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Tuberculosis and Pregnancy
Tuberculosis and Pregnancy
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Tuberculosis and Pregnancy |
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Last Updated: June 2005
Introduction
Untreated tuberculosis (TB) represents a greater hazard to a pregnant
woman and her fetus than does its treatment. Treatment of pregnant
women should be initiated whenever the probability of TB is moderate
to high. Infants born to women with untreated TB may be of lower
birth weight than those born to women without TB and, rarely, the
infant may be born with TB. Although the drugs used in the initial
treatment regimen cross the placenta, they do not appear to have
harmful effects on the fetus.
Testing
Tuberculin skin testing is considered valid and safe throughout
pregnancy. However, testing with QuantiFERON®-TB and
QuantiFERON®-TB Gold has not been evaluated for diagnosing
M. tuberculosis infection in pregnant women.
Treatment
Latent TB Infection (LTBI) – Isoniazid (INH)
administered either daily or twice weekly for 9 months is the preferred
regimen for the treatment of LTBI in pregnant women. Women taking
INH should also take pyridoxine (vitamin B6) supplementation.
TB Disease - Pregnant women should start treatment
as soon as TB is suspected. The preferred initial treatment regimen
is INH, rifampin (RIF), and ethambutol daily for 2 months, followed
by INH & RIF daily, or twice weekly for 7 months, for 9 months
of total treatment. Streptomycin should not be used because it has
been shown to have harmful effects on the fetus. In most cases,
pyrazinamide (PZA) is not recommended to be used because its effect
on the fetus is unknown.
HIV Infection - HIV-infected pregnant
women who are suspected of having TB disease should be treated without
delay. TB treatment regimens for HIV-infected pregnant women should
include a rifamycin. Although the routine use of PZA during pregnancy
is not recommended in the United States,
the benefits of a TB treatment regimen that includes PZA for HIV-infected
pregnant women outweigh the undetermined potential risks to the
fetus.
Contraindications
The following antituberculosis drugs are contraindicated in pregnant
women:
- Streptomycin
- Kanamycin
- Amikacin
- Capreomycin
- Fluoroquinolones
Women who are being treated for drug-resistant TB should receive
counseling concerning the risk to the fetus because of the known
and unknown risks of second-line antituberculosis drugs.
Breastfeeding
Breastfeeding should not be discouraged for women being treated
with the first-line antituberculosis drugs because the concentrations
of these drugs in breast milk are too small to produce toxicity
in the nursing newborn. For the same reason, drugs in breast milk
are not an effective treatment for TB disease or LTBI in a nursing
infant. Breastfeeding women taking INH should also take pyridoxine
(vitamin B6) supplementation.
For More Information
CDC. Treatment
of tuberculosis. MMWR 2003; 52 (No. RR-11).
American Thoracic Society/CDC. Targeted
tuberculin testing and treatment of latent TB infection. Am
J Respir Crit Care Med 2000; 161: S221.
CDC. Prevention
and treatment of tuberculosis among patients infected with human
immunodeficiency virus: principles of therapy and revised recommendations.
MMWR 1998;47:1-58.
CDC. Guidelines
for using the QuantiFERON®-TB test for diagnosing latent
Mycobacterium tuberculosis infection - MMWR 2003;
52 (No. RR-2).
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