Pregnancy

TB Disease in 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 Infection for Pregnant Women

Pregnant women at high risk for developing TB disease should be tested for TB infection. Generally, pregnant women at high risk for developing TB disease include:

  • Persons who have been recently infected with TB bacteria
  • Persons with medical conditions that weaken the immune system

The tuberculin skin test is both safe and reliable to use throughout pregnancy. The TB blood test is safe to use during pregnancy, but has not been fully evaluated for diagnosing TB infection in pregnant women. Therefore, TB blood test results should be interpreted with the help of a TB expert.

If a tuberculin skin test or TB blood test is positive, other tests are needed to diagnose TB disease. Healthcare providers should obtain a chest radiograph using proper shielding.

Latent TB Infection and TB Disease Treatment for Pregnant Women

Treatment for Latent TB Infection

For most pregnant women, treatment for latent TB infection can be delayed until 2–3 months post-partum to avoid administering unnecessary medication during pregnancy. However, for pregnant women who are at high risk for progression from latent TB infection to TB disease, especially those who are a recent contact of someone with infectious TB disease, treatment for latent TB infection should not be delayed on the basis of pregnancy alone, even during the first trimester.

Treatment for TB Disease

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

Treatment Regimens for Latent TB Infection and TB Disease

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
  • 4-month daily regimen of rifampin (RIF) (4R)
  • 3-month daily regimen of isoniazid (INH) and RIF (3HR)
  • 6- or 9-month daily regimen of INH (6H or 9H) , with pyridoxine (vitamin B6) supplementation
  • Supplementation with 25–50 mg/day of pyridoxine (vitamin B6) is recommended for pregnant women taking INH to ameliorate possible adverse effects of the drug.
    For women in the post-partum period (within 3 months of delivery), baseline liver function tests should be conducted.
  • The 3-month weekly INH and rifapentine (3HP) regimen is not recommended for pregnant women or women expecting to become pregnant during the treatment period because its safety during pregnancy has not been studied.
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 baby.
  • Pyrazinamide (PZA) is not recommended to be used because its effect on the baby is unknown.
HIV-Related TB Disease

Contraindications

The following antituberculosis drugs are contraindicated in pregnant women

  • Streptomycin
  • Kanamycin
  • Amikacin
  • Capreomycin
  • Fluoroquinolones

Drug-Resistant TB

Women who are being treated for drug-resistant TB should receive counseling concerning the risk to the baby because of the known and unknown risks of second-line antituberculosis drugs.

Breastfeeding

Breastfeeding is not contraindicated in women taking INH or RIF separately. Supplementation of pyridoxine (vitamin B6) is recommended for nursing women and for breastfed infants. The amount of INH or RIF in breast milk is inadequate for treatment of infants with LTBI.

RIF can cause orange discoloration of body fluids, including breast milk. Orange discoloration of body fluids is expected and harmless.

There currently is not enough data to indicate whether the 3HP regimen is safe for women to take while breastfeeding.

Page last reviewed: November 16, 2014