Josefine Beck-Friis1, Marie Studahl2, Aylin Yilmaz3, Rune Andersson4, Elisabet Lönnermark5. 1. Department of Infectious Diseases, Sahlgrenska University Hospital, SE-416 85 Gothenburg, Sweden. Electronic address: Josefine.Beck-Friis@gu.se. 2. Department of Infectious Diseases, Sahlgrenska University Hospital, SE-416 85 Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, P.O Box 480, SE-405 30 Gothenburg, Sweden. Electronic address: Marie.Studahl@infect.gu.se. 3. Department of Infectious Diseases, Sahlgrenska University Hospital, SE-416 85 Gothenburg, Sweden. Electronic address: Aylin.Yilmaz@infect.gu.se. 4. Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, P.O Box 480, SE-405 30 Gothenburg, Sweden; Department of Clinical Microbiology, Sahlgrenska University Hospital, Guldhedsgatan 10a, P.O Box 7193, SE-40234 Gothenburg, Sweden. Electronic address: Rune.Andersson@gu.se. 5. Department of Infectious Diseases, Sahlgrenska University Hospital, SE-416 85 Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, P.O Box 480, SE-405 30 Gothenburg, Sweden. Electronic address: Elisabet.Lonnermark@infect.gu.se.
Abstract
BACKGROUND: Few studies have focused on the treatment of tuberculosis (TB) during pregnancy. This study aimed to evaluate the risk of adverse events, particularly liver toxicity, in pregnant women during treatment for active TB. METHODS: We conducted a retrospective study on pregnant and age-matched non-pregnant women receiving treatment for active TB at four hospitals in Western Sweden between 1992 and 2017. RESULTS: A total of 135 women were included, 40 pregnant and 95 non-pregnant. The frequency of severe hepatotoxicity was 40% in pregnant women and 6% among non-pregnant women (p < 0.001) (odds ratio 9.9; 95% confidence interval 3.5-28.0). Temporary drug withdrawal due to elevated transaminase levels was more frequent for pregnant than non-pregnant women (40% vs 9.5%; p < 0.001) (odds ratio 6.4; 95% confidence interval 2.5-16.2). There was one fatal case of hepatotoxicity in a pregnant woman. CONCLUSION: Severe hepatotoxicity was significantly more frequent in pregnant women compared to non-pregnant women. Careful monitoring of liver transaminases while receiving TB treatment during pregnancy is mandatory, as well as ensuring adequate measures with adjustment of drug regimen and temporary drug withdrawals when a rise in liver enzymes is noted.
BACKGROUND: Few studies have focused on the treatment of tuberculosis (TB) during pregnancy. This study aimed to evaluate the risk of adverse events, particularly liver toxicity, in pregnant women during treatment for active TB. METHODS: We conducted a retrospective study on pregnant and age-matched non-pregnant women receiving treatment for active TB at four hospitals in Western Sweden between 1992 and 2017. RESULTS: A total of 135 women were included, 40 pregnant and 95 non-pregnant. The frequency of severe hepatotoxicity was 40% in pregnant women and 6% among non-pregnant women (p < 0.001) (odds ratio 9.9; 95% confidence interval 3.5-28.0). Temporary drug withdrawal due to elevated transaminase levels was more frequent for pregnant than non-pregnant women (40% vs 9.5%; p < 0.001) (odds ratio 6.4; 95% confidence interval 2.5-16.2). There was one fatal case of hepatotoxicity in a pregnant woman. CONCLUSION: Severe hepatotoxicity was significantly more frequent in pregnant women compared to non-pregnant women. Careful monitoring of liver transaminases while receiving TB treatment during pregnancy is mandatory, as well as ensuring adequate measures with adjustment of drug regimen and temporary drug withdrawals when a rise in liver enzymes is noted.