Maternal, pregnancy and infant outcomes in women treated for multidrug/rifampicin-resistant tuberculosis with novel and repurposed drugs in KwaZulu-Natal, South Africa.

Publication date: Oct 29, 2025

There is limited evidence on the safety and efficacy of new and repurposed second-line anti-tuberculosis (TB) drugs in pregnant women. Pregnant women initiating treatment for multidrug/rifampicin-resistant (MDR/RR)-TB from 1 January 2018 to 31 March 2024 were included in this prospective observational study. Maternal TB treatment and pregnancy outcomes were documented through ongoing record reviews and clinical assessments conducted to describe infant outcomes. Using Poisson regression with robust standard errors we evaluated factors associated with favourable maternal treatment and pregnancy outcomes. Of 70 pregnant women treated for MDR/RR-TB, 53 (76%) were living with HIV. Favourable TB treatment outcomes were reported in 44 (62. 9%) women. Sixty-seven (95. 7%) of the 70 infants were born alive, with a median gestational age of 38 weeks (interquartile range [IQR]: 37. 0-39. 0) and median birth weight of 2970 grams (IQR: 2560-3280). All infants were exposed to bedaquiline. Twenty-three (34. 3%) women had unfavourable pregnancy outcomes, with 20 (29. 8%) infants born prematurely and/or with low birthweight. Women with positive sputum smears at treatment initiation were less likely to have a favourable treatment outcome (adjusted risk ratio 0. 33; 95% confidence interval: 0. 17-0. 66, p=0. 002) compared to those with negative smears. Of the 43 infants evaluated at 12 months, 27 (62. 8%) had favourable outcomes, with 10 (23. 3%) infants developing TB in their first year of life. The high TB-HIV co-infection rate is likely to have contributed to unfavourable pregnancy outcomes. Supportive maternal adherence counselling and infant TB preventive treatment is needed to prevent TB transmission to the infant.

Semantics

Original Article