Tuberculosis Disease during Pregnancy and Treatment Outcomes in HIV-Infected and Uninfected Women at a Referral Hospital in Cape Town

Abstract

BackgroundTuberculosis during pregnancy and treatment outcomes are poorly defined in high prevalence tuberculosis and HIV settings.MethodsA prospective cohort study of pregnant and postpartum women identified to be routinely on antituberculosis treatment was conducted at Tygerberg Hospital, Cape Town, South Africa, from January 2011 through December 2011. Maternal tuberculosis disease spectrum and tuberculosis-exposed newborns were characterized by maternal HIV status. Maternal tuberculosis treatment outcomes were documented and a multivariable regression model identified predictors of unfavourable tuberculosis treatment outcomes. Infant outcomes were also described.ResultsSeventy-four women with tuberculosis, 53 (72%) HIV-infected, were consecutively enrolled; 35 (47%) were diagnosed at delivery or postpartum and 22 (30%) of women reported previous antituberculosis treatment. HIV-infected women were 5.67 times more likely to have extrapulmonary tuberculosis (95% CI 1.18–27.25, p = 0.03). All 5 maternal deaths were amongst HIV-infected women. Birth outcomes were available for 75 newborns (2 sets of twins, missing data for 1 stillbirth). Of the 75 newborns, 49 (65%) were premature and 44 (59%) were low birth weight (LBW; <2500 grams). All 6 infants who died and the 4 stillbirths were born to HIV-infected women. Unfavourable tuberculosis treatment outcomes were documented in 33/74 (45%) women. Unfavourable maternal tuberculosis outcome was associated with delivery of LBW infants (OR 3.83; 95% CI 1.40–10.53, p = 0.009).ConclusionsA large number of pregnant women with tuberculosis presented at a provincial referral hospital. All maternal and infant deaths occurred in HIV-infected women and their newborns. Maternal tuberculosis treatment outcomes were poor.

Smear-Positive Tuberculosis Prevalence and Associated Factors among Pregnant Women Attending Antinatal Care in North Gondar Zone Hospitals, Ethiopia

“…To our best knowledge, this is the first study showing the prevalence of smear positivity of tuberculosis in pregnant women of Ethiopia attending antenatal clinic. Many study findings reported that the burden of TB in pregnant women is high and has adverse impacts on perinatal and infant outcomes [4]. Surprisingly, our study also showed relatively higher rate of smear-positive tuberculosis in pregnant women.…”

“…In pregnant women living with HIV, increase in the risk of maternal and infant mortality by tuberculosis is almost 300% [2]. In high burden countries, the rate of active tuberculosis ranges from 0.7% to 7.9% among HIV-positive women and is as high as 11% if they are positive for tuberculin skin test [3, 4]. In developing countries, the TB prevalence was 10-fold higher in the HIV-infected mothers than that in those not infected with HIV [5].…”

Detecting tuberculosis in pregnant and postpartum women in Eswatini

“… 18 The low sensitivity of the tuberculosis screening tool has been reported in many other studies. 18 , 19 , 38 , 39 Adapting the screening tool to include a history of tuberculosis contact as an independent indicator of positive tuberculosis screen improved sensitivity by 18% but only in HIV-positive women. This sensitivity (18%) is still too low for effective tuberculosis case finding and ruling out tuberculosis among pregnant and postpartum women.…”

Retrospective record review of pregnant women treated for rifampicin-resistant tuberculosis in South Africa

“…In 2016 it was estimated that 8,400 pregnant women had drug-susceptible TB in South Africa [ 5 , 6 ] but little is known about the number of pregnant women with drug-resistant TB (DR-TB) [ 7 ]. The treatment remains challenging and is more complex in DR-TB/HIV co-infection where there is a limited evidence base to guide clinical practice.…”