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

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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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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Applying deep learning for adverse pregnancy outcome detection with pre-pregnancy health data

MATEC Web of Conferences ◽

10.1051/matecconf/201818910014 ◽

2018 ◽

Vol 189 ◽

pp. 10014 ◽

Cited By ~ 2

Author(s):

Yu Mu ◽

Kai Feng ◽

Ying Yang ◽

Jingyuan Wang

Keyword(s):

Deep Learning ◽

Pregnancy Outcome ◽

Pregnancy Outcomes ◽

Learning Algorithm ◽

Adverse Pregnancy Outcome ◽

Health Data ◽

Adverse Pregnancy Outcomes ◽

Deep Learning Algorithm ◽

Adverse Pregnancy

Adverse pregnancy outcomes can bring enormous losses to both families and the society. Thus, pregnancy outcome prediction stays a crucial research topic as it may help reducing birth defect and improving the quality of population. However, recent advances in adverse pregnancy outcome detection are driven by data collected after mothers having been pregnant. In this situation, if a bad pregnancy outcome is diagnosed, the parents will suffer both physically and emotionally. In this paper, we develop a deep learning algorithm which is able to detect and classify adverse pregnancy outcomes before parents getting pregnant. We train a multi-layer neural network by using a dataset of 75542 couples’ multidimension pre-pregnancy health data. Our model outperforms some of algorithms in accuracy, recall and F1 score.

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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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Reproductive Concerns Among Female Leukemia and Lymphoma Survivors with the History of Adverse Pregnancy Outcomes after Cancer Treatment

Blood ◽

10.1182/blood-2018-99-110590 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 5893-5893

Author(s):

Ksenya Shliakhtsitsava ◽

Emily Myers ◽

Irene Su

Keyword(s):

Pregnancy Outcome ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcome ◽

Adverse Pregnancy Outcomes ◽

The Future ◽

Reproductive Concerns ◽

History Of ◽

Adverse Pregnancy ◽

After Cancer ◽

Lymphoma Survivors

Abstract Introduction Due to advances in cancer treatment the majority of young adults diagnosed with leukemia or lymphoma become long-term survivors. These individuals have been shown to have higher pregnancy risks as a result of cancer and treatment exposure. Adverse pregnancy outcomes including miscarriage and premature delivery may impact survivor's reproductive concerns after cancer. We hypothesized that reproductive-aged female leukemia and lymphoma survivors who experienced miscarriage or premature birth after cancer would have higher reproductive concerns as compared to female leukemia and lymphoma survivors who did not have an adverse pregnancy outcome after cancer. Methods This is a retrospective cohort study of young adult female leukemia and lymphoma survivors with at least one pregnancy after cancer, who are participants of the Reproductive Window study. Study participants were recruited between March 2015 and December 2017 from population-based cancer registries (California and Texas), physician and advocacy group referrals. Eligible women were age 18 to 40 at enrollment, age 15-35 at cancer diagnosis, and had at least one ovary. Enrolled participants answered a questionnaire on pregnancy outcomes and reproductive concerns using the Reproductive Concerns After Cancer (RCAC) Scale. The exposure was adverse pregnancy outcome (miscarriage or premature birth). The outcomes were RCAC subscales measuring concerns regarding becoming pregnant in the future and personal and offspring health. Subscale scores were dichotomized at 3, with >3 indicating moderate to severe reproductive concerns. Logistic regression models were used to test the association between an adverse pregnancy outcome (miscarriage or preterm birth) and RCAC subscales of interest, while adjusting for confounding Results 76 participants, mean age 34.3±3.9 years and mean years since cancer diagnosis 12.0± 5.8 years were included. The majority of participants were white (80%), completed college (72%) and were partnered (87%). Thirty eight percent of participants reported an adverse pregnancy outcome after cancer (18% miscarriage, 21% premature delivery). Thirty-two percent reported moderate to severe concerns about becoming pregnant in the future, 60% regarding offspring health, and 46% over personal health. History of miscarriage after cancer, but not preterm birth, was associated with higher concerns about becoming pregnant. In a multivariable model that adjusted for Hispanic ethnicity, current age, and live birth after cancer, participants who experienced a miscarriage after cancer were more likely to have moderate to high concerns about becoming pregnant in the future (adjusted OR 4.1, 95% CI 1.05-15.5, p=0.042) compared to participants with no history of miscarriage. Neither adverse pregnancy outcomes was associated with concerns about offspring or personal health. Conclusions In the cohort of young adult female leukemia and lymphoma survivors, experiencing a miscarriage after cancer was associated with higher concerns regarding becoming pregnant in the future. Additional research is needed to determine whether interventions such as preconception counseling with consideration of prior cancer treatments may help manage these concerns and improve pregnancy outcomes. Disclosures No relevant conflicts of interest to declare.

