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Cochrane Database of Systematic Reviews. - 2008. - Vol. 1.
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UDC 615:616.12-073.7
Altynbekov M.A.
teacher
International Kazakh-Turkish University named H.A. Yasavi
Turkestan, Kazakhstan Ibragimova S.I. master-teacher
International kazakh-turkish university named H.A. Yasavi
Turkestan, Kazakhstan TUBERCULOSIS AND PREGNANCY
Annotation. This article provides an overview of literature data on the incidence of pulmonary tuberculosis among pregnant women. Tuberculosis is the leading cause of death from infectious diseases in the world. This disease is considered almost as ancient as human history, which is confirmed by the traces of this found in 7,000 years ago in Egyptian mummies, described by Hippocrates. According to estimates, in 2015, 10.4 million people became ill with tuberculosis, including 5.9 million (56%) of men, 3.5 million (34%) of women and 1.0 million (10%) of children. Sixty countries account for 60% of new cases: India, Indonesia, China, Nigeria, Pakistan and South Africa.
Keywords: tuberculosis, pregnancy, prevalence.
According to the World Health Organization (WHO), in 2015, 1.4 million deaths from tuberculosis were registered. Although the number of tuberculosis deaths decreased by 22% between 2000 and 2015, it remains one of 10 causes of death worldwide [1,2].
Tuberculosis is the third leading cause of death among women aged 15-44 years, which can cause infertility and negatively affect reproductive health [3].
According to WHO, about 700,000 women die of tuberculosis each year. The frequency of active tuberculosis in pregnant women ranges from 0.1% to 1.9% [4], although the exact incidence of tuberculosis during pregnancy is not always available in many countries due to the presence of a variety of confounding factors. However, it is expected that the incidence of tuberculosis among pregnant women will be as high as that of the entire population, and possibly a higher incidence in developing countries. Earlier, the Schaefer study reported a new case of tuberculosis - 18-29 per 100,000 pregnancies, which was similar to the rates (19-39 per 100,000) registered in New York City [5]. However, a recent study in the United Kingdom has shown that the incidence rate is 4.2 per 100 000 pregnant
women [6].
Tuberculosis is the leading cause of extragenital mortality worldwide, most of which occur in areas of high HIV prevalence [7]. In South Africa, a screening study found that the prevalence of tuberculosis among HIV-infected people is 10 times higher than that of HIV-uninfected pregnant women [8]. In addition, studies show that HIV-infected pregnant women co-infected with tuberculosis are 2.5 times more likely to transmit HIV to their children, and their children are 24 times more likely to have neonatal tuberculosis [9].
According to Tripathy S.N., a significant time has elapsed since the appearance of the patient's complaints before the diagnosis of tuberculosis due to the low sensitivity and long processing time of the available diagnostic tools, the need for multiple visits and nonspecific symptoms in pregnant women, especially those infected with HIV [10]. In Mexico, Golub JE found that maternal morbidity, neonatal mortality and extreme prematurity are significantly higher among pregnant women with tuberculosis who started treatment at the end of pregnancy (25-36 weeks of gestation), while in pregnant women who started treatment in the early stages there were minimal negative In addition, early diagnosis and treatment of tuberculosis reduces its transmission to family members, including newborns [11]. In view of this, it is clear that early diagnosis and treatment of both HIV and tuberculosis has to improving both maternal and child health. WHO recommends that treatment of tuberculosis and HIV in antenatal care and tuberculosis screening for all pregnant women in areas with a high prevalence of HIV infection [12].
Although the greatest burden of tuberculosis infection occurs in countries with low social status, it is reported that in developed countries there has been a resurgence of tuberculosis over the past few years, mainly as a result of an increase in the number of immigrants in these countries. Retrospective study in London for a 5-year period 1997-2001 showed an increase in the number of pregnant women with tuberculosis [13]. Another study conducted in 2008 showed that the national TB incidence during pregnancy in the UK was 4.2 per 100,000 pregnant women or about 1 per 24,000 pregnant women. All pregnant women with tuberculosis in both of these studies belonged to an ethnic minority, a significant number of whom had recently immigrated to the UK [14]. Centers for Disease Control and Prevention conveys that despite the reduction in the incidence of tuberculosis in the United States, the number of immigrants continues to be at a greater risk of contracting tuberculosis than those born in the US [15].
Thus, improving the diagnosis and treatment of tuberculosis in pregnant women are important measures to protect the health of the mother and child. A significant delay in diagnosing tuberculosis among pregnant women, as well as examining a newborn after childbirth to eliminate tuberculosis infection, is often overlooked. Therefore, the effective treatment of tuberculosis during pregnancy and the postpartum period requires a multidisciplinary approach, including an obstetrician, pediatrician, phthisiatrist and public health doctor, as well as large-scale population studies of these factors.
References:
1. Facts about health in African Subregion. Fact sheet N314 World Health Organisation, 2011.
2. WHO Library Cataloguing-in-Publication Data. Global tuberculosis report 2016.ISBN 978 92 4 156539 4. WHO/HTM/TB/2016.13. Geneva 27, Switzerland
3. World health Organization: Tuberculosis and gender. 2 September 2014.
4. Vo QT, Stettler W, Crowley K. Pulmonary tuberculosis in pregnancy. Prim Care Update ObGyns. 2000; 7:244-49.
5. Schaefer G, Zervoudakis IA, Fuchs FF, David S. Pregnancy and pulmonary tuberculosis. Obstetrics and Gynecology. 1975;46(6):706-715.
6. Knight M, Kurinczuk JJ, Nelson-Piercy C. Tuberculosis in pregnancy in the UK. BJOG. 2009;116(4):584-588.
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9. Hesseling AC, Cotton MF, Jennings T, et al. High incidence of tuberculosis among HIV-infected infants: evidence from a South African population-based study highlights the need for improved tuberculosis control strategies. Clinical Infectious Diseases. 2009;48(1): 108-114.
10. Tripathy SN. Tuberculosis and pregnancy. International Journal of Gynecology and Obstetrics. 2003;80(3):247-253.
11. Golub JE, Mohan CI, Comstock GW, Chaisson RE. Active case finding of tuberculosis: historical perspective and future prospects. International Journal of Tuberculosis and Lung Disease. 2005;9(11): 1183-1203.
12. Mnyani CN, McIntyre JA. Tuberculosis in pregnancy. International Journal of Obstetrics and Gynaecology. 2011;118(2):226-231.
13. Kothari A, Mahadevan N, Girling J. Tuberculosis and pregnancy - results of a study in a high prevalence area in London. Eur J ObstetGynecolReprodBiol 2006;126:48-55.
14. Knight M, Kurinczuk JJ, Nelson-Piercy C, Spark P, Brocklehurst P. Tuberculosis in pregnancy in the UK. BJOG 2009;116:584-8.
15. Centers for Disease Control and Prevention. Decrease in reported tuberculosis cases - United States, 2009. MMWR MorbMortalWklyRep 2010;59:289-94.
