Maternal and perinatal mortality and morbidity associated with tuberculosis during pregnancy and the postpartum period: a systematic review and meta-analysis

S. Sobhy; Z. O.E. Babiker; J. Zamora; K. S. Khan; H. Kunst

doi:10.1111/1471-0528.14408

Maternal and perinatal mortality and morbidity associated with tuberculosis during pregnancy and the postpartum period: a systematic review and meta-analysis

S. Sobhy, Z. O.E. Babiker, J. Zamora, K. S. Khan, H. Kunst^*

^*Corresponding author for this work

Metabolism and Systems Research

Research output: Contribution to journal › Review article › peer-review

68 Citations (Scopus)

Abstract

Background: There is a dearth of data on the clinical features and outcomes of active tuberculosis (TB) in pregnancy. Studies have shown varied results and the relationship between TB and adverse pregnancy outcomes remains unclear. Objectives: We conducted a systematic review and meta-analysis to evaluate pregnancy outcomes associated with TB. Search strategy: Major databases were searched from inception until December 2015 without restrictions using the terms: ‘TB’, ‘pregnancy’, ‘maternal morbidity’, ‘mortality’ and ‘perinatal morbidity’, ‘mortality’. Selection criteria: We included studies that compared the outcomes of pregnant women with and without active TB. Data collection and analysis: We computed odds ratios for maternal and perinatal complications, and pooled them using a random effects model. We assessed for heterogeneity using chi-squared tests and evaluated its magnitude using the I² statistic. We used the Newcastle–Ottawa scale for quality assessment. Main results: Thirteen studies, including 3384 pregnancies with active TB and 119 448 without TB were included. Compared with pregnant women without TB, pregnant women with active TB was associated with increased odds of maternal morbidity [odds ratio (OR) 2.8, 95% CI 1.7–4.6; I²= 60.3%], anaemia (OR 3.9, 95% CI 2.2–6.7; I² = 29.8%), caesarean delivery (OR 2.1, 95% CI 1.2–3.8; I² = 61.1%), preterm birth (OR 1.7, 95% CI 1.2–2.4; I² = 66.5%), low birth weight (OR 1.7, 95% CI 1.2–2.4; I² = 53.7%), birth asphyxia (OR 4.6, 95% CI 2.4–8.6; I² = 46.3), and perinatal death (OR 4.2, 95% CI 1.5–11.8; I² = 57.2%). Author's conclusion: Active TB in pregnancy is associated with adverse maternal and fetal outcomes. Early diagnosis of TB is important to prevent significant maternal and perinatal complications. Tweetable abstract: Active tuberculosis in pregnancy is associated with adverse maternal and perinatal outcomes.

Original language	English
Pages (from-to)	727-733
Number of pages	7
Journal	BJOG: An International Journal of Obstetrics and Gynaecology
Volume	124
Issue number	5
DOIs	https://doi.org/10.1111/1471-0528.14408
Publication status	Published - 1 Apr 2017

Bibliographical note

Funding Information:
a Women’s Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK b Department of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK c Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE d Multidisciplinary Evidence Synthesis Hub (mEsh), Centre of Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK e Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS) and CIBER Epidemiology and Public Health, Madrid, Spain f Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK Correspondence: Dr H Kunst, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, UK. Email h.kunst@qmul.ac.uk

Publisher Copyright:
© 2016 Royal College of Obstetricians and Gynaecologists

Keywords

Active
maternal
perinatal
pregnancy outcomes
tuberculosis

ASJC Scopus subject areas

Obstetrics and Gynaecology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1111/1471-0528.14408

Cite this

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title = "Maternal and perinatal mortality and morbidity associated with tuberculosis during pregnancy and the postpartum period: a systematic review and meta-analysis",

abstract = "Background: There is a dearth of data on the clinical features and outcomes of active tuberculosis (TB) in pregnancy. Studies have shown varied results and the relationship between TB and adverse pregnancy outcomes remains unclear. Objectives: We conducted a systematic review and meta-analysis to evaluate pregnancy outcomes associated with TB. Search strategy: Major databases were searched from inception until December 2015 without restrictions using the terms: {\textquoteleft}TB{\textquoteright}, {\textquoteleft}pregnancy{\textquoteright}, {\textquoteleft}maternal morbidity{\textquoteright}, {\textquoteleft}mortality{\textquoteright} and {\textquoteleft}perinatal morbidity{\textquoteright}, {\textquoteleft}mortality{\textquoteright}. Selection criteria: We included studies that compared the outcomes of pregnant women with and without active TB. Data collection and analysis: We computed odds ratios for maternal and perinatal complications, and pooled them using a random effects model. We assessed for heterogeneity using chi-squared tests and evaluated its magnitude using the I2 statistic. We used the Newcastle–Ottawa scale for quality assessment. Main results: Thirteen studies, including 3384 pregnancies with active TB and 119 448 without TB were included. Compared with pregnant women without TB, pregnant women with active TB was associated with increased odds of maternal morbidity [odds ratio (OR) 2.8, 95% CI 1.7–4.6; I2= 60.3%], anaemia (OR 3.9, 95% CI 2.2–6.7; I2 = 29.8%), caesarean delivery (OR 2.1, 95% CI 1.2–3.8; I2 = 61.1%), preterm birth (OR 1.7, 95% CI 1.2–2.4; I2 = 66.5%), low birth weight (OR 1.7, 95% CI 1.2–2.4; I2 = 53.7%), birth asphyxia (OR 4.6, 95% CI 2.4–8.6; I2 = 46.3), and perinatal death (OR 4.2, 95% CI 1.5–11.8; I2 = 57.2%). Author's conclusion: Active TB in pregnancy is associated with adverse maternal and fetal outcomes. Early diagnosis of TB is important to prevent significant maternal and perinatal complications. Tweetable abstract: Active tuberculosis in pregnancy is associated with adverse maternal and perinatal outcomes.",

