Tuberculosis in pregnancy
- Lloyd N Friedman, MD
Lloyd N Friedman, MD
- Clinical Professor of Medicine, Yale University School of Medicine
- Chief Operating Officer and Vice President, Medical Affairs, Milford Hospital
- Lynn T Tanoue, MD
Lynn T Tanoue, MD
- Professor of Medicine
- Yale University School of Medicine
- Section Editors
- C Fordham von Reyn, MD
C Fordham von Reyn, MD
- Section Editor — Tuberculosis; Nontuberculous Mycobacterial Infections
- Professor of Medicine
- Geisel School of Medicine at Dartmouth
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
Worldwide, the burden of tuberculosis (TB) disease in pregnant women is substantial . It was estimated that more than 200,000 cases of active tuberculosis occurred among pregnant women globally in 2011; the burden was greatest in Africa and Southeast Asia . In the United States between 2003 and 2011, the incidence of TB in pregnancy was 26.6 per 100,000 births . (See "Epidemiology of tuberculosis".)
Prenatal care presents a unique opportunity for evaluation and management of latent and active tuberculosis among individuals with risk of tuberculosis who may not otherwise present for medical care [4,5].
Issues related to diagnosis and treatment of latent TB infection and active TB disease in pregnant women will be reviewed here. Issues related to the management of latent and active TB in nonpregnant patients are discussed in detail separately, as are issues related to perinatal TB infection. (See "Diagnosis of latent tuberculosis infection (tuberculosis screening) in HIV-uninfected adults" and "Tuberculosis disease in children", section on 'Perinatal infection' and "Diagnosis of pulmonary tuberculosis in HIV-uninfected adults".)
NATURAL HISTORY OF TB IN PREGNANCY
Tuberculosis (TB) infection is caused by inhalation of viable bacilli, which may persist in an inactive state (known as latent TB infection [LTBI]) or progress to active TB disease.
Individuals with LTBI are asymptomatic and not contagious. Latent TB bacilli remain viable and may reactivate, causing active symptomatic TB disease, which can be transmitted via airborne spread.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- World Health Organization. Guidelines for treatment of drug-susceptible tuberculosis and patient care, 2017 update. http://apps.who.int/iris/bitstream/10665/255052/1/9789241550000-eng.pdf?ua=1 (Accessed on June 08, 2017).
- Sugarman J, Colvin C, Moran AC, Oxlade O. Tuberculosis in pregnancy: an estimate of the global burden of disease. Lancet Glob Health 2014; 2:e710.
- El-Messidi A, Czuzoj-Shulman N, Spence AR, Abenhaim HA. Medical and obstetric outcomes among pregnant women with tuberculosis: a population-based study of 7.8 million births. Am J Obstet Gynecol 2016; 215:797.e1.
- Carter EJ, Mates S. Tuberculosis during pregnancy. The Rhode Island experience, 1987 to 1991. Chest 1994; 106:1466.
- Mathad JS, Gupta A. Tuberculosis in pregnant and postpartum women: epidemiology, management, and research gaps. Clin Infect Dis 2012; 55:1532.
- Snider D. Pregnancy and tuberculosis. Chest 1984; 86:10S.
- Hamadeh MA, Glassroth J. Tuberculosis and pregnancy. Chest 1992; 101:1114.
- Schaefer G, Zervoudakis IA, Fuchs FF, David S. Pregnancy and pulmonary tuberculosis. Obstet Gynecol 1975; 46:706.
- Centers for Disease Control and Prevention (CDC). Tuberculosis among pregnant women--New York City, 1985-1992. MMWR Morb Mortal Wkly Rep 1993; 42:605, 611.
- Starke JR. Tuberculosis in childhood and pregnancy. In: Tuberculosis: Current concepts and treatment, 2nd ed, Friedman LN (Ed), CRC Press, Boca Raton, FL 2000.
- Davidson PT. Managing tuberculosis during pregnancy. Lancet 1995; 346:199.
- Espinal MA, Reingold AL, Lavandera M. Effect of pregnancy on the risk of developing active tuberculosis. J Infect Dis 1996; 173:488.
- Zenner D, Kruijshaar ME, Andrews N, Abubakar I. Risk of tuberculosis in pregnancy: a national, primary care-based cohort and self-controlled case series study. Am J Respir Crit Care Med 2012; 185:779.
- Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society. MMWR Recomm Rep 2000; 49:1.
- Boggess KA, Myers ER, Hamilton CD. Antepartum or postpartum isoniazid treatment of latent tuberculosis infection. Obstet Gynecol 2000; 96:757.
- Present PA, Comstock GW. Tuberculin sensitivity in pregnancy. Am Rev Respir Dis 1975; 112:413.
- Mazurek GH, Jereb J, Lobue P, et al. Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR Recomm Rep 2005; 54:49.
- Lighter-Fisher J, Surette AM. Performance of an interferon-gamma release assay to diagnose latent tuberculosis infection during pregnancy. Obstet Gynecol 2012; 119:1088.
