Re: Maternal and perinatal outcomes of tuberculosis during pregnancy and the postpartum period: a systematic review and meta‐analysis

Abstract

Introduction Our objective was to identify outcomes of pregnancies in women with maternal tuberculosis (TB). Methods Systematic review and meta-analysis. Data sources: Major electronic databases until October 2015. Eligibility criteria: Studies that compared pregnant women with and without active TB for outcome data. Data extraction and synthesis: Study selection, quality assessment and data extraction were carried out by two independent reviewers. Information on study design, setting, population characteristics, TB diagnosis and treatment as well as obstetric outcomes was obtained. Risk of bias was assessed using the Newcastle-Ottawa scale. Data were pooled and odds ratios using random effects modelling were calculated for maternal and perinatal outcomes. Results Out of 7521 citations, 13 studies were included; (3384 pregnancies associated with active TB, 119 480 pregnant women without TB). Using the Newcastle-Ottawa scale, seven studies had a low risk or medium risk of bias and six had a high risk of bias. There was a significantly increased risk of poor fetal outcomes; with quadruple the odds of perinatal death and asphyxia and double the odds of preterm birth and low birth rate. Maternal outcomes were also significantly worse with double the odds of maternal morbidity, anaemia and caesarean delivery, compared with pregnant women without active TB. Women who were diagnosed and treated in first trimester had better outcomes than those diagnosed and treated in second and third trimester. Conclusion TB in pregnancy results in poor maternal and fetal outcomes. A wider screening programme and case detection are needed to start early treatment and reduce poor outcomes.