The maternal and fetal effects of tuberculosis therapy

Although tuberculosis is an uncommon condition in pregnant women in the United States, endemic areas can have rates as high as 0.1%.(2) The clinical presentation of tuberculosis does not differ in pregnant and nonpregnant women except for increased rates of malaise and fatigue in noninfected pregnant women. The use of tine tuberculin (TB) testing is not contraindicated during pregnancy and may be considered a routine prenatal diagnostic test in endemic areas or in women at high risk for tuberculosis. Recent tine test converters and symptomatic women with more than 5 mm of induration should undergo shielded chest radiography (results in minimal radiation exposure to the fetus [< 3 mrads]). Sputum samples should be obtained from all women with active tuberculosis to evaluate for the presence of possible drug resistance. The presence of active disease mandates treatment at the time of diagnosis to protect the pregnant woman, fetus, family members, and members of the community. Numerous reports documented a steady decline in the rate of tuberculosis after effective therapies were found in the early 1950s. This decreasing trend in the United States was reversed in the mid-1980s, with a steady rise in the number of cases reported until the early 1990s. Many of these cases occurred in reproductive aged women (25- to 44-years-old) and were attributed to increasing rates of tuberculosis among intravenous drug abusers and HIV-infected patients during this period.(13) Although the overall number of tuberculosis cases reported to the Centers for Disease Control (CDC) decreased from 1992 to 1995 (26,673 to 22,813), the number of cases reported in foreign-born persons increased by 63.3% since 1986.(13) These numbers underscore the need for increased tuberculosis surveillance in high-risk populations. This article reviews the use of therapeutic agents for tuberculosis with a particular focus on their use during pregnancy. The maternal and fetal effects of first- and second-line agents are discussed in detail to aid the health care provider in providing the most safe and effective therapy.