho do tratamento e da gestação.…”

“…São escassos os trabalhos publicados e pequeno o número de pacientes nestes estudos [2][3][4][5][6][7][8][9] . Também, pouco se conhece sobre a segurança dos medicamentos para o tratamento da TB-MDR durante a gestação: alguns são contraindicados; os esquemas são mais agressivos, menos efetivos, evitados no primeiro trimestre e com reduzida probabilidade de cura.…”

Tuberculosis and Pregnancy: An Updated Systematic Review

“…The largest study to our knowledge is of 38 pregnant women treated for MDRTB in Peru and outcomes were similar to those of the general local population. 47 The majority of the second-line drugs are in FDA class C (animal studies suggest a problem, but human studies are inadequate), except for aminoglycosides, which are in class D (definite evidence of fetal risk). A TBNET consensus statement on the management of patients with M/XDRTB in Europe states that "safe treatment of M/XDRTB during pregnancy seems possible but needs individual decision-making" and "Pregnancies should not be terminated because of M/XDR-TB";"Aminoglycosides/polypeptides are not recommended for M/XDRTB treatment during pregnancy"; "Patients should be advised to maintain double barrier contraception during treatment of M/XDRTB''.…”