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Maternal and perinatal mortality and morbidity associated with tuberculosis during pregnancy and the postpartum period: a systematic review and meta-analysis. / Sobhy, S.; Babiker, Z. O.E.; Zamora, J. et al.
In: BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 124, No. 5, 01.04.2017, p. 727-733.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - Maternal and perinatal mortality and morbidity associated with tuberculosis during pregnancy and the postpartum period

T2 - a systematic review and meta-analysis

AU - Sobhy, S.

AU - Babiker, Z. O.E.

AU - Zamora, J.

AU - Khan, K. S.

AU - Kunst, H.

N1 - Funding Information: a Women’s Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK b Department of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK c Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE d Multidisciplinary Evidence Synthesis Hub (mEsh), Centre of Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK e Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS) and CIBER Epidemiology and Public Health, Madrid, Spain f Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK Correspondence: Dr H Kunst, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, UK. Email h.kunst@qmul.ac.uk Publisher Copyright: © 2016 Royal College of Obstetricians and Gynaecologists

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Background: There is a dearth of data on the clinical features and outcomes of active tuberculosis (TB) in pregnancy. Studies have shown varied results and the relationship between TB and adverse pregnancy outcomes remains unclear. Objectives: We conducted a systematic review and meta-analysis to evaluate pregnancy outcomes associated with TB. Search strategy: Major databases were searched from inception until December 2015 without restrictions using the terms: ‘TB’, ‘pregnancy’, ‘maternal morbidity’, ‘mortality’ and ‘perinatal morbidity’, ‘mortality’. Selection criteria: We included studies that compared the outcomes of pregnant women with and without active TB. Data collection and analysis: We computed odds ratios for maternal and perinatal complications, and pooled them using a random effects model. We assessed for heterogeneity using chi-squared tests and evaluated its magnitude using the I2 statistic. We used the Newcastle–Ottawa scale for quality assessment. Main results: Thirteen studies, including 3384 pregnancies with active TB and 119 448 without TB were included. Compared with pregnant women without TB, pregnant women with active TB was associated with increased odds of maternal morbidity [odds ratio (OR) 2.8, 95% CI 1.7–4.6; I2= 60.3%], anaemia (OR 3.9, 95% CI 2.2–6.7; I2 = 29.8%), caesarean delivery (OR 2.1, 95% CI 1.2–3.8; I2 = 61.1%), preterm birth (OR 1.7, 95% CI 1.2–2.4; I2 = 66.5%), low birth weight (OR 1.7, 95% CI 1.2–2.4; I2 = 53.7%), birth asphyxia (OR 4.6, 95% CI 2.4–8.6; I2 = 46.3), and perinatal death (OR 4.2, 95% CI 1.5–11.8; I2 = 57.2%). Author's conclusion: Active TB in pregnancy is associated with adverse maternal and fetal outcomes. Early diagnosis of TB is important to prevent significant maternal and perinatal complications. Tweetable abstract: Active tuberculosis in pregnancy is associated with adverse maternal and perinatal outcomes.

AB - Background: There is a dearth of data on the clinical features and outcomes of active tuberculosis (TB) in pregnancy. Studies have shown varied results and the relationship between TB and adverse pregnancy outcomes remains unclear. Objectives: We conducted a systematic review and meta-analysis to evaluate pregnancy outcomes associated with TB. Search strategy: Major databases were searched from inception until December 2015 without restrictions using the terms: ‘TB’, ‘pregnancy’, ‘maternal morbidity’, ‘mortality’ and ‘perinatal morbidity’, ‘mortality’. Selection criteria: We included studies that compared the outcomes of pregnant women with and without active TB. Data collection and analysis: We computed odds ratios for maternal and perinatal complications, and pooled them using a random effects model. We assessed for heterogeneity using chi-squared tests and evaluated its magnitude using the I2 statistic. We used the Newcastle–Ottawa scale for quality assessment. Main results: Thirteen studies, including 3384 pregnancies with active TB and 119 448 without TB were included. Compared with pregnant women without TB, pregnant women with active TB was associated with increased odds of maternal morbidity [odds ratio (OR) 2.8, 95% CI 1.7–4.6; I2= 60.3%], anaemia (OR 3.9, 95% CI 2.2–6.7; I2 = 29.8%), caesarean delivery (OR 2.1, 95% CI 1.2–3.8; I2 = 61.1%), preterm birth (OR 1.7, 95% CI 1.2–2.4; I2 = 66.5%), low birth weight (OR 1.7, 95% CI 1.2–2.4; I2 = 53.7%), birth asphyxia (OR 4.6, 95% CI 2.4–8.6; I2 = 46.3), and perinatal death (OR 4.2, 95% CI 1.5–11.8; I2 = 57.2%). Author's conclusion: Active TB in pregnancy is associated with adverse maternal and fetal outcomes. Early diagnosis of TB is important to prevent significant maternal and perinatal complications. Tweetable abstract: Active tuberculosis in pregnancy is associated with adverse maternal and perinatal outcomes.

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Maternal and perinatal mortality and morbidity associated with tuberculosis during pregnancy and the postpartum period: a systematic review and meta-analysis

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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Cite this