Multidrug-resistant tuberculosis in pregnant women: Treatment and birth outcomes

Background: There were reported 5844 patients with multidrug-resistant tuberculosis (MDR-TB) living in Ukraine in 2013, compared to 1255 in all EU/EEA countries together (ECDC). Management of MDR-TB cases is more expensive and always challenging in pregnant women. Aims and objectives: We hypothesized to find out whether women who were treated for MDR-TB during pregnancy was associated with higher rate of unfavorable treatment and birth outcomes in comparison with non-MDR TB cases. Methods: This was a retrospective cohort study of all registered coincidences of TB and pregnancy in patients who underwent treatment in Regional TB Dispensary of Vinnytsia, Ukraine between 2011 and 2013. TB case detection in Ukraine based on annual chest radiology rather than smear microscopy (only 1.8% TB cases identified by finding acid-fast bacilli in 2013). MDR-TB was considered if detected resistance at least to isoniazid and rifampicin. Results: Pregnant women with MDR-TB had the same rate for cure and death- 40% (4/10) whilst 100% (15/15) non-MDR-TB pregnant patients were cured (p=0.0022). We found 1 spontaneous and 1 therapeutic abortions in MDR-TB cohort compared to 1 woman with non-MDR-TB who has terminated the pregnancy. MDR-TB treatment was associated with higher rate of complications of pregnancy (3/10 and 1/15 respectively, p=0.1263) and advers events to TB medications (6/10 and 5/15 respectively, p=0.1825). Exposure to second-line drugs was mostly associated with delivery of healthy term infants (1 newborn with low body weight and 1 with confirmed TB and HIV). Conclusions: Pregnant women are hard-to-reach and hard-to-treat group of TB patients in countries with predominant fluorography-based TB screening method.