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Latent Tuberculosis in Pregnancy: A Systematic Review
Isabelle Malhamé1,2,3, Maxime Cormier1,2,3, Jordan Sugarman2,3
1Department of Medicine, McGill University, Montreal, Quebec, Canada.
Plos One
|May 6, 2016
Summary
Screening pregnant immigrants for latent tuberculosis infection (LTBI) is feasible using interferon-gamma release assays. Improving postpartum follow-up and treatment adherence is crucial for managing LTBI in this population.
Area of Science:
- Public Health
- Infectious Diseases
- Maternal Health
Background:
- Immigrants from high tuberculosis (TB) incidence countries are a key population for latent TB infection (LTBI) screening.
- The antenatal period offers a critical opportunity for medical system engagement and potential LTBI screening and treatment among immigrant women.
- Screening and treating LTBI during pregnancy remains a subject of ongoing debate and research.
Purpose of the Study:
- To systematically review the literature on the prevalence, natural history, screening, and management of LTBI in pregnant women without HIV infection.
- To evaluate the efficacy and safety of LTBI screening tools and treatment regimens during pregnancy.
Main Methods:
- A systematic literature review was conducted across four major databases (Embase, Embase Classic, Medline, Cochrane Library) from January 1980 to April 2014.
- Eligible articles focused on LTBI screening and treatment in pregnant women, excluding those with HIV, case series, or focusing solely on active TB.
- Included studies analyzed prevalence, natural history, screening tools, strategies, and treatment of LTBI during pregnancy.
Main Results:
- LTBI prevalence in the USA ranged from 14-48%, with TST positivity linked to ethnicity.
- Active TB incidence increased postpartum (IRR, 1.95).
- High adherence (90-100%) was observed for skin testing and chest radiography. Interferon-gamma release assays (IGRAs) showed good concordance with TST (77-91%) and appear unaffected by pregnancy.
- Follow-up and treatment completion rates for LTBI varied significantly (14-69% for follow-up, 5-42% for treatment).
- Potential associations between pregnancy/postpartum status and isoniazid (INH) hepatitis were noted, though INH was deemed safe during breastfeeding in one study.
Conclusions:
- Pregnancy presents a valuable opportunity for LTBI screening.
- Interferon-gamma release assays (IGRAs) are comparable to tuberculin skin tests (TST) and suitable for use during pregnancy.
- Enhanced strategies are needed to improve postpartum follow-up and treatment adherence for LTBI.
- Further research is required on the safety and feasibility of antepartum isoniazid therapy and alternative treatment regimens.