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Effects of sanitation practices on adverse pregnancy outcomes in India: a conducive finding from recent Indian demographic health survey

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2528-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Ratna Patel ◽

Ajay Gupta ◽

Shekhar Chauhan ◽

Dhananjay W. Bansod

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Pregnancy Outcome ◽

Health Survey ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcome ◽

Wealth Index ◽

Adverse Pregnancy Outcomes ◽

Adverse Outcomes ◽

Adverse Pregnancy

Abstract Background Several risk factors predisposing women and their live-borns to adverse outcomes during pregnancy have been documented. Little is known about sanitation being a factor contributing to adverse pregnancy outcomes in India. The role of sanitation in adverse pregnancy outcomes remains largely unexplored in the Indian context. This study is an attempt to bring the focus on sanitation as a factor in adverse pregnancy outcome. Along with the sanitation factors, few confounder variables have also been studied in order to understand the adverse pregnancy outcomes. Methods The study is based on the fourth round of National Family Health Survey (NFHS-IV) covering 26,972 married women in the age-group 15–49. The study variables include the mother’s age, Body Mass Index (BMI), education, anemia, and Antenatal care (ANC) visits during their last pregnancy. The household level variable includes place of residence, religion, caste, wealth index, access to toilet, type of toilet, availability of water within toilet premises, and facility of hand wash near the toilet. Children study variables include Low Birth Weight (LBW), the order of birth (Parity), and the death of the children of the women in the last 5 years. The target variable Adverse Pregnancy Outcome (APO) was constructed using children born with low birth weight or died during the last pregnancy. Results We calculated both adjusted as well as unadjusted odds ratios for a better understanding of the association between sanitation and adverse pregnancy outcomes. Findings from the study showed that women who did not have access to a toilet within the house had a higher risk of adverse pregnancy outcome. In the multivariable model, no association was observed for adverse pregnancy outcome among women who did not have access to toilet and women who used shared toilet. Teenage (15–19 years), uneducated, underweight and anemic mothers were more likely to face APO as compare to other mothers in similar characteristics group. Conclusions Our findings contribute to the decidedly less available literature on maternal sanitation behaviour and adverse pregnancy outcomes. Our results support that sanitation is a very significant aspect for women who are about to deliver a baby as there was an association between sanitation and adverse pregnancy outcome. Education on sanitation practices is the need of the hour as much as it needs to follow.

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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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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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Vitamin D Concentration during Early Pregnancy and Adverse Outcomes among HIV-Negative Women in Dar-es-Salaam, Tanzania: A Case-Control Study

Nutrients ◽

10.3390/nu11122906 ◽

2019 ◽

Vol 11 (12) ◽

pp. 2906

Author(s):

Aneth V. Kalinjuma ◽

Anne Marie Darling ◽

Christopher R. Sudfeld ◽

Ferdinand Mugusi ◽

Julie Wright ◽

...

Keyword(s):

Vitamin D ◽

Pregnancy Outcome ◽

Early Pregnancy ◽

Pregnancy Outcomes ◽

Case Control Study ◽

Adverse Pregnancy Outcome ◽

Adverse Pregnancy Outcomes ◽

Adverse Pregnancy ◽

Control Study ◽

Hiv Negative

We examined the associations of plasma vitamin D concentration and adverse pregnancy outcomes among HIV-negative women in Dar-es-Salaam, Tanzania. We used an unmatched case-control study design, with 25-hydroxyvitamin D [25(OH)D] concentration assessed in the first trimester. Cases were individuals with adverse pregnancy outcomes, including stillbirth, premature birth, or small for gestational age births (SGA). Unconditional logistic regression and weighted logistic regression models were used to describe the associations of 25(OH)D concentration with the composite of adverse pregnancy outcome and individual adverse pregnancy outcomes, respectively. We included 310 cases and 321 controls. In controls, 5(2%) were vitamin D deficient (25(OH)D < 20 ng/mL), and 17(5%) had insufficient 25(OH)D concentration (20.0–29.9 ng/mL). Women with 25(OH)D < 20 ng/mL had 1.82 times the odds of occurrence of the composite adverse pregnancy outcome (OR = 1.82, 95% CI: 0.56–5.93; p = 0.32), however we noted a non-linear association between 25(OH)D concentration and adverse pregnancy outcome (p = 0.02). We found a 3-fold increased odds of stillbirth in women with low 25(OH)D concentration (OR = 3.11, 95% CI: 1.18–8.23, p = 0.02). Vitamin D concentration in early pregnancy may be an important factor in determining the course of pregnancy. Further research is needed to investigate whether the association of maternal 25(OH)D concentration in early pregnancy and stillbirth is causal.

