Tuberculosis and Pregnancy
Treatment of Tuberculosis in Pregnancy
In almost all situations, tuberculosis discovered during pregnancy should be treated without delay. A pregnant woman with a positive skin test and abnormal chest x-ray findings compatible with tuberculosis should start treatment. Three samples of induced sputum should be submitted for smear, culture, and drug-susceptibility testing. The outcome of these tests will determine the regimen for continuation of treatment.
Drug Treatment for HIV-Seronegative Women with Drug-Susceptible TB
- • The initial treatment regimen should consist of isoniazid (INH), rifampin (RIF), and ethambutol (EMB)
- • Pyridoxine (Vitamin B6) is recommended for pregnant women taking INH
- • Routine use of pyrazinamide (PZA) should be avoided because of inadequate teratogenicity data
- • Para-aminosalicyclin (PAS) has been used safely in pregnancy but may be poorly tolerated
- • Avoid: streptomycin (which interferes with development of the ear and may cause congenital deafness), kanamycin, amikacin, capreomycin, fluoroquinolones (ciprofloxacin, levofloxacin, ofloxacin, and sparfloxacin), cycloserine, ethionamide, and clofazimine
Treatment of Latent TB Infection in Pregnant Women
In most pregnant women, treatment of latent TB infection (LTBI) should be delayed until 2 or 3 months after delivery, even though no harmful effects of INH (the standard treatment regimen for TB infection) on the fetus have been documented. However, in some cases treatment for LTBI (INH, 300 mg) should begin during pregnancy for women with a positive tuberculin skin test:
- • Treatment of latent TB infection should be started during the first trimester of pregnancy for:
- Pregnant women who have HIV infection or behavioral risk factors for HIV infection but refuse HIV testing
- Pregnant women who have been in recent close contact with an individual with smear-positive pulmonary TB (at the physician's discretion)
- • Treatment of latent TB infection should be started after the first trimester of pregnancy for pregnant women who have had a documented tuberculin skin test conversion in the past 2 years
Treatment of LTBI, if indicated, should be started 2 to 3 months after delivery for all other pregnant women, including those with radiographic evidence of old, healed TB.
If a woman taking INH and/or rifampin for treatment of LTBI becomes pregnant, treatment should be interrupted and started again 2 or 3 months after delivery, unless one or more of the above risk factors are present.
Breast Feeding
Because the small concentrations of anti-tuberculosis drugs in breast milk do not produce toxicity in the nursing newborn, breast feeding should not be discouraged for an HIV-seronegative woman who is planning to take or is taking INH or other anti-TB medications. Furthermore, the low concentration of anti-TB medications in breast milk should not be considered effective treatment for disease or as treatment for latent TB infection in a nursing infant. Women who are HIV seropositive should not breast feed because of the risk factor of HIV transmission to the infant.
For additional information on pregnancy, please see Women's Healthline.
To find out more about tuberculosis, call 311.
