Tuberculosis and Pregnancy: An Updated Systematic Review
DOI:
https://doi.org/10.17140/PRRMOJ-2-109Keywords:
Tuberclosis, Pregnancy, Mycobacterium tuberculosis, Maternal mortalityAbstract
Tuberculosis (TB) affects women, especially in the child-bearing years. TB is associated with a poorer outcome of pregnancy, although this may be due to the general risk factors for TB, namely poverty, malnutrition and overcrowding. New studies have shown that symp-tom screening has a low sensitivity and specificity, but is improved by the addition of a tuber-culin skin test (TST) or interferon-gamma release assay (IGRA) or, in high incidence areas, DNA amplification tests (e.g. Xpert MTB/RIF). TB-HIV co-infection is a common cause of mortality and morbidity in pregnancy. The diagnostic process remains the same in pregnancy, but non-specific symptoms and extra pulmonary disease demand a higher level of suspicion of TB. Standard first-line treatment is safe in pregnancy. Data on second-line drugs in pregnancy is still limited, but injectable drugs may affect the hearing and balance of the fetus. The IGRA responses appear to change during pregnancy, with more positive responses after delivery. The increasing incidence of drug-resistant TB, especially in Eastern Europe and Central Asia, requires an evaluation of the safety of second-line drugs in pregnancy.
References
World Health Organization. Global tuberculosis report 2013, 2013. WHO/HTM/TB/2013.11. http://apps.who.int/iris/bitstr eam/10665/91355/1/9789241564656_eng.pdf?ua=1 Accessed September 12, 2014.
Sugarman J, Colvin C, Moran AC, Oxlade O. Tuberculosis in pregnancy: an estimate of the global burden of disease. Lancet Glob Health. 2014; 2: e710-e716. doi: http://dx.doi.org/10.1016/ S2214-109X(14)70330-4
Bothamley GH. Screening for tuberculosis in pregnancy. Ex-pert. Rev. Obstet. Gynecol. 2012; 7(4): 387-395.
Bothamley GH. Management of TB during pregnancy, espe-cially in high-risk communities. Expert. Rev. Obstet. Gynecol. 2009; 4(5): 555-563. doi: 10.1586/eog.09.39
Asuquo B, VelloreAD, Walters G, Manney S, Mignini L, Kunst H. A case-control study of the risk of adverse perinatal outcomes due to tuberculosis during pregnancy. J. Obstet. Gynaecol. 2012; 32 (7): 635 -638. doi: 10.3109/01443615.2012.704436
Peng W, Yang J, Liu E. Analysis of 170 cases of congenital TB reported in the literature between 1946 and 2009. Pediatr. Pulmonol. 2011; 46: 1215-1224. doi: 10.1002/ppul.21490
Bekker A, Du Preez K, Schaaf HS, Cotton MF, Hesseling AC. High tuberculosis exposure among neonates in a high tu-berculosis and human immunodeficiency virus burden setting. Int. J. Tuberc. Lung Dis. 2012; 16: 1040-1046. doi: 10.5588/ ijtld.11.0821
Cranmer LM, Kanyugo M, Jonnalagadda SR, et al. High prevalence of tuberculosis infection in HIV-1 exposed Kenyan infants. Pediatr. Infect. Dis. J. 2014; 33: 401-406. doi: 10.1097/ INF.0000000000000124
Banerjee A, Prateek S, Malik S, Dhingra D. Genital tuberculo-sis in adolescent girls from low socioeconomic status with acute ectopic pregnancy presenting at a tertiary care hospital in urban Northern India: are we missing an opportunity to treat? Arch. Gynecol. Obstet. 2012; 286: 1477-1482. doi: 10.1007/s00404- 012-2487-z
World Health Organization. Guidelines for intensified tuber-culosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings, 2011. http:// whqlibdoc.who.int/publications/2011/9789241500708_eng. pdf?ua=1. Accessed September 12, 2014.
Getahun H, Kittikraisak W, Heilig CM, et al. Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies. PLoS Med. 2011; 8: e1000391. doi: 10.1371/journal.pmed.1000391
Gupta A, Chandrasekhar A, Gupte N, et al. Symptom screen-ing among HIV-infected pregnant women is acceptable and has high negative predictive value for active tuberculosis. Clin. In-fect. Dis. 2011; 53: 1015-1018. doi: 10.1093/cid/cir605
Hoffmann CJ, Variava E, Rakgokong M, et al. High preva-lence of pulmonary tuberculosis but low sensitivity of symp-tom screening among HIV-infected pregnant women in South Africa. PLoS One. 2013; 8: e62211. doi: 10.1371/journal. pone.0062211
Kosgei RJ, Ndavi PM, Ong JO, et al. Symptom screen: diagnostic usefulness in detecting pulmonary tuberculosis in HIV-infected pregnant women in Kenya. Public Health Action. 2011; 1(2): 30-33.
