Drug-resistant tuberculosis and pregnancy: treatment outcomes of 38 cases in Lima, Peru.
BACKGROUND
Multidrug-resistant tuberculosis (MDR-TB) disproportionately affects young adults, including women of childbearing age; however, treatment of MDR-TB during pregnancy is still controversial. This study looks at the treatment and pregnancy outcomes in a cohort of women who were treated for MDR-TB during pregnancy during a period of 10 years.


METHODS
A retrospective case study was performed using a standardized data collection form and data from 3 ranked sources of patient records. All 38 participants were treated during pregnancy with individualized regimens that included second-line TB medications. We examined the frequency of favorable and adverse outcomes with regard to disease and pregnancy.


RESULTS
After completion of MDR-TB treatment, 61% of the women were cured, 13% had died, 13% had defaulted, 5% remained in treatment, and 5% had experienced treatment failure. Four of the women experienced clinical deterioration of TB during pregnancy. Five of the pregnancies terminated in spontaneous abortions, and 1 child was stillborn. Among the living newborns, 3 were born with low birth weight, 1 was born prematurely, and 1 had fetal distress.


CONCLUSIONS
The rates of success in treating MDR-TB in our cohort are comparable to those of other MDR-TB treatment programs in Peru. The birth outcomes of our cohort are similar to those among the general Peru population. Therefore, we advocate that a woman should be given the option to continue treatment of MDR-TB rather than terminating pregnancy or discontinuing MDR-TB treatment.
Palacios
Eda
E
Socios En Salud, Sucursal Peru, Carabayllo, Lima, Peru. epalacios_ses@pih.org
Dallman
Rebecca
R
Muñoz
Maribel
M
Hurtado
Rocio
R
Chalco
Katiuska
K
Guerra
Dalia
D
Mestanza
Lorena
L
Llaro
Karim
K
Bonilla
Cesar
C
Drobac
Peter
P
Bayona
Jaime
J
Lygizos
Melissa
M
Anger
Holly
H
Shin
Sonya
S
D000293:Adolescent; D000328:Adult; D000818:Animals; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008875:Middle Aged; D010568:Peru; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*; D055815:Young Adult
D000995:Antitubercular Agents