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TB and PregnancyEspañol (Spanish)|Print										Related Pages
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			TB Disease in PregnancyTesting for TB Infection for Pregnant WomenTreatment for Latent TB InfectionDrug-Resistant TBBreastfeedingRelated Links
		
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 systemThe 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.
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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.
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**Treatment for TB Disease**
Pregnant women who are diagnosed with TB disease should start treatmentas 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.
Top of PageTreatment 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
TreatmentLatent 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
Treatment of TB disease for pregnant women co-infected with HIV should be the same as for nonpregnant women, but with attention given to additional considerations. For more information please review the Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents.Contraindications
The following antituberculosis drugs are contraindicated in pregnant women
Streptomycin
Kanamycin
Amikacin
Capreomycin
FluoroquinolonesTop of Page
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
Pregnant woman
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.
Top of PageRelated LinksState TB Control Offices
Fact Sheets on TuberculosisFor Patients
Treatment for TB Disease and Pregnancy
Testing During Pregnancy
Staying on Track with TB Medicine [PDF – 8MB] (Pamphlet)For Health Care Providers
Latent Tuberculosis Infection: A Guide for Primary Health Care Providers [PDF – 4MB]
Treatment for TB Disease & Pregnancy
Testing and Diagnosis Guidelines
TB Treatment GuidelinesTB Personal Stories: Pregnancy
							
					
							Last Reviewed:  November 16, 2014						Source: 	Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
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