title: Medical and obstetric outcomes among pregnant women with tuberculosis: a population-based study of 7.8 million births.
abstract: BACKGROUND
  Worldwide, tuberculosis remains a major health concern, with an estimated 9.6 million people infected in the year 2014, of which one-third were women. Tuberculosis is estimated to be even more prevalent in pregnant women than the general population. To date there has been conflicting evidence on the maternal and neonatal complications of tuberculosis in pregnancy.
  
  
  OBJECTIVE
  We sought to determine trends in the incidence of tuberculosis in pregnancy and to examine the associations between tuberculosis in pregnancy and maternal and fetal complications.
  
  
  METHODS
  We conducted a retrospective cohort study using the 2003 through 2011 Healthcare Cost and Utilization Project Nationwide Inpatient Sample. We identified hospital admissions during which women with and without tuberculosis delivered. The temporal patterns in incidence of tuberculosis were estimated, as were the rates of pulmonary and nonpulmonary tuberculosis. Multivariate logistic regression was used to examine the adjusted effects of tuberculosis on maternal and neonatal outcomes.
  
  
  RESULTS
  During the study period, there were 7,772,999 births, of which 2064 were to women with tuberculosis, for an overall incidence of 26.6 per 100,000 births. From 2003 through 2011, there was an upward trend in the incidence of tuberculosis from 1.92-4.06 per 10,000 births (P < .0001), mostly due to increasing numbers of nonpulmonary tuberculosis. Compared with noncases, tuberculosis occurred with greater frequency in women who were 25-34 years of age and of Hispanic ethnicity. Significantly more women with tuberculosis had concurrent HIV. In addition, delivery hospitalizations with tuberculosis compared with those without tuberculosis were more likely to experience chorioamnionitis, preterm labor, postpartum anemia, blood transfusion, pneumonia, acute respiratory distress syndrome, and mechanical ventilation. Maternal mortality was significantly increased in women with tuberculosis. Congenital anomalies were higher among babies delivered to women with tuberculosis.
  
  
  CONCLUSIONS
  The rate of tuberculosis in pregnancy is rising in the United States. Although this increase appears to be mostly due to nonpulmonary disease, there was also a high incidence of maternal respiratory complications, mortality, and postpartum obstetric morbidity.
authors.affiliation: Department of Obstetrics and Gynecology, Royal Victoria Hospital, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada.
authors.forename: Amira
authors.initials: A
authors.lastname: El-Messidi
authors.affiliation: Center for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Czuzoj-Shulman
authors.affiliation: Center for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Spence
authors.affiliation: Center for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada; Department of Obstetrics and Gynecology, Jewish General Hospital, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada. Electronic address: haim.abenhaim@gmail.com.
authors.forename: Haim Arie
authors.initials: HA
authors.lastname: Abenhaim
mesh_terms: D000328:Adult; D001741:Black or African American; D000740:Anemia / Q000453:epidemiology*; D016022:Case-Control Studies; D002821:Chorioamnionitis / Q000453:epidemiology; D000013:Congenital Abnormalities / Q000453:epidemiology*; D016208:Databases, Factual; D036861:Delivery, Obstetric; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008428:Maternal Mortality; D015999:Multivariate Analysis; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D015995:Prevalence; D011644:Puerperal Disorders / Q000453:epidemiology*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012128:Respiratory Distress Syndrome / Q000453:epidemiology*; D014376:Tuberculosis / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D044465:White People; D055815:Young Adult
keywords: outcome; pregnancy; tuberculosis