Maternal TB is potentially dangerous for the fetus and newborn. Only five well-matched comparative studies detailing perinatal effects of maternal TB could be identified worldwide. These comparative

studies from India,7,8 Mexico12,13 and Taiwan22 clearly suggested that infants born to tuberculous mothers are smaller than in healthy controls (Table 1). This is evident Ku-0059436 chemical structure by higher risks of low-birthweight (LBW) and small-for-gestational-age (SGA) babies in tuberculous mothers.46 The risks for prematurity, though inconsistent (a twofold rise in Indian7 and Mexican13 cohorts, but no change in Taiwan22), alone cannot explain birthweight reduction in women with TB. A significant birthweight reduction (215 g in pulmonary TB and 277 g in extrapulmonary TB in India, and 240 g in a combined group in Mexico) is most likely due to fetal growth restriction, which might have been superimposed on a higher prematurity rate.7,13 In our experience from northern India, pulmonary TB is associated with an approximately twofold increase in fetal distress during labor (relative risk [RR] 2.4; 95% confidence interval [CI] 1.2–4.7), and SGA (RR 2.6; 95%CI 1.4–4.6), preterm (RR 2.1;

95%CI 1.2–3.4), find protocol and LBW (RR 2.1; 95%CI 1.4–3.1) neonates when compared with the healthy controls.7 Similarly, extrapulmonary TB (except tuberculous lymphadenitis) is also associated with adverse perinatal outcomes.8 More importantly, perinatal mortality is approximately fivefold higher in both pulmonary and extrapulmonary TB.7,8,46 These perinatal effects were even more pronounced in cases with late diagnosis, incomplete or irregular drug treatment,

and in those with advanced pulmonary lesions.7 Therefore, antenatal and intrapartum care may be modified according to severity of disease, Sulfite dehydrogenase and associated obstetric complications. As incomplete and irregular treatment of TB remains a major challenge in pregnant women, any strategy to promote adherence to TB treatment requires overcoming barriers at three levels – health system, social and family, and personal levels.47 Removal of these barriers for pregnant women with TB remains a daunting task. In contrast, Tripathy and Tripathy reported overall good perinatal outcome among 111 women with pulmonary/extrapulmonary TB over a period of 16 years (1986–2001) from eastern India.9 Unfortunately, this study only had a 41% follow-up rate (original cohort of 271 patients). This might have introduced a bias, because the defaulters in the TB cohort could represent a relatively worse/severe spectrum of the disease and outcome. Furthermore, lack of follow up in the study was mostly attributed to non-compliance to medication and regular check-up, which has remained a major concern in South Asian countries.18 In this study, extreme prematurity, LBW, and neonatal mortality were more common among pregnant women with TB, who started treatment late in pregnancy.