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TB Treatment & Pregnancy

Untreated tuberculosis (TB) disease represents a greater hazard to a pregnant woman and her fetus than does its treatment. Treatment should be initiated whenever the probability of TB is moderate to high.

  • Infants born to women with untreated TB may be of lower birth weight than those born to women without TB and, in rare circumstances, the infant may be born with TB.
  • Although the drugs used in the initial treatment regimen for TB cross the placenta, they do not appear to have harmful effects on the fetus.

TB Treatment Regimens for Pregnant Women

 TB Treatment Regimens for Pregnant Women
Diagnosis Treatment
Latent TB Infection
  • Isoniazid (INH) daily or twice weekly for 9 months, with pyridoxine (vitamin B6) supplementation
  • 3HP INH and Rifapentine is not recommended for pregnant women or women expecting to be pregnant in the next 3 months
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 fetus.
  • Pyrazinamide (PZA) is not recommended to be used because its effect on the fetus is unknown.
HIV-Related TB Disease

Contraindications

The following antituberculosis drugs are contraindicated in pregnant women:

  • Streptomycin
  • Kanamycin
  • Amikacin
  • Capreomycin
  • Fluoroquinolones

Drug-Resistant TB

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

Breastfeeding

Breastfeeding should not be discouraged for women being treated with the first-line antituberculosis drugs because the concentrations of these drugs in breast milk are too small to produce toxicity in the nursing newborn. For the same reason, drugs in breast milk are not an effective treatment for TB disease or latent TB infection in a nursing infant. Breastfeeding women taking INH should also take pyridoxine (vitamin B6) supplementation.

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