The Enigma of Antituberculosis Treatment on Pregnancy Outcomes
Antituberculosis treatment has long been a subject of medical scrutiny, especially when it comes to its effects on pregnancy outcomes in infertile women with genital tuberculosis. A recent systematic review dives into this complex issue, but leaves us with more questions than answers.
The Source Article Details
Effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis: a systematic review by Kevin Flores-Lovon et al. in 2023.
The Source Article's Abstract
To evaluate the efficacy of antituberculosis therapy on pregnancy outcomes in infertile women with genital tuberculosis.
We searched in PubMed/MEDLINE, CENTRAL and EMBASE up to 15 January 2023.
We included randomised controlled trials (RCT), non-RCTs (non-RCT) and cohort studies that evaluated the effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis compared with not receiving antituberculosis treatment or receiving the treatment for a shorter period.
Data Extraction and Synthesis
Two independent reviewers extracted data.
Two RCTs and one non-RCT were included. The antituberculosis regimens were based on isoniazid, rifampicin, pyrazinamide and ethambutol for 6-12 months. In women without structural damage, very low certainty of evidence from one RCT showed that the antituberculosis treatment may have little to no effect on pregnancy, full-term pregnancy, abortion or intrauterine death and ectopic pregnancy, but the evidence is very uncertain.
The Source Article References
- Prevalence of female genital tuberculosis, its risk factors and associated clinical features among the women of Andaman Islands, India: a community-based study by Parvez, 2017 in Public Health
- Female genital tuberculosis in Pakistan - A retrospective review of 10-year laboratory data and analysis of 32 cases by Fatima, 2021 in Int J Mycobacteriol
- Female genital tuberculosis: Revisited by Sharma, 2018 in Indian J Med Res
- Clinical presentation and epidemiology of female genital tuberculosis in Eastern Sudan by Ali, 2012 in Int J Gynaecol Obstet
- Female genital tuberculosis in light of newer laboratory tests: A narrative review by Munne, 2020 in Indian J Tuberc
- Comparative study of Laparoscopic Abdominopelvic and Fallopian tube findings before and after Antitubercular therapy in female genital tuberculosis with infertility by Sharma, 2016 in J Minim Invasive Gynecol
- Insight into the diagnosis and management of Subclinical genital tuberculosis in women with infertility by Mahajan, 2016 in J Hum Reprod Sci
- Recent advances in diagnosis and management of female genital tuberculosis by Sharma, 2021 in J Obstet Gynecol India
- Infestation of Endometrium by Mycobacterium tuberculosis Bacilli-cause of reproductive failure by Chowdhury, 2010 in Al Ameen Journal of Medical Sciences
- In vitro fertilization outcome in women with endometrial tuberculosis and Tubal tuberculosis by Dai, 2020 in Gynecol Endocrinol
- Genital TB-diagnostic algorithm and treatment by Sharma, 2020 in Indian J Tuberc
- Role of anti-Tubercular treatment for positive endometrial Aspirate DNA-PCR reproductive outcome in infertile patients in Indian setting - A randomized trial by Kriplani, 2017 in Indian J Tuberc
- Effect of Antitubercular treatment on the pregnancy outcomes and prognoses of patients with genital tuberculosis by Yue, 2019 in Front Med
- Six months versus nine months anti-tuberculous therapy for female genital tuberculosis: a randomized controlled trial by Sharma, 2016 in European Journal of Obstetrics & Gynecology and Reproductive Biology
- Bias as a source of inconsistency in Ivermectin trials for COVID-19: A systematic review. Ivermectin's suggested benefits are mainly based on potentially biased results by Izcovich, 2022 in J Clin Epidemiol
- Incidence of adverse reactions caused by first-line anti-tuberculosis drugs and treatment outcome of pulmonary tuberculosis patients in Morocco by El Hamdouni, 2020 in Infection
Citing the Source Article (APA)
Flores-Lovon, K., Soriano-Moreno, D.R., Medina-Ramirez, S.A., Fernandez-Guzman, D., Caira-Chuquineyra, B., Fernandez-Morales, J., Tuco, K.G., Turpo-Prieto, J., Alave, J., Goicochea-Lugo, S. (2023). Effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis: a systematic review. BMJ Open, 13(9), e070456-e070456. 10.1136/bmjopen-2022-070456
What the Study Explores
The study aims to evaluate the efficacy of antituberculosis therapy on pregnancy outcomes in infertile women with genital tuberculosis. It includes randomized controlled trials (RCTs), non-RCTs, and cohort studies for a comprehensive view.
Various antituberculosis regimens were considered, primarily based on isoniazid, rifampicin, pyrazinamide, and ethambutol, administered for 6-12 months.
Findings: A Mixed Bag
The evidence is, to put it mildly, very uncertain. For women without structural damage, the treatment may have little to no effect on pregnancy, full-term pregnancy, abortion, or intrauterine death, and ectopic pregnancy.
In women with structural damage, the treatment may actually reduce the pregnancy rate, but again, the evidence is very uncertain.
PP-ICONS: A Quick Evaluation
- Problem: Infertility in women with genital tuberculosis.
- Patient or Population: Infertile women with genital tuberculosis.
- Intervention: Antituberculosis treatment.
- Comparison: Not receiving antituberculosis treatment or receiving it for a shorter period.
- Outcome: Pregnancy outcomes include full-term pregnancy, abortion, and intrauterine death.
- Number of Subjects: Two RCTs and one non-RCT were included.
- Statistics: Very low certainty of evidence.
Implications and Unanswered Questions
While the study is comprehensive, it leaves the medical community with an array of unanswered questions. The uncertain evidence makes it difficult to form concrete clinical guidelines.
Could different antituberculosis regimens yield different results? Are there other factors at play that the study didn’t account for? These are questions that future research will need to address.
What are your thoughts on these findings? Do you think antituberculosis treatment has a significant impact on pregnancy outcomes? Share your insights below.