Tuberculosis Disease during Pregnancy and Treatment Outcomes in HIV-Infected and Uninfected Women at a Referral Hospital in Cape Town

Adrie Bekker; Hendrik S Schaaf; Heather R Draper; Magdalena Kriel; Anneke C Hesseling

doi:10.1371/journal.pone.0164249

Tuberculosis Disease during Pregnancy and Treatment Outcomes in HIV-Infected and Uninfected Women at a Referral Hospital in Cape Town

PLoS One. 2016 Nov 3;11(11):e0164249. doi: 10.1371/journal.pone.0164249. eCollection 2016.

Authors

Adrie Bekker¹, Hendrik S Schaaf¹, Heather R Draper¹, Magdalena Kriel², Anneke C Hesseling¹

Affiliations

¹ Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
² DST/NRF Centre of Excellence for Biomedical Tuberculosis Research/Medical Research Council (MRC) Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.

Abstract

Background: Tuberculosis during pregnancy and treatment outcomes are poorly defined in high prevalence tuberculosis and HIV settings.

Methods: A prospective cohort study of pregnant and postpartum women identified to be routinely on antituberculosis treatment was conducted at Tygerberg Hospital, Cape Town, South Africa, from January 2011 through December 2011. Maternal tuberculosis disease spectrum and tuberculosis-exposed newborns were characterized by maternal HIV status. Maternal tuberculosis treatment outcomes were documented and a multivariable regression model identified predictors of unfavourable tuberculosis treatment outcomes. Infant outcomes were also described.

Results: Seventy-four women with tuberculosis, 53 (72%) HIV-infected, were consecutively enrolled; 35 (47%) were diagnosed at delivery or postpartum and 22 (30%) of women reported previous antituberculosis treatment. HIV-infected women were 5.67 times more likely to have extrapulmonary tuberculosis (95% CI 1.18-27.25, p = 0.03). All 5 maternal deaths were amongst HIV-infected women. Birth outcomes were available for 75 newborns (2 sets of twins, missing data for 1 stillbirth). Of the 75 newborns, 49 (65%) were premature and 44 (59%) were low birth weight (LBW; <2500 grams). All 6 infants who died and the 4 stillbirths were born to HIV-infected women. Unfavourable tuberculosis treatment outcomes were documented in 33/74 (45%) women. Unfavourable maternal tuberculosis outcome was associated with delivery of LBW infants (OR 3.83; 95% CI 1.40-10.53, p = 0.009).

Conclusions: A large number of pregnant women with tuberculosis presented at a provincial referral hospital. All maternal and infant deaths occurred in HIV-infected women and their newborns. Maternal tuberculosis treatment outcomes were poor.

Publication types

Clinical Trial

MeSH terms

Adult
Cohort Studies
Female
HIV Infections / complications*
Humans
Pregnancy
Pregnancy Complications, Infectious / drug therapy*
Prospective Studies
Referral and Consultation*
South Africa
Treatment Outcome
Tuberculosis / complications*
Tuberculosis / drug therapy*

Grants and funding

This work was supported by the United States Agency for International Development (USAID) Cooperative Agreement (TREAT TB – Agreement No. GHN‐A‐00‐08‐00004‐00). The content is the responsibility of the authors and does not necessarily reflect the views of USAID. The South African Medical Research Council and the Discovery Foundation provided salary support to A. Bekker, who completed this research in support of her PhD thesis. For the remaining authors no source of funding were declared.