Prophylaxis for Tuberculosis in Pregnant Women.

Area of Science:

• Public Health
• Infectious Diseases
• Maternal Health

Background:

• Increasing immigration of women at risk for tuberculosis (TB) reactivation necessitates improved perinatal care.
• Tuberculosis screening and chemoprophylaxis are crucial for preventing TB reactivation in pregnant individuals.

Purpose of the Study:

• To outline current recommendations for tuberculosis screening and treatment in pregnant women at increased risk.
• To provide guidance on managing latent tuberculosis infection during the perinatal period.

Main Methods:

• Review of existing data on interferon-gamma release assays (IGRAs) and tuberculin skin tests (TST) in pregnancy.
• Analysis of safety and efficacy data for tuberculosis chemoprophylaxis in pregnant and breastfeeding women.

Main Results:

• Both IGRAs and TST are acceptable screening methods, with TST having more supporting data in pregnancy.
• Latent TB infection is likely in women screening positive after active TB is excluded.
• Prophylaxis is generally deferred until 3 months postpartum, except in specific high-risk cases.
• Isoniazid with pyridoxine for 9 months is the preferred prophylactic regimen, demonstrating reasonable safety during pregnancy and breastfeeding.

Conclusions:

• Effective perinatal tuberculosis screening and management are essential for at-risk immigrant populations.
• Isoniazid prophylaxis is considered safe for pregnant and breastfeeding women, with maternal hepatotoxicity monitoring recommended.