Maternal, Pregnancy, and Infant Outcomes in Women Treated for Multidrug-Resistant/Rifampicin-Resistant Tuberculosis With Novel and Repurposed Drugs in KwaZulu-Natal, South Africa

Abstract

Background: There is limited information on the safety and efficacy of new and repurposed second-line anti-tuberculosis (TB) drugs in pregnant women. Methods: Pregnant women initiating treatment for multidrug-resistant/rifampicin-resistant (MDR/RR) TB from 1 January 2018 to 31 March 2024 were included in this prospective, observational study. Maternal TB treatment and pregnancy outcomes were documented through ongoing record reviews and clinical assessments conducted to describe infant outcomes. Using Poisson regression with robust standard errors, we evaluated factors associated with favorable maternal treatment and pregnancy outcomes. Results: Of 70 pregnant women treated for MDR/RR TB, 53 (76%) were diagnosed with human immunodeficiency virus (HIV). Favorable TB treatment outcomes were reported in 44 (62.9%) women. Sixty-seven (95.7%) of the 70 infants were born alive;median gestational age 38 weeks (interquartile range [IQR], 37.0–39.0) and median birth weight 2970 g (IQR, 2560–3280). All infants were exposed to bedaquiline. Twenty-three (34.3%) women had unfavorable pregnancy outcomes, with 20 (29.8%) infants born prematurely and/or with low birth weight. Women with positive sputum smears at treatment initiation were less likely to have a favorable treatment outcome (adjusted risk ratio, 0.33; 95% confidence interval, .17–.66; P = .002). Of the 43 infants evaluated at 12 months, 27 (62.8%) had favorable outcomes, with 10 (23.3%) infants developing TB in their first year of life. Conclusions: The high TB–HIV coinfection rate is likely to have contributed to unfavorable pregnancy outcomes. Supportive maternal adherence counseling and infant TB preventive treatment are needed to prevent TB transmission to infants.