Simpson Grace, Philip Moira, Vogel Joshua P, Scoullar Michelle J L, Graham Stephen M, Wilson Alyce N
Maternal Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia.
Centre for International Health, University of Melbourne Department of Paediatrics, Melbourne, Australia.
PLOS Glob Public Health. 2023 Aug 23;3(8):e0002222. doi: 10.1371/journal.pgph.0002222. eCollection 2023.
For women infected with Mycobacterium tuberculosis, pregnancy is associated with an increased risk of developing or worsening TB disease. TB in pregnancy increases the risk of adverse maternal and neonatal outcomes, however the detection of TB in pregnancy is challenging. We aimed to identify and summarise the findings of studies regarding the clinical presentation and diagnosis of TB during pregnancy and the postpartum period (within 6 months of birth) in low-and middle-income countries (LMICs). A systematic review was conducted searching Ovid MEDLINE, Embase, CINAHL and Global Index Medicus databases. We included any primary research study of women diagnosed with TB during pregnancy or the postpartum period in LMICs that described the clinical presentation or method of diagnosis. Meta-analysis was used to determine pooled prevalence of TB clinical features and health outcomes, as well as detection method yield. Eighty-seven studies of 2,965 women from 27 countries were included. 70.4% of women were from South Africa or India and 44.7% were known to be HIV positive. For 1,833 women where TB type was reported, pulmonary TB was most common (79.6%). Most studies did not report the prevalence of presenting clinical features. Where reported, the most common were sputum production (73%) and cough (68%). Having a recent TB contact was found in 45% of women. Only six studies screened for TB using diagnostic testing for asymptomatic antenatal women and included mainly HIV-positive women ‒ 58% of women with bacteriologically confirmed TB did not report symptoms and only two were in HIV-negative women. Chest X-ray had the highest screening yield; 60% abnormal results of 3036 women tested. Screening pregnant women for TB-related symptoms and risk factors is important but detection yields are limited. Chest radiography and bacteriological detection methods can improve this, but procedures for optimal utilisation remain uncertain in this at-risk population. Trial registration: Prospero registration number: CRD42020202493.
对于感染结核分枝杆菌的女性而言，怀孕会增加患结核病或使结核病病情加重的风险。孕期结核病会增加孕产妇和新生儿出现不良结局的风险，然而，孕期结核病的检测颇具挑战性。我们旨在识别并总结中低收入国家关于孕期及产后（出生后6个月内）结核病临床表现及诊断的研究结果。我们进行了一项系统综述，检索了Ovid MEDLINE、Embase、CINAHL和全球医学索引数据库。我们纳入了中低收入国家任何一项关于孕期或产后被诊断为结核病的女性的原发性研究，这些研究描述了临床表现或诊断方法。采用荟萃分析来确定结核病临床特征和健康结局的合并患病率以及检测方法的检出率。纳入了来自27个国家的2965名女性的87项研究。70.4%的女性来自南非或印度，44.7%的女性已知感染艾滋病毒。在报告了结核病类型的1833名女性中，肺结核最为常见（79.6%）。大多数研究未报告临床表现的患病率。在有报告的情况下，最常见的是咳痰（73%）和咳嗽（68%）。45%的女性近期有结核病接触史。只有六项研究对无症状产前女性进行结核病诊断检测筛查，且主要纳入了艾滋病毒阳性女性——58%经细菌学确诊为结核病的女性未报告症状，只有两名是艾滋病毒阴性女性。胸部X光检查的筛查检出率最高；3036名接受检测的女性中有六成结果异常。对孕妇筛查结核病相关症状和风险因素很重要，但检测检出率有限。胸部X光检查和细菌学检测方法可以改善这种情况，但在这一高危人群中，最佳利用程序仍不明确。试验注册：国际前瞻性系统评价注册库注册号：CRD42020202493 。
