Targeted Testing and Treatment of Women at High Risk for Tuberculosis
Testing and treatment for latent tuberculosis infection (LTBI) of asymptomatic women during pregnancy should be pursued only in the context of known risk factors for exposure to TB (such as residence in a homeless shelter or birth or residence in a high TB prevalence country) or for progression to TB disease (such as diabetes or HIV). The TB skin test and interferon gamma release assays (IGRAs) are safe in pregnancy.
LTBI treatment should be delayed until three or more months after delivery, when possible, to minimize the risk of hepatitis, but treatment during pregnancy may be indicated for contacts and those at highest risk for progression to TB disease (i.e., those with HIV infection or recent M. tuberculosis infection). Providers should closely monitor those receiving LTBI treatment for adverse events and to ensure adherence.
Women with signs or symptoms of TB disease or a positive test for TB infection should be further evaluated for TB disease.
TB disease is associated with adverse maternal and fetal outcomes, and should always be promptly treated, even in pregnant women. These evaluations should include: a clinical history and physical examination, a chest radiograph (with shielding to protect the fetus), and sputum smear microscopy, culture, and nucleic acid amplification testing (if indicated based on history or radiographic findings).
Pyridoxine should be given to pregnant or breastfeeding women who are prescribed isoniazid.
- Close contact with persons known or suspected to have TB
- Having been born or lived in high TB prevalence countries
- Living or working in congregate settings, such as correctional institutions, homeless facilities, or healthcare facilities
Medical risk factors known to increase risk of disease in the context of infection:
- HIV infection
- Potent immunosuppressive therapy (e.g. immunosuppressive drugs such as prednisone or TNF-a antagonists)
- Substance use