Pregnancy Outcomes in HIV-Infected Women Receiving Long-Term Isoniazid Prophylaxis for Tuberculosis and Antiretroviral Therapy

Objective. While 6- to 12-month courses of isoniazid for tuberculosis prevention are considered safe in pregnant women, the effects of longer-term isoniazid prophylaxis or isoniazid in combination with antiretroviral therapy (ART) are not established in human-immunodeficiency-virus-(HIV-) infected women who experience pregnancy during the course of therapy.Design.Nested study of pregnancy outcomes among HIV-infected women participating in a placebo-controlled, TB-prevention trial using 36 months daily isoniazid. Pregnancy outcomes were collected by interview and record review.Results. Among 196 pregnant women, 103 (52.6%) were exposed to isoniazid during pregnancy; all were exposed to antiretroviral drugs. Prior to pregnancy they had received a median of 341 days (range 1–1095) of isoniazid. We observed no isoniazid-associated hepatitis or other severe isoniazid-associated adverse events in the 103 women. Pregnancy outcomes were 132 term live births, 42 premature births, 11 stillbirths, 8 low birth weight, 6 spontaneous abortions, 4 neonatal deaths, and 1 congenital abnormality. In a multivariable model, neither isoniazid nor ART exposure during pregnancy was significantly associated with adverse pregnancy outcome (adjusted odds ratios 0.6, 95% CI: 0.3–1.1 and 1.8, 95% CI 0.9–3.6, resp.).Conclusions. Long-term isoniazid prophylaxis was not associated with adverse pregnancy outcomes, such as preterm delivery, even in the context of ART exposure.

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COVID-19 and Adverse Pregnancy Outcome: A Systematic Review of 104 Cases

Journal of Clinical Medicine ◽

10.3390/jcm9113441 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3441

Author(s):

Ramy Abou Ghayda ◽

Han Li ◽

Keum Hwa Lee ◽

Hee Won Lee ◽

Sung Hwi Hong ◽

...

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcome ◽

Mode Of Delivery ◽

Maternal Mortality Ratio ◽

Case Series ◽

Neonatal Outcomes ◽

Treatment Modalities ◽

Adverse Pregnancy

(1) Background: Until now, several reports about pregnant women with confirmed coronavirus disease 2019 (COVID-19) have been published. However, there are no comprehensive systematic reviews collecting all case series studies on data regarding adverse pregnancy outcomes, especially association with treatment modalities. (2) Objective: We aimed to synthesize the most up-to-date and relevant available evidence on the outcomes of pregnant women with laboratory-confirmed infection with COVID-19. (3) Methods: PubMed, Scopus, MEDLINE, Google scholar, and Embase were explored for studies and papers regarding pregnant women with COVID-19, including obstetrical, perinatal, and neonatal outcomes and complications published from 1 January 2020 to 4 May 2020. Systematic review and search of the published literature was done using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). (4) Results: In total, 11 case series studies comprising 104 pregnant women with COVID-19 were included in our review. Fever (58.6%) and cough (30.7%) were the most common symptoms. Other symptoms included dyspnea (14.4%), chest discomfort (3.9%), sputum production (1.0%), sore throat (2.9%), and nasal obstruction (1.0%). Fifty-two patients (50.0%) eventually demonstrated abnormal chest CT, and of those with ground glass opacity (GGO), 23 (22.1%) were bilateral and 10 (9.6%) were unilateral. The most common treatment for COVID-19 was administration of antibiotics (25.9%) followed by antivirals (17.3%). Cesarean section was the mode of delivery for half of the women (50.0%), although no information was available for 28.8% of the cases. Regarding obstetrical and neonatal outcomes, fetal distress (13.5%), pre-labor rupture of membranes (9.6%), prematurity (8.7%), fetal death (4.8%), and abortion (2.9%) were reported. There are no positive results of neonatal infection by RT-PCR. (5) Conclusions: Although we have found that pregnancy with COVID-19 has significantly higher maternal mortality ratio compared to that of pregnancy without the disease, the evidence is too weak to state that COVID-19 results in poorer maternal outcome due to multiple factors. The number of COVID-19 pregnancy outcomes was not large enough to draw a conclusion and long-term outcomes are yet to be determined as the pandemic is still unfolding. Active and intensive follow-up is needed in order to provide robust data for future studies.

