title: Comparing an Interferon Gamma Release Assay with the Tuberculin Skin Test During Pregnancy: Implications for Tuberculosis Screening During Prenatal Care.
abstract: Background Currently there are no guidelines regarding optimal screening for latent tuberculosis infection during pregnancy. Objective This study measures completion rates and the concordance between the TSPOT.TB, a commercially available interferon gamma release assay (IGRA), and the traditional tuberculin skin test (TST) in a predominantly urban minority obstetrics practice. Design This is an observational cohort study of 141 pregnant women enrolled from an obstetrics practice with a large immigrant population. Women with a history of a positive TST result were excluded. Demographic and clinical risk factors for tuberculosis were assessed. Enrolled women underwent a T-SPOT.TB test and placement of TST, and returned in 48-72 h for TST interpretation. We calculated the completion rate and frequency of a positive result for each test, as well as the concordance between the T-SPOT.TB and TST. Results Among the 141 women enrolled, 75 % were either Latina or African-American, 44 % were born in a country with a high TB prevalence, and 52 % had received the Bacillus Calmette-Guerin vaccine. Seven women (5 %) had a positive screening test, a total of 3 positive T-SPOT.TB results and 6 positive TST results, and all were from countries with a high TB prevalence. The concordance of the two tests was 96.3 %. The completion rate for the T-SPOT.TB was 98 %, while the completion rate for the TST was 63 %.
  
  
  
  The IGRA test had a markedly higher completion rate in addition to maintaining high concordance with the two-step TST in this population of pregnant women with a high prevalence of prior TB exposure. Targeted screening of women from countries with a high prevalence of tuberculosis may be warranted during prenatal care.
authors.affiliation: Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA. rlmolina@partners.org.
authors.forename: Rose
authors.initials: R
authors.lastname: Molina
authors.affiliation: Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
authors.forename: Kartik
authors.initials: K
authors.lastname: Venkatesh
authors.affiliation: Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
authors.forename: Julianna
authors.initials: J
authors.lastname: Schantz-Dunn
authors.affiliation: Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
authors.forename: Audra
authors.initials: A
authors.lastname: Meadows
authors.affiliation: Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
authors.forename: Nawal
authors.initials: N
authors.lastname: Nour
authors.affiliation: Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
authors.forename: Khady
authors.initials: K
authors.lastname: Diouf
mesh_terms: D000328:Adult; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D059425:Interferon-gamma Release Tests / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000379:methods*; D061212:Memory, Episodic; D011237:Predictive Value of Tests; D011247:Pregnancy; D011295:Prenatal Care; D015995:Prevalence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014374:Tuberculin Test / Q000706:statistics & numerical data*; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D014505:Urban Population
keywords: Immigrant; Interferon gamma release assay; Pregnancy; Screening; Tuberculosis; Underserved