Tuberculosis In Pregnancy: Effects, Risks & Treatment

Tuberculosis (TB) is a contagious bacterial disease that affects the lungs. One of the conditions that are tested for early in pregnancy is tuberculosis. Untreated TB harms the baby and the mother more than the actual treatment. It is associated with a 9-fold higher rate of miscarriage.

This article aims to provide an understanding of TB during pregnancy.

Types of tuberculosis in pregnancy

Tuberculosis accounts for a significant share of the global burden of disease. It is also a significant contributor to maternal mortality. The disease is among the three leading causes of death among women between the ages of 15 and 45.

TB is seen in two forms:

• Latent TB

• Active TB

Persons with latent TB do not experience active manifestations of the condition. And it rarely progresses to active TB. It progresses to active TB only when the bacteria defeat the immune barrier and multiply.

Persons who progress to active TB begin to show symptoms. The spread of the disease mainly occurs through blood. The signs of disease are seen either in the lungs or other parts of the body. During this time, the person can actively spread the disease.

Active TB can be either primary or secondary. Primary TB affects the middle and lower lobes of the lung, whereas secondary TB affects the upper lobe of the lung.

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Symptoms of tuberculosis in pregnancy

Symptoms of active TB disease include:

• Fever

• Loss of appetite

• Weight loss

• Night sweats

• Weakness

• Chills

TB of the lungs includes symptoms of

• Cough for more than 3 weeks

• Chest pain

• Coughing up blood

The clinical presentation shows the organ system that is involved in the disease.

However, in both active TB of the lung and other organs, clinical progression can be so gradual that people do not report symptoms.

The signs of TB in pregnancy can coincide with the pregnancy symptoms such as weakness, weight changes, and shortness of breath. This makes it difficult to diagnose.

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Risks of tuberculosis in pregnancy

The effect of tuberculosis in pregnancy depends on

• The severity of the disease

• How far along the pregnancy is at the time of diagnosis

• Spread to internal organs

• HIV coinfection

• The type of treatment used

• TB in pregnancy poses a risk to both the mother and the baby.

• These are some of the risk factors observed.

• A higher incidence of death among mothers has been seen.

• Low birth weight babies are born.

• The disease is passed on to the baby at birth.

• Anaemia in the mother

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Tuberculosis treatment during pregnancy

Pregnancy can make the diagnosis of TB more difficult. Because the symptoms are similar to those of pregnancy, X-rays are avoided.

A tuberculin skin test can be done when symptoms are seen. This is thought to be risk-free during pregnancy.

Latent Tuberculosis Infection (LTBI)

• For nine months, an isoniazid (INH) medication is given either twice a week or daily. It is the accepted course of action for LTBI in expectant mothers.

• Women using INH should also take vitamin B6 supplements.

• Women who are pregnant or plan to get pregnant within the next 3 months. They should not undergo treatment with INH and Rifapentine (RPT)

TB Disease

• As soon as TB is suspected, pregnant women should begin treatment.

• For the first two months of treatment, INH, rifampin (RIF), and ethambutol (EMB) are taken daily.

• For the next seven months, INH and RIF should be followed (for a total of 9 months of treatment).

• Since streptomycin is bad for the developing infant, it is better avoided.

HIV Infection

• Pregnant HIV-positive women should receive treatment right away if they could also have TB disease.

• Rifamycin should be a part of TB treatment plans for expectant HIV-positive women.

Side effects of tuberculosis in pregnancy

• Babies born to women with TB can have a low birth weight.

• The medicines used during treatment could cross the placenta and reach the baby. The baby has experienced no negative side effects.

• In rare cases, a baby could be born with TB.

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Complications of tuberculosis in pregnancy

If the drugs taken during treatment do not work, the doctor may begin something called "second-line" drugs. This is because the bacteria would have gained resistance to the first-line drugs. Some of these drugs are not safe during pregnancy. They can cause birth defects in the baby. Therefore, it is always better to plan pregnancy after TB treatment has been completed.

That said, can a TB patient get pregnant? Yes, the medications consumed during treatment do not affect fertility.

Last but not least, it is critical to understand this illness and its risks before becoming pregnant. It is important to visit the doctor and have yourself checked if any of these indicators are present, as TB puts the unborn child at risk. This problem is not only challenging to diagnose but also difficult to treat if it develops during pregnancy.

References

1. Miele K, Bamrah Morris S, Tepper NK. (2020). Tuberculosis in Pregnancy. Obstet Gynecol.

2. Loto OM, Awowole I. (2012). Tuberculosis in pregnancy: a review. J Pregnancy.

3. Hui SYA, Lao TT. (2022). Tuberculosis in pregnancy. Best Pract Res Clin Obstet Gynaecol.

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