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Assessment of HCMV-encoded microRNAs in Plasma as Potential Biomarkers in Pregnant Women with Adverse Pregnancy Outcomes

10.21203/rs.3.rs-95116/v1 ◽

2020 ◽

Author(s):

Zhiying Gao ◽

Likun Zhou ◽

Jing Bai ◽

Meng Ding ◽

Deshui Liu ◽

...

Keyword(s):

Pregnant Women ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcome ◽

Expression Profiles ◽

Plasma Concentrations ◽

Adverse Pregnancy Outcomes ◽

Immunoglobulin M ◽

Validation Data ◽

Adverse Pregnancy ◽

Normal Controls

Abstract Background: Human cytomegalovirus (HCMV) is the most frequent cause of congenital infections and can lead to adverse pregnancy outcomes (APO). HCMV encodes multiple microRNAs (miRNAs) that have been reported to be partially related to host immune responses, cell cycle regulation, viral replication and viral latency, and can be detected in human plasma. However, the relevance of HCMV-encoded miRNAs in maternal plasma as an indicator for APO has never been evaluated.Methods: The expression profiles of 25 HCMV-encoded miRNAs were first measured in plasma samples from 20 pregnant women with APO and 28 normal controls by quantitative reverse-transcription polymerase chain reaction (RT-qPCR) technology. Next, markedly changed miRNAs were validated in another independent validation set consisting of 20 pregnant women with APO and 27 control subjects. HCMV DNA in peripheral blood leukocytes (PBLs) and anti-HCMV immunoglobulin M (IgM) and anti-HCMV immunoglobulin G (IgG) in plasma were also examined in both the training and validation sets. Diagnostic value and risk factors were compared between adverse pregnancy outcome cohorts and normal controls.Results: The analysis of training and validation data sets revealed that plasma concentrations of hcmv-miR-UL148D, hcmv-miR-US25-1-5p and hcmv-miR-US5-1 were obviously increased in pregnant women with APO compared with normal controls. Hcmv-miR-US25-1-5p presented the largest area under the receiver-operating characteristic (ROC) curve (0.735; 95% CI, 0.635–0.836), with a sensitivity of 68% and specificity of 71%. Furthermore, the plasma levels of hcmv-miR-US25-1-5p and hcmv-miR-US5-1 were obviously positively correlated with APO (P = 0.029 and 0.035, respectively). Nevertheless, neither the concentration of HCMV DNA in PBLs nor the positivity rates of anti-HCMV IgM and IgG in plasma showed statistically significant correlation with APO.Conclusion: We identified a unique signature of HCMV-encoded miRNAs in pregnant women with APO, which may be useful as a potential noninvasive biomarker for predicting and monitoring APO during HCMV infection.

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Treatment and pregnancy outcomes of pregnant women exposed to second-line anti-tuberculosis drugs in South Africa

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03956-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Idah Mokhele ◽

Nelly Jinga ◽

Rebecca Berhanu ◽

Thandi Dlamini ◽

Lawrence Long ◽

...

