Ecker JL, Ganiats TG; International Society of Technology Assessment in Health Care. Meeting.

Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1996; 12: 22.

University of California, San Francisco, USA.

OBJECTIVE: Isoniazid (INH) prophylaxis of those with a positive PPD in pregnancy remains controversial. Common practice presupposes that INH use in pregnancy is associated with a higher risk of hepatitis, but data supporting this is scant. On the other hand, delaying prophylaxis until after pregnancy may affect compliance. This project re-evaluates the risks and benefits of prophylactic treatment with INH during pregnancy in women with asymptomatic tuberculosis infection. METHODS: Decision analysis was used to estimate life expectancy for a strategy that initiated INH prophylaxis during pregnancy and a strategy that delayed prophylaxis until the postpartum period. Assumptions were drawn from a literature review. RESULTS: Using our baseline assumptions, when the risks and mortality or INH-induced hepatitis were not increased compared to the non-pregnant state, INH prophylaxis during pregnancy was favored in all cases. 1.2 or 1.0 additional years of life were gained for every 100 white and non-white women treated, respectively, compared to delaying treatment until the postpartum period. With an increased risk for INH in pregnancy, treatment during pregnancy was favored only in those populations at high risk for reactivation or likely to fail postpartum follow-up. CONCLUSIONS: The benefit obtained from initiating INH prophylaxis during pregnancy is dependent on the relative risk and morbidity of INH hepatitis during pregnancy as well as the probability of receiving adequate postpartum follow-up. Those at risk for reactivation of tuberculosis or failing postpartum will benefit the most from treatment during pregnancy. A better evaluation of the actual risks of INH in pregnancy is needed before definitive recommendations are made.

Publication Types:

• Meeting Abstracts

Keywords:

• Decision Support Techniques
• Female
• Hepatitis
• Hepatitis, Toxic
• Humans
• Isoniazid
• Life Expectancy
• Patient Compliance
• Postpartum Period
• Pregnancy
• Pregnancy Complications
• Pregnancy Complications, Infectious
• Prenatal Care
• Tuberculin Test
• Tuberculosis
• prevention & control
• therapy
• hsrmtgs

Other ID:

• HTX/97607211

UI: 102222523

From Meeting Abstracts