Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Mar 5;66(6):921-929.
doi: 10.1093/cid/cix851.

Poor Obstetric and Infant Outcomes in Human Immunodeficiency Virus-Infected Pregnant Women With Tuberculosis in South Africa: The Tshepiso Study

Nicole Salazar-Austin  1   2 , Jennifer Hoffmann  1 , Silvia Cohn  1 , Fildah Mashabela  3 , Ziyaad Waja  3 , Sanjay Lala  4 , Christopher Hoffmann  1   2 , Kelly E Dooley  1   2 , Richard E Chaisson  1 , Neil Martinson  1   3 ; TSHEPISO Study Team
Affiliations

Poor Obstetric and Infant Outcomes in Human Immunodeficiency Virus-Infected Pregnant Women With Tuberculosis in South Africa: The Tshepiso Study

Nicole Salazar-Austin et al. Clin Infect Dis. .

Abstract

Background: Before the wide availability of antiretroviral therapy (ART), tuberculosis and human immunodeficiency virus (HIV) disease among pregnant women resulted in poor maternal and neonatal outcomes, including high rates of mother-to-child transmission of both HIV and tuberculosis. We aimed to describe the impact of tuberculosis among HIV-infected mothers on obstetric and infant outcomes in a population with access to ART.

Methods: In this prospective cohort study, we followed up HIV-infected pregnant women with or without tuberculosis disease from January 2011 through January 2014 in Soweto, South Africa. Two controls were enrolled for each case patient, matched by enrollment time, maternal age, gestational age, and planned delivery clinic and followed up for 12 months after delivery.

Results: We recruited 80 case patients and 155 controls, resulting in 224 live-born infants. Infants of mothers with HIV infection and tuberculosis disease had a higher risk of low birth weight (20.8% vs 10.7%; P = .04), prolonged hospitalization at birth (51% vs 16%; P < .001), infant death (68 vs 7 deaths per 1000 births; P < .001), and tuberculosis disease (12% vs 0%; P < .001) despite appropriate maternal therapy and infant tuberculosis preventive therapy. HIV transmission was higher among these infants (4.1% vs 1.3%; P = .20), though this difference was not statistically significant. Obstetric outcomes in coinfected women were also poorer with higher risks of maternal hospitalization (25% vs 11%; P = .005) and preeclampsia (5.5% vs 0.7%; P = .03).

Conclusions: Tuberculosis in HIV coinfected pregnant women remains a significant threat to the health of both mothers and infants. Improving tuberculosis prevention and early diagnosis among pregnant women is critical.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Participant flow diagrams. A, Pregnant women with or without tuberculosis disease. B, Infants born to women with or without tuberculosis disease. Abbreviations: HIV, human immunodeficiency virus; LTFU, lost to follow-up.
See this image and copyright information in PMC

References

    1. World Health Organization. Tuberculosis fact sheet: tuberculosis in women Available at: http://www.who.int/tb/publications/tb_women_factsheet_251013.pdf. Accessed 15 October 2017.
    1. Sugarman J, Colvin C, Moran AC, Oxlade O. Tuberculosis in pregnancy: an estimate of the global burden of disease. Lancet Glob Health 2014; 2:e710–6. - PubMed
    1. Gounder CR, Wada NI, Kensler C et al. . Active tuberculosis case-finding among pregnant women presenting to antenatal clinics in Soweto, South Africa. J Acquir Immune Defic Syndr 2011; 57:e77–84. - PMC - PubMed
    1. 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. - PMC - PubMed
    1. Hoffmann CJ, Variava E, Rakgokong M et al. . High prevalence of pulmonary tuberculosis but low sensitivity of symptom screening among HIV-infected pregnant women in South Africa. PLoS One 2013; 8:e62211. - PMC - PubMed

Publication types

MeSH terms