Keyword(s):

South Africa ◽

Pregnant Women ◽

Pregnancy Outcome ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcome ◽

Adverse Pregnancy Outcomes ◽

Close Monitoring ◽

Second Line ◽

Tb Treatment ◽

Adverse Pregnancy

Abstract Background Multi-drug resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) in pregnant women is a cause for concern globally; few data have described the safety of second-line anti-TB medications during pregnancy. We aim to describe TB treatment and pregnancy outcomes among pregnant women receiving second-line anti-tuberculosis treatment for MDR/RR-TB in Johannesburg, South Africa. Methods We conducted a retrospective record review of pregnant women (≥ 18 years) who received treatment for MDR/RR-TB between 01/2010–08/2016 at three outpatient treatment sites in Johannesburg, South Africa. Demographic, treatment and pregnancy outcome data were collected from available medical records. Preterm birth (< 37 weeks), and miscarriage were categorized as adverse pregnancy outcomes. Results Out of 720 women of child-bearing age who received MDR/RR-TB treatment at the three study sites, 35 (4.4%) pregnancies were identified. Overall, 68.7% (24/35) were HIV infected, 83.3% (20/24) were on antiretroviral therapy (ART). Most women, 88.6% (31/35), were pregnant at the time of MDR/RR-TB diagnosis and four women became pregnant during treatment. Pregnancy outcomes were available for 20/35 (57.1%) women, which included 15 live births (11 occurred prior to 37 weeks), 1 neonatal death, 1 miscarriage and 3 pregnancy terminations. Overall, 13/20 (65.0%) women with known pregnancy outcomes had an adverse pregnancy outcome. Of the 28 women with known TB treatment outcomes 17 (60.7%) completed treatment successfully (4 were cured and 13 completed treatment), 3 (10.7%) died and 8 (28.6%) were lost-to-follow-up. Conclusions Pregnant women with MDR/RR-TB suffer from high rates of adverse pregnancy outcomes and about 60% achieve a successful TB treatment outcome. These vulnerable patients require close monitoring and coordinated obstetric, HIV and TB care.

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Association of Implementation of a Comprehensive Preconception-to-Pregnancy Management Plan With Pregnancy Outcomes Among Chinese Pregnant Women With Type 1 Diabetes: The CARNATION Study

10.2337/figshare.13623029.v1 ◽

2021 ◽

Author(s):

Xueying Zheng ◽

Daizhi Yang ◽

Sihui Luo ◽

Jinhua Yan ◽

Xiaohui Guo ◽

...

Keyword(s):

Pregnant Women ◽

Pregnancy Outcome ◽

Pregnancy Outcomes ◽

Prospective Cohort ◽

Retrospective Cohort ◽

Adverse Pregnancy Outcome ◽

Management Plan ◽

Comprehensive Management ◽

Adverse Pregnancy

Objective To investigate the effect on pregnancy outcome of integrating a comprehensive management plan for type 1 diabetic (T1D) patients into the WHO universal maternal care infrastructure. Research Design and Methods A comprehensive preconception-to-pregnancy management plan for women with T1D was implemented in 11 centers from eight Chinese cities during 2015–2017. Sequential eligible pregnant women (n=133 out of 137 initially enrolled) with T1D and singleton pregnancies attending these management centers formed the prospective cohort. The main outcome was severe adverse pregnancy outcome comprising maternal mortality, neonatal death, congenital malformation(s), miscarriage in the second trimester and stillbirth. We compared pregnancy outcomes in this prospective cohort with two control groups with the same inclusion and exclusion criteria: a retrospective cohort (n=153) of all eligible pregnant women with T1D attending the same management centers during 2012–2014 and a comparison cohort (n=116) of all eligible pregnant women with T1D receiving routine care during 2015–2017 in 11 different centers from seven cities. Results The rate of severe adverse pregnancy outcome was lower in the prospective cohort (6.02%) than in either the retrospective cohort (18.30%, adjusted odds ratio[aOR]=0.31, 95% CI 0.13–0.74) or the contemporaneous comparison cohort (25.00%, aOR=0.22, 95% CI 0.09–0.52). Conclusion The substantial improvements in the prospective cohort are evidence of a potentially clinically important effect of the comprehensive management plan on pregnancy outcomes among Chinese pregnant women with pregestational T1D. This supports the development of similar approaches in other countries.

