9 A prospective observational study over a period of 10 years (1991–2000) Nivolumab order from Mumbai, western India, included 153 pregnant women with TB (133 pulmonary and 20 extrapulmonary cases).10 This study revealed that maternal TB was associated with a high incidence of LBW neonates, which was primarily attributed to fetal growth restriction. Although there was some improvement of perinatal outcomes in the latter half of the study, the problems of LBW and late fetal death remained unabated. Because of sparse literature on perinatal effects of

maternal TB, it may be worthwhile extrapolating the experience from a comparative study carried out in Mexico, which also showed increased risk of perinatal morbidity and mortality among 35 women with pulmonary or extrapulmonary TB: prematurity (RR 2.1; 95%CI 1–4.3), LBW neonates (RR 2.2; 95%CI 1.1–4.9), neonatal complications (RR 2.1; 95%CI 1.1–3.9) and perinatal death (RR 3.1; 95%CI 1.6–6).13 Approximately twofold increase

in prematurity and fetal growth restriction was responsible for most neonatal complications.13 In this study, pulmonary localization of TB and late start of treatment were two major factors which determined poor perinatal outcome Doxorubicin clinical trial in maternal TB.12,13 Furthermore, by stratified analysis, the authors inferred that anti-TB treatment early in pregnancy can reverse these complications.12 This is in contrast to a recent comparative study from Taiwan, which showed an increased risk of LBW (odds ratio [OR] 1.35; 95%CI 1.01–1.81) and SGA (OR 1.22; 95%CI 1.00–1.49) babies born to mothers who started

anti-TB drugs even before conception.22 Although several case series from developed countries reaffirmed potential perinatal dangers of maternal TB,14,21,48 the others reported satisfactory pregnancy outcomes.49–51 Pregnancy outcome among women Inositol monophosphatase 1 with TB is often influenced by poverty, which is a multidimensional phenomenon.32,52,53 In South Asian countries, poverty, hunger and undernutrition are widespread.2 There is a close link between TB and poverty.32,52 It is very important to understand the potential effects of this combination on maternal and perinatal health, especially in low-income South Asian countries, where the health-care system is relatively dysfunctional and barriers to care are substantial.27 Pervasive poverty, inequitable economic growth, political instability and widespread corruption are major roadblocks to most public health measures in the South Asian region.2,54 It is well known that nutritional status, chronic disease like TB and pregnancy events are influenced by each other.7,8,32,52 These factors are synergistically modulated by the socioeconomic factors that include education, income and occupation of couples, demographic features of home, access to quality food and health-care practices.