Tuberculosis in pregnancy: The challenges for South Asian countries

Abstract

Abstractj og_1856 1125..1136Aim: Despite tuberculosis (TB) being a global problem, maternal TB remains an unrecognized and underestimated tragedy, especially in South Asian countries. Therefore, we performed a non-systematic review regarding implications of maternal TB on obstetric and perinatal outcomes in the South Asian context. Material and Methods:We reviewed original studies, both descriptive and analytical, that originated from South Asian countries following an electronic search supplemented by a manual search. Although relevant studies from developed countries were reviewed, they were not included in the tabulation process because those studies had different socioeconomic/epidemiological background. Results: Diagnosis of TB is often delayed during pregnancy, because of its non-specific symptoms, and overlapping presentation with other infectious diseases. Poverty, undernutrition, lack of social support and poor health infrastructure along with complications of TB and need for prolonged medications lead to increased maternal morbidity and mortality. Maternal TB in general (except lymphadenitis), is associated with an increased risk of small-for-gestational age, preterm and low-birthweight neonates, and high perinatal mortality. These adverse perinatal outcomes are even more pronounced in women with advanced disease, late diagnosis, and incomplete or irregular drug treatment. There could be a synergy of TB, socioeconomic and nutritional factors, which might have contributed to adverse perinatal effects, especially in low-income countries. Conclusions: As active TB poses grave maternal and perinatal risks, early, appropriate and adequate anti-TB treatment is a mainstay for successful pregnancy outcome. The current knowledge gaps in perinatal implications of maternal TB can be addressed by a multicenter comparative cohort study.

Massive hemoptysis and complete unilateral lung collapse in pregnancy due to pulmonary tuberculosis with good maternal and fetal outcome: a case report

“…Small for dates, sub optimal weight gain and being a health care worker (higher risk of tuberculosis [12]) are features in our patient that could have helped make the diagnosis of tuberculosis sooner. However, establishing a definitive diagnosis of tuberculosis in pregnancy usually takes time [13]. …”

Clinical Focus: Infections in Pregnancy

“…85,86 What is certain is that TB is an important cause of maternal mortality around the world, particularly in the context of HIV infection. 85,87,88 In pregnant women TB is also responsible for a significant degree of infant morbidity and mortality, 89 and cases of congenital TB, although rare, are still seen occasionally. 90,91 All of the above factors also apply in cases of extrapulmonary TB (except for isolated TB lymphadenitis).…”

Are TB control programmes in South Asia ignoring children with disease? A situational analysis

“…The few studies on the subject from India have been limited because of poor follow-up rates 36. Integration of maternal and neonatal health programmes will serve to establish continuum of care while also ensuring that chronic illnesses such as TB when diagnosed in mothers are also sought in neonates 37.…”