BARCELONA, Spain – At a symposium on Thursday on the intersection between tuberculosis and maternal and infant health, Adrie Bekker presented disturbing findings from a study looking at outcomes for pregnant women with tuberculosis who came for care at Tygerberg Hospital in Cape Town, South Africa. Over the course of a year, clinicians identified 74 maternal tuberculosis patients to the researchers by clinicians. Of those women, 53 percent also had HIV infection and 30 percent of the women had previously been treated for TB disease. Eight percent had drug-resistant tuberculosis. Of the HIV-infected women, 36 percent had extra pulmonary tuberculosis including eight women who had TB meningitis. While 60 percent of the HIV-infected women were on antiretroviral therapy, they had started recently, and the immune systems of most were severely suppressed.
Five of the mothers died—three during delivery and two within two months of delivery. Nine of the babies died. All of the maternal and infant deaths occurred in cases involving HIV-infected mothers.
Two-thirds of the infants were born prematurely and 58 percent of infants had low birth weight. Isoniazid preventive therapy was given to 73 percent of the infants and four of the infants were treated for tuberculosis.
Tuberculosis treatment outcomes among those women treated were poor with 18 percent of women lost to follow-up before TB treatment could be initiated and another 18 percent lost to follow-up after treatment initiation. For those who completed TB treatment, outcomes were the same for both HIV-infected and uninfected women.
Dr. Jyoti Mathad from Cornell University provided a context for the Cape Town study in an overview of tuberculosis in women of child-bearing age and pregnant women. In TB endemic countries, she said, a higher proportion of women, especially younger women contract tuberculosis than the global gender breakdown indicated. And women get the disease at much younger ages than men, and are twice as likely to develop tuberculosis during pregnancy than their non-pregnant counterparts.
Nevertheless, good epidemiological data on latent tuberculosis or TB disease during pregnancy does not yet exist, beyond small studies. No official guidelines on treatment for drug-resistant tuberculosis during pregnancy exist, while current TB screening tools to identify TB disease present challenges in diagnosing disease in pregnant women. Research questions in this area, Dr. Mathad said, call for qualitative studies of external factors that influence treatment outcomes.