Tuberculosis (TB) in pregnancy - A review

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Public Health

Background:

• Tuberculosis (TB) is a significant global health challenge, particularly in low-income countries, and can complicate pregnancy.
• While pulmonary TB is historically more common, extrapulmonary TB (EPTB) is increasing, especially in individuals with HIV co-infection or comorbidities.
• Pregnancy symptoms can mask TB, leading to diagnostic delays and potentially adverse maternal and fetal outcomes.

Purpose of the Study:

• To review the maternal and perinatal outcomes associated with tuberculosis during pregnancy.
• To discuss the diagnostic approaches for pulmonary and extrapulmonary TB in pregnant individuals.
• To outline the management strategies for TB in pregnancy, including drug-sensitive and drug-resistant forms.

Main Methods:

• This review synthesizes current literature on tuberculosis in pregnancy.
• It examines epidemiological trends, diagnostic challenges, and treatment guidelines.
• Focus is placed on maternal and perinatal outcomes, including complications and management of drug-resistant TB.

Main Results:

• Timely diagnosis and treatment of both pulmonary and EPTB are linked to excellent maternal and perinatal results.
• Delayed diagnosis and treatment can lead to adverse outcomes such as preterm labor, fetal growth restriction, and stillbirth.
• Severe TB forms like miliary TB and multidrug-resistant TB (MDR TB) are associated with poor prognoses.

Conclusions:

• Effective management of TB in pregnancy involves standard diagnostic and treatment protocols, similar to non-pregnant individuals.
• A four-drug regimen (isoniazid, rifampicin, pyrazinamide, ethambutol) for 2 months, followed by a three-drug regimen (isoniazid, rifampicin, ethambutol) for 4 months, is recommended for drug-sensitive TB.
• Optimal antenatal care, nutrition, and cautious use of second-line drugs for resistant TB are crucial for favorable maternal and perinatal outcomes.