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POS0148 MATERNAL AND NEONATAL OUTCOMES IN PREGNANT WOMEN WITH PSORIASIS AND PSORIATIC ARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2283 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 287.2-287

Author(s):

W. Xie ◽

H. Huang ◽

Z. Zhang

Keyword(s):

Psoriatic Arthritis ◽

General Population ◽

Pregnant Women ◽

Pregnancy Outcomes ◽

Odds Ratio ◽

Meta Analysis ◽

Adverse Pregnancy Outcomes ◽

Maternal Outcomes ◽

Close Monitoring ◽

Adverse Pregnancy

Background:Psoriasis and psoriatic arthritis (PsA) are inflammatory diseases that affect women in their reproductive years. The evidence regarding the pregnancy outcomes in psoriasis and PsA is more limited and conflicting, to a large extent, confusing our knowledge on this topic.Objectives:We aim to investigate whether maternal psoriasis and PsA are associated with adverse pregnancy outcomes.Methods:We searched multiple electronic databases from inception to 3 August 2020, and reference lists of selected articles. Observational studies reporting at least one pregnancy outcomes in women with psoriasis or PsA with a comparator of general population or healthy subjects were included. Data were pooled by random-effects models (DerSimonian and Laird method) and expressed as odds ratio (OR) and 95% confidence interval (CI).Results:Overall, 16 studies were included in the meta-analysis. The pooled analyses showed pregnant women with psoriatic diseases have significantly higher risk of adverse maternal outcomes compared with general population (caesarean delivery: 1.33 (1.17-1.52); preterm birth: 1.32 (1.15-1.52); (pre)eclampsia: 1.28 (1.14-1.43); gestational diabetes: 1.19 (1.10-1.30); gestational hypertension: 1.30 (1.18-1.44) (Figure 1). However, no statistically increased risks of fetal complications were observed in women with psoriatic diseases (small for gestational age: 1.02 (0.93-1.11); low birth weight: 1.15 (0.93-1.42); congenital malformations: 1.03 (0.93-1.14); Apgar score <7: 1.07 (0.81-1.39); neonatal mortality: 1.13 (0.90-1.43); stillbirth: 1.19 (0.95-1.50)). Subgroup analysis found similar results in women with either psoriasis or PsA regarding maternal outcomes, but the magnitude of risk estimates seems to be greater in PsA.Conclusion:Pregnant women with psoriasis and PsA have excess risk of adverse maternal events, with seemingly higher risk in women with PsA, but not adverse neonatal events. Close monitoring of the mothers’ clinical status before and during pregnancy are decidedly required in daily practice.Figure 1.Forest plots of the odds ratio for the risk of adverse pregnancy outcomes in patients with psoriatic diseases.Disclosure of Interests:None declared

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Clinical significance of unexplained elevated maternal serum alpha feto-protein in second trimester of pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182329 ◽

2018 ◽

Vol 7 (6) ◽

pp. 2245

Author(s):

Urmila Karya ◽

Sweta Kumari ◽

Anupam Rani ◽

Shakun Singh

Keyword(s):

Pregnant Women ◽

Pregnancy Outcome ◽

Pregnancy Outcomes ◽

Predictive Value ◽

Maternal Serum ◽

Adverse Pregnancy Outcomes ◽

Alpha Fetoprotein ◽

Second Trimester ◽

Serum Alpha Fetoprotein ◽

Adverse Pregnancy

Background: Alpha-fetoprotein (AFP) is the major serum protein in the embryonic stage and in the early fetal stage. The aim of this study was to measure maternal serum AFP levels in second trimester between 15-20 weeks of gestation and to determine whether unexplained elevated MSAFP levels is an effective predictor of adverse pregnancy outcome among Indian population.Methods: This study was a prospective observational study, carried out on 400 pregnant women. Maternal serum alpha-fetoprotein (MSAFP) was measured between 15 and 20 weeks of gestation after excluding congenital malformation or birth defects. MSAFP level was determined by using a radio-immunoassay technique. Women with MSAFP level >2.0 MoM was considered as abnormal while MSAFP level≤ 2.0 MoM was considered as normal. All women were followed up till delivery and pregnancy outcomes were noted and compared between two groups.Results: Women with elevated MSAFP had significantly higher adverse pregnancy outcomes (75.4%) compared to women with MSAFP ≤2.0 MoM (26.1%) (p<0.0001 with relative risk of 2.89, 95% confidence interval 2.276 -3.667).Conclusions: Unexplained elevated MSAFP has high sensitivity, specificity, positive predictive value and negative predictive value in predicting adverse pregnancy outcomes. It would, therefore be worthwhile screening pregnant women in second trimester for maternal serum alpha-fetoprotein levels as it would help to identify high risk pregnancies and allow close antenatal survillence for better pregnancy outcome.

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