Kosgei RJ, Szkwarko D, Callens S, et al. Screening for tuber-culosis in pregnancy: do we need more than a symptom screen? Experience from western Kenya. Public Health Action. 2013; 3: 294-298. doi: 10.5588/pha.13.0073
Present PA, Comstock GW. Tuberculin sensitivity in preg-nancy. Am Rev Respir Dis. 1975; 112: 413-416.
Bleknapp R, Daley CL. Interferon-gamma release as-says. Clin. Lab. Med. 2014; 34(2): 337-349. doi: 10.1016/j. cll.2014.02.007
Worjoloh A, Kato-Maeda M, Osmond D, Freyre R, Aziz N, Cohan D. Interferon-gamma release assay compared with tuberculin skin test for latent tuberculosis detection in preg-nancy. Obs. Gynecol. 2011; 118: 1363-1370. doi: 10.1097/ AOG.0b013e31823834a9
Lighter-Fisher J, Surette AM. Performance of an interferon-gamma release assay to diagnose latent tuberculosis infection during pregnancy. Obstet. Gynecol. 2012; 119: 1088-1095. doi: 10.1097/AOG.0b013e3182546aff
Mathad JS, Bhosale R, Sangar V, et al. Pregnancy differen-tially impacts performance of latent tuberculosis diagnostics in a high-burden setting. PLoS One. 2014; 9: 1-8. doi: 10.1371/ journal.pone.0092308
Pillay T, Khan M, Moodley J, Adhikari M, Coovadia H. Perinatal tuberculosis and HIV-1: considerations for resource-limited settings. Lancet Infect. Dis. 2004; 4: 155-165. doi: http:// dx.doi.org/10.1016/S1473-3099(04)00939-9
Gounder CR, Wada NI, Kensler C, et al. Active tuberculo-sis case-finding among pregnant women presenting to antenatal clinics in Soweto, South Africa. J Acquir Immune. Defic. Syndr. 2011; 57: e77-e84. doi: 10.1097/QAI.0b013e31821ac9c1
Desai M, Phillips-Howard PA, Odhiambo FO, et al. An anal-ysis of pregnancy-related mortality in the KEMRI/CDC health and demographic surveillance system in western Kenya. PLoS One. 2013; 8: e68733. doi: 10.1371/journal.pone.0068733
Garenne M, Kahn K, Collinson MA, Gómez-Olivé FX, Toll-man S. Maternal mortality in rural South Africa: the impact of case definition on levels and trends. Int. J. Womens Health. 2013; 5: 457-463. doi: 10.2147/IJWH.S45983
Gupta A, Bhosale R, Kinikar A, et al. Maternal tuberculo-sis: a risk factor for mother-to-child transmission of human im-munodeficiency virus. J. Infect. Dis. 2011; 203: 358-363. doi: 10.1093/infdis/jiq064
Jonnalagadda S, Lohman Payne B, Brown E, et al. Latent tuberculosis detection by interferon γ release assay during preg-nancy predicts active tuberculosis and mortality in human im-munodeficiency virus type 1-infected women and their children. J. Infect. Dis. 2010; 202: 1826-1835. doi: 10.1086/657411
Jonnalagadda SR, Brown E, Lohman-Payne B, et al. Consis-tency of Mycobacterium tuberculosis-specific interferon-gamma responses in HIV-1-infected women during pregnancy and post-partum. Infect. Dis. Obstet. Gynecol. 2012; 2012: 950650. doi:
Jonnalagadda SR, Brown E, Lohman-Payne B, Wamalwa D, Farquhar C, John-Stewart GC. Predictive value of interfer-on-gamma release assays for postpartum active tuberculosis in HIV-1-infected women. Int. J. Tuberc. Lung Dis. 2013; 17: 1552-1557. doi: 10.5588/ijtld.13.0239
Kowada A. Cost effectiveness of interferon-γ release assay for TB screening of HIV positive pregnant women in low TB incidence countries. J. Infect. 2013; 68: 32-42. doi: 10.1016/j. jinf.2013.08.009
Centers for Disease Control and Prevention Updated Guide-lines for Using Interferon Gamma Release Assays to Detect Mycobacterium tuberculosis Infection. MMWR Recomm Rep, 2010. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5905a1. htm. Accessed October 3, 2014.