- Worjoloh A, Kato-Maeda M, Osmond D, et al. Interferon gamma release assay compared with the tuberculin skin test for latent tuberculosis detection in pregnancy. Obstet Gynecol 2011; 118:1363.
- Jonnalagadda S, Lohman Payne B, Brown E, et al. Latent tuberculosis detection by interferon γ release assay during pregnancy predicts active tuberculosis and mortality in human immunodeficiency virus type 1-infected women and their children. J Infect Dis 2010; 202:1826.
- Bothamley G. Drug treatment for tuberculosis during pregnancy: safety considerations. Drug Saf 2001; 24:553.
- Centers for Disease Control and Prevention (CDC). Recommendations for use of an isoniazid-rifapentine regimen with direct observation to treat latent Mycobacterium tuberculosis infection. MMWR Morb Mortal Wkly Rep 2011; 60:1650.
- Cruz CA, Caughey AB, Jasmer R. Postpartum follow-up of a positive purified protein derivative (PPD) among an indigent population. Am J Obstet Gynecol 2005; 192:1455.
- Ormerod P. Tuberculosis in pregnancy and the puerperium. Thorax 2001; 56:494.
- Knight M, Kurinczuk JJ, Nelson-Piercy C, et al. Tuberculosis in pregnancy in the UK. BJOG 2009; 116:584.
- Kothari A, Mahadevan N, Girling J. Tuberculosis and pregnancy--Results of a study in a high prevalence area in London. Eur J Obstet Gynecol Reprod Biol 2006; 126:48.
- Wilson EA, Thelin TJ, Dilts PV Jr. Tuberculosis complicated by pregnancy. Am J Obstet Gynecol 1973; 115:526.
- Llewelyn M, Cropley I, Wilkinson RJ, Davidson RN. Tuberculosis diagnosed during pregnancy: a prospective study from London. Thorax 2000; 55:129.
- Good JT Jr, Iseman MD, Davidson PT, et al. Tuberculosis in association with pregnancy. Am J Obstet Gynecol 1981; 140:492.
- Sobhy S, Babiker Z, Zamora J, et al. Maternal and perinatal mortality and morbidity associated with tuberculosis during pregnancy and the postpartum period: a systematic review and meta-analysis. BJOG 2017; 124:727.
- Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. Clin Infect Dis 2016; 63:e147.
- Snider DE Jr, Layde PM, Johnson MW, Lyle MA. Treatment of tuberculosis during pregnancy. Am Rev Respir Dis 1980; 122:65.
- Enarson DA, Rieder HL, Arnodottir T, Trebucq A. Management of tuberculosis: A guide for low income countries, 5th ed, International Union Against Tuberculosis and Lung Disease, Paris 2000.
- World Health Organization. Guidelines for treatment of tuberculosis, 4th edition. WHO, Geneva 2010. http://apps.who.int/iris/bitstream/10665/44165/1/9789241547833_eng.pdf?ua=1&ua=1 (Accessed on October 05, 2016).
- American Academy of Pediatrics. Tuberculosis. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.805.
- Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation: A reference guide to fetal and neonatal risk, 7th ed, Lippincott Williams & Wilkins, Philadelphia 2005.
- US Food and Drug Administration. http://www.fda.gov/medwatch/SAFETY/2004/aug_PI/Rifadin_PI.pdf (Accessed on April 03, 2009).
- Franks AL, Binkin NJ, Snider DE Jr, et al. Isoniazid hepatitis among pregnant and postpartum Hispanic patients. Public Health Rep 1989; 104:151.
- Moulding TS, Redeker AG, Kanel GC. Twenty isoniazid-associated deaths in one state. Am Rev Respir Dis 1989; 140:700.
- Snider DE Jr, Caras GJ. Isoniazid-associated hepatitis deaths: a review of available information. Am Rev Respir Dis 1992; 145:494.
- Columbia Basin College Library. Micromedex: Isoniazid - Adverse effects. http://www.micromedexsolutions.com (Accessed on October 05, 2016).
- Snider DE Jr, Powell KE. Should women taking antituberculosis drugs breast-feed? Arch Intern Med 1984; 144:589.
- NATURAL HISTORY OF TB IN PREGNANCY
- LATENT TUBERCULOSIS INFECTION IN PREGNANCY
- Screening for LTBI
- - Whom to test
- - How to test
- - Diagnostic evaluation after positive test
- Clinical manifestations
- - Whom to treat during pregnancy
- Selecting a treatment regimen
- - Whom to treat after delivery
- ACTIVE TUBERCULOSIS DISEASE IN PREGNANCY
- Clinical manifestations
- - Whom to treat
- - Selecting a treatment regimen
- Controlling transmission
- MONITORING DURING TREATMENT
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS
- General principles
- Latent tuberculosis
- Active tuberculosis
- Other principles