Unfortunately, combined influences of maternal TB and co-existing undernutrition are not explored systematically in clinical studies. The potential role of socioeconomic factors55 and maternal impoverished nutrition56 has been suggested in earlier studies from developed

countries. A recent study from India also showed that multiparity, anemia, undernutrition and overcrowding, all added to the problem of maternal TB.10 The risk factors for TB also adversely affect perinatal outcome. Selleck RG7422 It is very difficult, if not impossible to dismantle the potential effects of those risk factors on pregnancy outcome from that of TB. In addition, TB being a chronic debilitating disease requiring long-term care and medication, often consumes enormous financial and non-financial resources

of the family. Furthermore, simultaneously attending maternity care and the TB clinic can be a very daunting task for an indigent family. As a consequence, irregular treatment and advanced tuberculous disease can adversely affect both maternal and perinatal health and survival, especially for women in South Asian countries and ethnic minorities in the UK.7,8,14 Therefore, it is important to consider the problem of TB not as a medical problem alone, but to consider it holistically in the context of socioeconomic background (Fig. 1).57 Anti-TB GDC-0199 mouse drug therapy is only a part of the solution to a more complex issue with medical-social-economic-cultural factors, which need a multidimensional approach ifenprodil from several agencies. Education and emotional support of the affected women and their family members emphasizing the twin need of TB treatment and pregnancy care are two vital issues,29 which can affect successful obstetric outcome. These require the concerted efforts of the public health system and maternity service, which remain suboptimal in most South Asian countries.27 Advocacy, communication and social mobilization are three key factors, which can effectively bridge pre-existing gaps between the health system and the community by enhancing TB knowledge, attitude

and practice.58 It is a sad irony that despite TB largely affecting young women of reproductive age, only piecemeal information about its effects in pregnancy is available, and this incomplete knowledge has clouded our understanding regarding management of TB in pregnant women, and its effect on perinatal outcomes. TB and HIV are inextricably related.23,59 The negative impacts of each on the other have been widely documented.59–62 Both infections occur in women of the reproductive age group.60 HIV infection and TB during pregnancy are considered a ‘deadly combination’ and are independent risk factors for maternal mortality.63 Although Africa is worst affected by this dual disease,23,59 HIV co-infection affects approximately 4–5% of all TB incidence cases in India in 2008 and to a lesser extent, other South Asian countries.