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Mobile phone application use in pregnant women: does it make a difference? Usage and perinatal outcomes in China (Preprint)

10.2196/preprints.29644 ◽

2021 ◽

Author(s):

Puhong Zhang ◽

Huan Chen ◽

Jie Shang ◽

Jun Ge ◽

Huichen Zhang ◽

...

Keyword(s):

Child Health ◽

Pregnant Women ◽

Maternal And Child Health ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcome ◽

Perinatal Outcomes ◽

Northern China ◽

Mobile Phone Application ◽

Adverse Pregnancy ◽

And Child Health

BACKGROUND Maternal and child health (MCH) related mobile applications (apps) are becoming increasingly popular amongst pregnant women, however, few have demonstrated they lead to improvements in pregnancy outcomes. OBJECTIVE This study aimed to investigate the use of MCH apps amongst pregnant women and explore associations with pregnancy outcomes in China. METHODS A retrospective study was conducted in six maternal and child health hospitals in Northern China. Women who delivered a singleton baby greater than 28 weeks gestation in the study hospitals were sequentially recruited from postnatal wards during October 2017 to January 2018. Information was collected on self-reported MCH app use during their pregnancy, with clinical outcomes. Women were categorized as non-users of MCH apps, and users (further divided into intermittent users and continuous users). The primary outcome was a composite adverse pregnancy outcome (CAPO) comprising preterm birth, birth weight <2500 grams, birth defects, stillbirth and neonatal asphyxia. The association between app use and CAPO was explored using multivariable logistic analysis. RESULTS The 1850 participants reported using 127 different MCH apps during pregnancy. App use frequency was reported as never, 457 (24.7%); intermittent 876 (47.4%); and continuous 517 (27.9%). Amongst app users, the most common reasons for app use were for health education (100.0%), self-monitoring (54.2%) and antenatal appointment reminders (43.2%). Non-users were older, with fewer years of education, lower incomes, and higher parity (P<0.01). No association was found between “any app” use and the CAPO (6.8% in non-users compared to 6.3% in any users, OR 0.77, 95% CI: 0.48-1.25). CONCLUSIONS Women in China access a large number of different MCH apps, with social disparities in access and frequency of use. “Any app” use was not found associated with improved pregnancy outcomes, highlighting the needs for rigorous development and testing of apps before recommendation for use in clinical settings.

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Association of Implementation of a Comprehensive Preconception-to-Pregnancy Management Plan With Pregnancy Outcomes Among Chinese Pregnant Women With Type 1 Diabetes: The CARNATION Study

10.2337/figshare.13623029 ◽

2021 ◽

Author(s):

Xueying Zheng ◽

Daizhi Yang ◽

Sihui Luo ◽

Jinhua Yan ◽

Xiaohui Guo ◽

...

Keyword(s):

Pregnant Women ◽

Pregnancy Outcome ◽

Pregnancy Outcomes ◽

Prospective Cohort ◽

Retrospective Cohort ◽

Adverse Pregnancy Outcome ◽

Management Plan ◽

Comprehensive Management ◽

Adverse Pregnancy

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Isoniazid Preventive Therapy and Pregnancy Outcomes in Women Living With Human Immunodeficiency Virus in the Tshepiso Cohort

Clinical Infectious Diseases ◽

10.1093/cid/ciz1024 ◽

2019 ◽

Vol 71 (6) ◽

pp. 1419-1426 ◽

Cited By ~ 1

Author(s):

Nicole Salazar-Austin ◽

Silvia Cohn ◽

Sanjay Lala ◽

Ziyaad Waja ◽

Kelly E Dooley ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Pregnant Women ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcome ◽

