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 Regimen for Pregnant Women
Treatment at per National Tuberculosis Elimination Programme (Previously RNTCP) includes Isoniazid (H), Rifampicin (R), Ethambutol(E), Pyrazinamide(Z) for 2 months and then H, R, E for next 4 months usually. Sometimes some modification is required from case to case basis.
Contraindications
The following antituberculosis drugs are contraindicated in pregnant women:
- • Streptomycin
- • Kanamycin
- • Amikacin
- • Capreomycin
- • Ethionamide
- • Bedaquiline
Drug-Resistant TB
Pregnant women who are being treated for drug-resistant TB should receive counselling concerning the risk to the fetus because of the known and unknown risks of second-line antituberculosis drugs.
Consider termination of pregnancy if the mother’s life is compromised. When the condition of the mother is so poor that a pregnancy would carry a significant risk to her life, a medical abortion may be indicated.
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 new born. 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.