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. In 2011, it was estimated that more than 200,000 cases of active tuberculosis occurred among pregnant women globally; the greatest burdens were in Africa and Southeast Asia .
Prenatal care presents a unique opportunity for evaluation and management of latent and active tuberculosis in pregnant women . Routine tuberculin skin test (TST) screening is not indicated for all pregnant women. However, individuals with an increased risk of tuberculosis may seek medical care only during pregnancy (such as foreign-born individuals within five years of immigration from TB-endemic countries or individuals with HIV infection) . (See "Epidemiology of tuberculosis".)
The pathogenesis of tuberculosis infection and disease in pregnant women is similar to that in nonpregnant women [4,5]. There is no firm evidence that the risk of new infection or reactivation of tuberculosis in pregnant women is significantly different from matched controls. However, tuberculosis in pregnant women can present insidiously, since symptoms of malaise and fatigue may be attributed to pregnancy rather than disease . In addition, during pregnancy it can be difficult to recognize weight loss. (See "Natural history, microbiology, and pathogenesis of tuberculosis".)
Since pregnancy has not been shown to increase the risk of TB, the epidemiology of TB in pregnancy is a reflection of the general incidence of disease . This also is true in HIV-infected women, as shown in a group of predominantly HIV-infected pregnant women in New York City during 1991 to 1992, where the rate of TB was 94.8 per 100,000 deliveries .
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. (See "Diagnosis of latent tuberculosis infection (tuberculosis screening) in HIV-uninfected adults" and "Diagnosis of pulmonary tuberculosis in HIV-uninfected patients" and "Treatment of pulmonary tuberculosis in HIV-uninfected adults".)
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- LATENT TB
- Toxicity and monitoring
- ACTIVE TB
- Clinical manifestations
- Treatment of active TB
- - First-line drugs
- - Second-line drugs
- Agents to avoid
- Agents to consider
- - Follow-up
- CONGENITAL AND NEONATAL TB
- CONTROLLING TRANSMISSION
- SUMMARY AND RECOMMENDATIONS