Jana Narayan, Barik Sukumar, Arora Nalini, Singh Arun Kumarendu
Department of Obstetrics and Gynaecology, Burdwan Medical College, Burdwan, India.
J Obstet Gynaecol Res. 2012 Sep;38(9):1125-36. doi: 10.1111/j.1447-0756.2012.01856.x. Epub 2012 May 8.
Despite tuberculosis (TB) being a global problem, maternal TB remains an unrecognized and underestimated tragedy, especially in South Asian countries. Therefore, we performed a non-systematic review regarding implications of maternal TB on obstetric and perinatal outcomes in the South Asian context.
We reviewed original studies, both descriptive and analytical, that originated from South Asian countries following an electronic search supplemented by a manual search. Although relevant studies from developed countries were reviewed, they were not included in the tabulation process because those studies had different socioeconomic/epidemiological background.
Diagnosis of TB is often delayed during pregnancy, because of its non-specific symptoms, and overlapping presentation with other infectious diseases. Poverty, undernutrition, lack of social support and poor health infrastructure along with complications of TB and need for prolonged medications lead to increased maternal morbidity and mortality. Maternal TB in general (except lymphadenitis), is associated with an increased risk of small-for-gestational age, preterm and low-birthweight neonates, and high perinatal mortality. These adverse perinatal outcomes are even more pronounced in women with advanced disease, late diagnosis, and incomplete or irregular drug treatment. There could be a synergy of TB, socioeconomic and nutritional factors, which might have contributed to adverse perinatal effects, especially in low-income countries.
As active TB poses grave maternal and perinatal risks, early, appropriate and adequate anti-TB treatment is a mainstay for successful pregnancy outcome. The current knowledge gaps in perinatal implications of maternal TB can be addressed by a multicenter comparative cohort study.
尽管结核病是一个全球性问题，但孕产妇结核病仍是一个未被认识和低估的悲剧，尤其是在南亚国家。因此，我们针对南亚背景下孕产妇结核病对产科和围产期结局的影响进行了一项非系统性综述。
我们检索了来自南亚国家的原始研究，包括描述性和分析性研究，检索方式为电子检索辅以手工检索。尽管对来自发达国家的相关研究进行了综述，但在制表过程中未将其纳入，因为这些研究具有不同的社会经济/流行病学背景。
由于结核病症状不具特异性且与其他传染病表现重叠，孕期结核病的诊断往往延迟。贫困、营养不良、缺乏社会支持、卫生基础设施差，以及结核病并发症和需要长期用药，导致孕产妇发病率和死亡率增加。一般来说，孕产妇结核病（淋巴结炎除外）与小于胎龄儿、早产和低体重新生儿风险增加以及高围产期死亡率相关。这些不良围产期结局在疾病晚期、诊断延迟以及药物治疗不完整或不规律的女性中更为明显。结核病、社会经济和营养因素之间可能存在协同作用，这可能导致了不良围产期影响，尤其是在低收入国家。
由于活动性结核病会给孕产妇和围产儿带来严重风险，早期、适当且充分的抗结核治疗是成功妊娠结局的关键。孕产妇结核病围产期影响方面目前的知识空白可通过多中心比较队列研究来填补。
