Multidrug-resistant tuberculosis during pregnancy and adverse birth outcomes: a systematic review and meta-analysis

Background Multidrug-resistant tuberculosis (MDR-TB) is a major global public health concern. However, there is a dearth of literature on whether MDR-TB and its medications impact maternal and perinatal outcomes, and when such evidence exists the findings are conflicting. Objectives This systematic review and meta-analysis aimed to examine the impact of MDR-TB and its medications during pregnancy on maternal and perinatal outcomes. Search strategy PubMed, Scopus and Web of Science databases were searched from earliest to February 2020. Selection criteria Records were screened based on pre-defined selection criteria and assessed for quality by two independent reviewers. Data collection and analysis A meta-analysis was performed using the random effects model to calculate pooled prevalence for each outcome. Main results Of the 72 records identified, 12 were included in the systematic review and meta-analysis, consisting of 174 pregnant women with MDR-TB and 110 adverse outcomes. Maternal death, pregnancy loss, preterm birth and low birthweight were the most common maternal and perinatal adverse outcomes reported in the studies. The overall pooled prevalence was 7.5% (95% CI 3.2-12.8) for maternal death, 10.6% (95% CI 6.0-16.3) for pregnancy loss, 12.9% (95% CI 0.0-38.0) for preterm birth and 23.7% (95% CI 17.0-31.0) for low birthweight. Conclusions The findings suggest that MDR-TB is associated with a high risk of adverse maternal and perinatal outcomes, but these should be interpreted cautiously because the evidence is largely preliminary. Adequately powered prospective cohort studies are urgently required to corroborate these findings. Tweetable abstract Multidrug-resistant tuberculosis may increase the risk of adverse maternal and perinatal outcomes.