K J Snow, A Bekker, G K Huang, S M Graham
Centre for International Child Health, University of Melbourne, Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
Paediatr Respir Rev. 2020 Nov;36:27-32. doi: 10.1016/j.prrv.2020.02.001. Epub 2020 Feb 14.
Pregnant women and their infants are a vulnerable but neglected population in tuberculosis (TB) control efforts. Recent advances in TB prevention, diagnosis and treatment have implications for their care, despite their frequent exclusion from research. We have conducted a meta-review of current evidence and clinical guidelines for TB prevention, diagnosis and management in pregnant women and neonates, focusing on review articles published since 2010. The actual burden of TB in pregnancy is unmeasured, but has been estimated at 216,500 cases per year. Although the effect of pregnancy on TB risk is uncertain and controversial, two large whole-of-population studies found that pregnancy was associated with a two- to three-fold increase in risk of TB. Congenital TB is rare but extremely serious. Neonates exposed to TB after delivery will be at high risk of disease, and preventive therapy is recommended once disease has been ruled out. At present, there is limited evidence regarding the performance of different screening strategies for pregnant women, appropriate drug dosing for either pregnant women or neonates, and the safety of most second-line drugs in pregnancy. High quality evidence on these topics is needed, as are detailed guidelines to inform efforts by TB control programs and clinicians working with pregnant women and their infants.
孕妇及其婴儿是结核病防控工作中易受伤害但却被忽视的群体。尽管她们常常被排除在研究之外，但结核病预防、诊断和治疗方面的最新进展对她们的护理仍具有重要意义。我们对目前关于孕妇和新生儿结核病预防、诊断及管理的证据和临床指南进行了综合回顾，重点关注自2010年以来发表的综述文章。孕期结核病的实际负担尚无确切数据，但估计每年有216,500例。虽然妊娠对结核病风险的影响尚不确定且存在争议，但两项大规模全人群研究发现，妊娠会使结核病风险增加两到三倍。先天性结核病虽罕见但极其严重。分娩后接触结核病的新生儿患病风险很高，一旦排除疾病，建议进行预防性治疗。目前，关于针对孕妇的不同筛查策略的效果、孕妇或新生儿的适当药物剂量以及大多数二线药物在孕期的安全性的证据有限。需要高质量的关于这些主题的证据，以及详细的指南，以为结核病防控项目和诊治孕妇及其婴儿的临床医生提供指导。
