OBJECTIVES: Tuberculosis (TB) disease adversely affects mother and child, and strategies to control TB in this group are important. The aim of this study was to analyze the epidemiology of TB in pregnancy, and to establish whether pregnancy is an independent risk factor for TB. METHODS: The United Kingdom-wide cohort study was based on the General Practitioner Research Database (GPRD), enrolling all women with pregnancies between 1996 and 2008. Incidence rates and incidence rate ratios (IRRs) of TB events during pregnancy, 6 months postpartum, and outside pregnancy were calculated and compared by Poisson regression. A nested self-controlled case series compared the risk of TB in these periods, adjusting for individual and time-bound confounders. MEASUREMENTS AND MAIN RESULTS: The crude TB rate for the combined pregnancy and postpartum period was 15.4 per 100,000 person-years, significantly higher than outside of pregnancy (9.1 per 100,000 person-years; P = 0.02). Adjusting for age, region, and socioeconomic status the postpartum TB risk was significantly higher than outside pregnancy (IRR, 1.95; 95% confidence interval [CI], 1.24-3.07), whereas there was no significant increase during pregnancy (IRR, 1.29; 95% CI, 0.82-2.03). These observations were confirmed in the self-controlled case series (IRR, 1.62; 95% CI, 1.01-2.58 and IRR, 1.03; 95% CI, 0.64-1.65, respectively). CONCLUSIONS: The incidence of TB diagnosis is significantly increased postpartum. Although we did not find an increase during pregnancy, the postpartum incidence may reflect an increase during pregnancy given diagnostic, immunological and administrative delays. Clinicians' awareness should be improved and the effectiveness of public health policy measures such as targeted screening of pregnant and postpartum women in high-risk groups should be evaluated.
OBJECTIVES:Tuberculosis (TB) disease adversely affects mother and child, and strategies to control TB in this group are important. The aim of this study was to analyze the epidemiology of TB in pregnancy, and to establish whether pregnancy is an independent risk factor for TB. METHODS: The United Kingdom-wide cohort study was based on the General Practitioner Research Database (GPRD), enrolling all women with pregnancies between 1996 and 2008. Incidence rates and incidence rate ratios (IRRs) of TB events during pregnancy, 6 months postpartum, and outside pregnancy were calculated and compared by Poisson regression. A nested self-controlled case series compared the risk of TB in these periods, adjusting for individual and time-bound confounders. MEASUREMENTS AND MAIN RESULTS: The crude TB rate for the combined pregnancy and postpartum period was 15.4 per 100,000 person-years, significantly higher than outside of pregnancy (9.1 per 100,000 person-years; P = 0.02). Adjusting for age, region, and socioeconomic status the postpartum TB risk was significantly higher than outside pregnancy (IRR, 1.95; 95% confidence interval [CI], 1.24-3.07), whereas there was no significant increase during pregnancy (IRR, 1.29; 95% CI, 0.82-2.03). These observations were confirmed in the self-controlled case series (IRR, 1.62; 95% CI, 1.01-2.58 and IRR, 1.03; 95% CI, 0.64-1.65, respectively). CONCLUSIONS: The incidence of TB diagnosis is significantly increased postpartum. Although we did not find an increase during pregnancy, the postpartum incidence may reflect an increase during pregnancy given diagnostic, immunological and administrative delays. Clinicians' awareness should be improved and the effectiveness of public health policy measures such as targeted screening of pregnant and postpartum women in high-risk groups should be evaluated.
Authors: Sylvia M LaCourse; Lisa M Cranmer; Daniel Matemo; John Kinuthia; Barbra A Richardson; David J Horne; Grace John-Stewart Journal: J Acquir Immune Defic Syndr Date: 2017-05-01 Impact factor: 3.731
Authors: Jeffrey M Collins; Amnah Siddiqa; Dean P Jones; Ken Liu; Russell R Kempker; Azhar Nizam; N Sarita Shah; Nazir Ismail; Samuel G Ouma; Nestani Tukvadze; Shuzhao Li; Cheryl L Day; Jyothi Rengarajan; James Cm Brust; Neel R Gandhi; Joel D Ernst; Henry M Blumberg; Thomas R Ziegler Journal: JCI Insight Date: 2020-05-21
Authors: S Jonnalagadda; S M LaCourse; P Otieno; B Lohman-Payne; E Maleche-Obimbo; L M Cranmer; G C John-Stewart Journal: Int J Tuberc Lung Dis Date: 2015-07 Impact factor: 2.373
Authors: L M Cranmer; A Langat; K Ronen; C J McGrath; S LaCourse; J Pintye; B Odeny; B Singa; A Katana; L Nganga; J Kinuthia; G John-Stewart Journal: Int J Tuberc Lung Dis Date: 2017-03-01 Impact factor: 2.373
Authors: Ruth N Moro; Nigel A Scott; Andrew Vernon; Naomi K Tepper; Stefan V Goldberg; Kevin Schwartzman; Chi-Chiu Leung; Neil W Schluger; Robert W Belknap; Richard E Chaisson; Masahiro Narita; Elizabeth S Machado; Marta Lopez; Jorge Sanchez; Margarita E Villarino; Timothy R Sterling Journal: Ann Am Thorac Soc Date: 2018-05
Authors: Amita Gupta; Jyoti S Mathad; Susan M Abdel-Rahman; Jessica D Albano; Radu Botgros; Vikki Brown; Renee S Browning; Liza Dawson; Kelly E Dooley; Devasena Gnanashanmugam; Beatriz Grinsztejn; Sonia Hernandez-Diaz; Patrick Jean-Philippe; Peter Kim; Anne D Lyerly; Mark Mirochnick; Lynne M Mofenson; Grace Montepiedra; Jeanna Piper; Leyla Sahin; Radojka Savic; Betsy Smith; Hans Spiegel; Soumya Swaminathan; D Heather Watts; Amina White Journal: Clin Infect Dis Date: 2015-12-09 Impact factor: 9.079
Authors: Kelly E Dooley; Paolo Denti; Neil Martinson; Silvia Cohn; Fildah Mashabela; Jennifer Hoffmann; David W Haas; Jennifer Hull; Regina Msandiwa; Sandra Castel; Lubbe Wiesner; Richard E Chaisson; Helen McIlleron Journal: J Infect Dis Date: 2014-07-31 Impact factor: 5.226