| Abstrakt: |
Re: Multidrug-resistant tuberculosis during pregnancy and adverse birth outcomes: a systematic review and meta-analysis: Practice-embedded research to address knowledge gaps in multidrug-resistant tuberculosis in pregnancy Although the safety of several second-line MDR-TB drugs in pregnancy is debatable, bedaquiline, recently included in most short- and long-term regimens for MDR-TB, has been used for MDR-TB among pregnant women in South Africa. I Sir, i Maternal and perinatal tuberculosis (TB) is a global problem.1 As multidrug-resistant tuberculosis (MDR-TB) has emerged as a formidable public health challenge, the recent systematic review by Alene et al. on MDR-TB during pregnancy is a laudable effort, highlighting several pertinent issues for both clinicians and policymakers.2 Among pregnant women, MDR-TB is more dangerous than drug-susceptible TB, but evidence is sparse.1,2 MDR-TB in pregnancy led to approximately 37-fold higher maternal deaths compared with the baseline estimate made by the World Health Organization (WHO; 7.5 versus 0.2%).2 Pregnancy loss, preterm labour and low birthweight - commonly responsible for increased perinatal mortality - were probably less obvious because of the small sample size.2 Thus, the recent review provided us a timely reminder that more research/evidence with progressive guidelines is needed for the optimum management of MDR-TB during pregnancy.2 Despite the shortcomings of the current evidence, we have enough clues from this review to look forward.2 The following steps can perhaps overcome the current conundrum: A "dynamic" national TB database should be in place to identify TB/MDR-TB in pregnancy. [Extracted from the article] |
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