Nguyen HT, Pandolfini C, Chiodini P, Bonati M. Tuberculo-sis care for pregnant women: a systematic review. BMC Infec-tious Diseases. 2014; 14: 617. doi: 10.1186/s12879-014-0617-x
Jana N, Barik S, Arora N, Singh AK. Tuberculosis in preg-nancy: the challenges for South Asian countries. J. Obstet. Gy-naecol. Res. 2012; 38: 1125-1136. doi: 10.1111/j.1447-0756- .2012.01856.x
Bothamley G. Drug treatment for tuberculosis: safety con-siderations. Drug Saf. 2001; 24: 553-565.
Cohen K, Meintjes G. Management of individuals requiring ART and TB treatment. Curr Opin HIV AIDS. 2010; 5: 61-69. doi: 10.1097/COH.0b013e3283339309
Samandari T, Agizew TB, Nyirenda S, et al. 6-month ver-sus 36-month isoniazid preventive treatment for tuberculosis in adults with HIV infection in Botswana: a randomised, double-blind, placebo-controlled trial. Lancet. 2011; 377: 1588-1598. doi: 10.1016/S0140-6736(11)60204-3
Swaminathan S, Menon PA, Gopalan N, Perumal V. Effi-cacy of a six-month versus a 36-month regimen for prevention of tuberculosis in HIV-infected persons in India: A randomized clinical trial. PLoS One. 2012; 7: e47400. doi: 10.1371/journal. pone.0047400
Martinson NA, Barnes GL, Moulton LH, et al. New regimens to prevent tuberculosis in adults with HIV infection. N Engl J. Med. 2011; 365: 11-20. doi: 10.1056/NEJMoa1005136
Taylor AW, Mosimaneotsile B, Mathebula U, et al. Preg-nancy outcomes in HIV-infected women receiving long-term isoniazid prophylaxis for tuberculosis and antiretroviral therapy. Infect. Dis. Obstet. Gynecol. 2013; 195637. doi: http://dx.doi. org/10.1155/2013/195637
Hart D, Wall BF. Radiation exposure of the UK population from medical and dental X-ray examinations. Natl. Radiol. Prot. Board, Didcot, UK. 2002.
Lawn SD, Mwaba P, Bates M, et al. Advances in tuberculosis diagnostics: the Xpert MTB/RIF assay and future prospects for a point-of-care test. Lancet Infect. Dis. 2013; 13: 349-361. doi: 10.1016/S1473-3099(13)70008-2
Turnbull ER, Kancheya NG, Harris JB, Topp SM, He-nostroza G, Reid SE. A model of tuberculosis screening for pregnant women in resource-limited settings using Xpert MTB/RIF. J. Pregnancy. 2012; 565049. doi: http://dx.doi. org/10.1155/2012/565049
Bates M, Ahmed Y, Chilukutu L, et al. Use of the Xpert® MTB/RIF assay for diagnosing pulmonary tuberculosis comor-bidity and multidrug-resistant TB in obstetrics and gynaecology inpatient wards at the University Teaching Hospital, Lusaka, Zambia. Trop. Med. Int. Health. 2013; 18: 1134-1140. doi: 10.1111/tmi.12145
World Health Organization. Treatment of tuberculo-sis guidelines. 4th edition, 2010. http://whqlibdoc.who.int/ publications/2010/9789241547833_eng.pdf?ua=1. Accessed September 12, 2014.
World Health Organization. Guidelines for the pro-grammatic management of drug-resistant tuberculosis 2011 Update. WHO/HTM/TB/2011.6, 2011. http://whqlibdoc.who. int/publications/2011/9789241501583_eng.pdf?ua=1. Accessed June 12, 2014.
Centers for Disease Control and Prevention.Provisional CDC guidelines for the use and safety monitoring of bedaquiline fumarate (Sirturo) for the treatment of multidrug-resistant tuber-culosis. MMWR Recomm Rep. 2013 62(RR-09): 1-12. http:// www.cdc.gov/mmwr/preview/mmwrhtml/rr6209a1.htm. 2013. Accessed September 3, 2014.
Ryan NJ, Lo JH. Delamanid: first global approval. Drugs. 2014; 74: 1041-1045. doi: 10.1007/s40265-014-0241-5
Palacios E, Dallman R, Muñoz M, et al. Drug-resistant tuberculosis and pregnancy: treatment outcomes of 38 cases in Lima, Peru. Clin. Infect. Dis. 2009; 48: 1413-1419. doi: 10.1086/598191
Lange C, Abubakar I, Alffenaar J-WC, et al. Management of patients with multidrug-resistant/extensively drug-resistant tuberculosis in Europe: a TBNET consensus statement. Eur. Re-spir. J. 2014; 1-41.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in Pulmonary Research and Respiratory Medicine (PRRM) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.
