Pregnancy

TB and Pregnancy

While dealing with a TB diagnosis in pregnancy is not easy, there is a greater risk to the pregnant woman and her baby if TB disease is not treated. Babies born to women with untreated TB disease may have lower birth weight than those babies born to women without TB. Rarely, a baby may be born with TB.

Testing for TB

The tuberculin skin test is considered both valid and safe to use throughout pregnancy. The TB blood test is safe to use during pregnancy, but has not been evaluated for diagnosing TB infection in pregnant women. Other tests are needed to diagnose TB disease.

Treatment

Pregnant women who are diagnosed with TB disease should start treatment as soon as TB is detected. Although the TB drugs used in treatment cross the placenta, these drugs do not appear to have harmful effects on the baby.

 

Diagnosis	Treatment
Latent TB Infection	Isoniazid (INH) daily or twice weekly for 9 months, with pyridoxine (vitamin B6) supplementation 3HP INH and Rifapentine is not recommended for pregnant women or women expecting to be pregnant in the next 3 months
TB Disease	The preferred initial treatment regimen is INH, rifampin (RIF), and ethambutol (EMB) daily for 2 months, followed by INH and RIF daily, or twice weekly for 7 months (for a total of 9 months of treatment). Streptomycin should not be used because it has been shown to have harmful effects on the fetus. Pyrazinamide (PZA) is not recommended to be used because its effect on the fetus is unknown.
HIV-Related TB Disease	Treatment of TB disease for pregnant women co-infected with HIV should be the same as for nonpregnant women, but with attention given to additional considerations.  For more information please review the Guidelines for Prevention and Treatment of OpportunisticInfections in HIV-Infected Adults and Adolescents. TB treatment regimens for HIV-infected pregnant women should include a rifamycin. 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 may 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.