Preventive Therapy ◽

Women Living With Hiv ◽

Immunodeficiency Virus ◽

Adverse Pregnancy ◽

Living With Hiv ◽

Tuberculosis Disease

Abstract Background Both pregnancy and human immunodeficiency virus (HIV) increase the risk of tuberculosis disease, which results in poor maternal, pregnancy, and infant outcomes. Isoniazid preventive therapy (IPT) reduces mortality among individuals living with HIV in high-burden settings but has recently been associated with adverse pregnancy outcomes when initiated during pregnancy. Methods In this secondary analysis, we used multivariable logistic regression to evaluate the association between IPT exposure and adverse pregnancy outcomes (fetal demise, prematurity, low birth weight, congenital anomaly) in pregnant women living with HIV enrolled as controls in the Tshepiso study, a prospective observational cohort of pregnant women living with HIV with and without tuberculosis disease in Soweto, South Africa, from 2011–2014. Results There were 151 women enrolled with known pregnancy outcomes; 69 (46%) reported IPT initiation during pregnancy. Of the 69 IPT-exposed women, 11 (16%) had an adverse pregnancy outcome compared with 23 (28%) IPT-unexposed women. The adjusted odds of having an adverse pregnancy outcome was 2.5 (95% confidence interval, 1.0–6.5; P = .048) times higher in IPT-unexposed women compared with IPT-exposed women after controlling for maternal age, CD4 count, viral load, antiretroviral regimen, body mass index, and anemia. Conclusions IPT exposure during pregnancy was not negatively associated with pregnancy outcomes after controlling for demographic, clinical, and HIV-related factors. These results provide some reassurance that IPT can be safely used in the second or third trimester of pregnancy. Additional research is needed to evaluate the safety of IPT and new short-course tuberculosis preventive therapies during pregnancy.

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Pregnancy Outcomes Among HIV-Infected Women Undergoing Antiretroviral Therapy

The Open AIDS Journal ◽

10.2174/1874613600903010008 ◽

2009 ◽

Vol 3 (1) ◽

pp. 8-13 ◽

Cited By ~ 14

Author(s):

Darin Areechokchai ◽

Chureeratana Bowonwatanuwong ◽

Benjaluck Phonrat ◽

Punnee Pitisuttithum ◽

Wirach Maek-a-Nantawat

Keyword(s):

Antiretroviral Therapy ◽

Adverse Effects ◽

Pregnant Women ◽

Pregnancy Outcomes ◽

Hiv Transmission ◽

Antiretroviral Drugs ◽

Normal Term ◽

Term Delivery ◽

Age Range ◽

Mother To Child

Background The use of antiretroviral drugs (ARV) to prevent mother-to-child HIV transmission (PMTCT) promises to be effective. However, limited data on the adverse effects of ARV among pregnant women and pregnancy outcomes have been reported in clinical practice. Objectives This study aimed to assess adverse effects and outcomes among pregnant HIV-infected women receiving antiretroviral drugs for either antiretroviral therapy (ART) or PMTCT. Study Design This cohort study was at Chonburi Hospital, Thailand, in 2002-2006. Results A total of 246 pregnant HIV-infected women with the median age (range) of 27 (16-41) years were included in this study. ART was initiated in 16.3% for treatment during ANC, 66.7% for PMTCT during ANC, and 17.1% for PMTCT in labor. Adverse effects, especially anemia, were significantly associated with continuing combined ART in pregnancy (p<0.001). 88.9% delivered normal-term neonates. The prevalence of pre-term delivery was 10.2%. Overall, 24 adverse events from 21 pregnant women (8.5%) were noted. A significantly higher prevalence of pre-term delivery was noted in the groups continuing combined ART, or initiating of PMTCT during labor rather than ANC (p=0.02). The incidence of low Apgar scores was 3.6%, and these were associated with initiation of PMTCT during labor (p=0.004). Conclusion Adverse ARV events were more numerous among the pregnant women who needed ART than PMTCT. ANC is beneficial and strongly recommended for all pregnant HIV-infected women for better pregnancy outcomes.

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Pregnant under the pressure of a pandemic: a large-scale longitudinal survey before and during the COVID-19 outbreak

European Journal of Public Health ◽

10.1093/eurpub/ckaa223 ◽

2020 ◽

Cited By ~ 1

Author(s):

Elin Naurin ◽

Elias Markstedt ◽

Dietlind Stolle ◽

Daniel Enström ◽

Anton Wallin ◽

...

