Risk of Tuberculosis in Pregnancy A National, Primary Care-based Cohort and Self-controlled Case Series Study
Risk of Tuberculosis in Pregnancy A National, Primary Care-based Cohort and Self-controlled Case Series Study
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DOI：
10.1164/rccm.201106-1083oc
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发表时间：
2012-04-01
影响因子：
24.7
通讯作者：
Abubakar, Ibrahim
中科院分区：
文献类型：
--
作者：
Zenner, Dominik;Kruijshaar, Michelle E.;Abubakar, Ibrahim
目的：结核病（TB）疾病对母亲和儿童产生不利影响，在这一群体中控制结核病的策略是重要的。本研究的目的是分析妊娠期结核病的流行病学，并确定妊娠是否是结核病的独立危险因素。方法：英国范围内的队列研究基于全科医生研究数据库（GPRD），纳入1996年至2008年间怀孕的所有妇女。采用泊松回归计算妊娠期、产后6个月和妊娠期外的结核病发病率和发病率比（IRRs），并进行比较。一个嵌套的自我控制病例系列比较了这些时期的结核病风险，调整了个体和时间限制的混杂因素。测量结果和主要结果：合并妊娠和产后的粗结核率为15.4 / 10万人-年，显著高于非妊娠期（9.1 / 10万人-年，P = 0.02）。经年龄、地区和社会经济地位调整后，产后结核病风险显著高于妊娠外（IRR, 1.95； 95%可信区间[CI]， 1.24-3.07），而妊娠期间没有显著增加（IRR, 1.29; 95% CI, 0.82-2.03）。这些观察结果在自我对照病例系列中得到证实（IRR分别为1.62,95% CI为1.01-2.58，IRR为1.03,95% CI为0.64-1.65）。结论：产后肺结核的诊断率明显增高。虽然我们没有发现怀孕期间发病率增加，但产后发病率可能反映了怀孕期间诊断，免疫和行政延误的增加。应提高临床医生的认识，评价高危人群孕妇、产后妇女定向筛查等公共卫生政策措施的有效性。
Objectives: Tuberculosis (TB) disease adversely affects mother and child, and strategies to control TB in this group are important. The aim of this study was to analyze the epidemiology of TB in pregnancy, and to establish whether pregnancy is an independent risk factor for TB.Methods: The United Kingdom-wide cohort study was based on the General Practitioner Research Database (GPRD), enrolling all women with pregnancies between 1996 and 2008. Incidence rates and incidence rate ratios (IRRs) of TB events during pregnancy, 6 months postpartum, and outside pregnancy were calculated and compared by Poisson regression. A nested self-controlled case series compared the risk of TB in these periods, adjusting for individual and time-bound confounders.Measurements and Main Results: The crude TB rate for the combined pregnancy and postpartum period was 15.4 per 100,000 person-years, significantly higher than outside of pregnancy (9.1 per 100,000 person-years; P = 0.02). Adjusting for age, region, and socioeconomic status the postpartum TB risk was significantly higher than outside pregnancy (IRR, 1.95; 95% confidence interval [CI], 1.24-3.07), whereas there was no significant increase during pregnancy (IRR, 1.29; 95% CI, 0.82-2.03). These observations were confirmed in the self-controlled case series (IRR, 1.62; 95% CI, 1.01-2.58 and IRR, 1.03; 95% CI, 0.64-1.65, respectively).Conclusions: The incidence of TB diagnosis is significantly increased postpartum. Although we did not find an increase during pregnancy, the postpartum incidence may reflect an increase during pregnancy given diagnostic, immunological and administrative delays. Clinicians' awareness should be improved and the effectiveness of public health policy measures such as targeted screening of pregnant and postpartum women in high-risk groups should be evaluated.