Keyword(s):

Pregnant Women ◽

Large Scale ◽

Adverse Pregnancy Outcome ◽

Longitudinal Survey ◽

Long Term Effects ◽

Health Related ◽

Adverse Pregnancy ◽

In The Beginning

Abstract Background One of the groups that is most vulnerable to the COVID-19 pandemic is pregnant women. They cannot choose to refrain from care; they and their children are at risk of severe complications related to the virus; and they lose comfort and support as clinics prohibit their partners and as societal restrictions demand isolation from friends and relatives. It is urgent to study how this group is faring during the pandemic and we focus here on their health-related worries. Methods A longitudinal survey at a Swedish hospital starting 6 months before (16 September 2019) and continuing during the COVID-19 outbreak (until 25 August 2020). A total of 6941 pregnant women and partners of diverse social backgrounds were recruited. Ninety-six percent of birth-giving women in the city take early ultrasounds where recruitment took place. Sixty-two percent of the women with an appointment and fifty-one percent of all partners gave consent to participate. Results Pregnant women experienced dramatically increased worries for their own health, as well as for their partner’s and their child’s health in the beginning of the pandemic. The worries remained at higher than usual levels throughout the pandemic. Similar, but less dramatic changes were seen among partners. Conclusions There is a need for heightened awareness of pregnant women’s and partners’ health-related worries as a consequence of the COVID-19 pandemic. Related feelings, such as anxiety, have been linked to adverse pregnancy outcome and might have long-term effects. The healthcare system needs to prepare for follow-up visits with these families.

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Treatment and Pregnancy Outcomes of Pregnant Women Exposed to Second-line Anti-tuberculosis Drugs in South Africa

10.21203/rs.3.rs-155326/v1 ◽

2021 ◽

Author(s):

Idah Mokhele ◽

Nelly Jinga ◽

Rebecca Berhanu ◽

Thandi Dlamini ◽

Lawrence Long ◽

...

Keyword(s):

South Africa ◽

Pregnant Women ◽

Pregnancy Outcome ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcome ◽

Adverse Pregnancy Outcomes ◽

Close Monitoring ◽

Second Line ◽

Tb Treatment ◽

Adverse Pregnancy

Abstract Background:Multi-drug resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) in pregnant women is a cause for concern globally; few data have described the safety of second-line anti-TB medications during pregnancy. We characterize maternal, and pregnancy outcomes for pregnant women receiving second-line anti-tuberculosis treatment for MDR/RR-TB.Methods: We conducted a retrospective record review of pregnant women (≥18 years) who received treatment for MDR/RR-TB between 01/2010–08/2016 at three outpatient treatment sites in Johannesburg, South Africa. Demographic, treatment and pregnancy outcome data were collected from available medical records. Preterm birth (<37 weeks), and miscarriage were categorized as adverse pregnancy outcomes.Results: Out of 720 women of child-bearing age who received MDR/RR-TB treatment at the three study sites, 35 (4.4%) pregnancies were identified. Overall, 68.7% (24/35) were HIV infected, 83.3% were on ART. Most women (88.6%) were pregnant at the time of MDR/RR-TB diagnosis and four women became pregnant during treatment. Pregnancy outcomes were available for 20/35 (57.1%) women, which included 15 live births (11 occurred prior to 37 weeks), 1 neonatal death, 1 miscarriage and 3 pregnancy terminations. Overall, 13/17 (76.5%) had an adverse pregnancy outcome. Of the 28 women with known TB treatment outcomes 17 (60.7%) completed treatment successfully (4 were cured and 13 completed treatment), 3 (10.7%) died and 8 (28.6%) were lost-to-follow-up.Conclusions:Pregnant women with MDR/RR-TB suffer from high rates of adverse pregnancy outcomes and about 60% achieve a successful TB treatment outcome. These vulnerable patients require close monitoring and coordinated obstetric, HIV and TB care.

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