Navigating Tuberculosis in Pregnancy and Lactation: A Review of Maternal and Neonatal Considerations

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. Despite the availability of effective treatments and advances in diagnostic methods, TB remains the leading cause of death from infectious disease globally, with its incidence tending to increase. Pregnant women constitute a population group with particular characteristics, as the diagnosis and treatment of certain conditions can be challenging. Early diagnosis and monitoring of TB by a multidisciplinary team are crucial to guide treatment and reduce complications. Congenital TB, although uncommon, is a serious complication that should be assessed in neonates, especially when the mother has previously been diagnosed with the disease. First-line anti-TB drugs are considered safe during pregnancy and lactation. In contrast, second-line drugs have a less well-established safety profile during breastfeeding, and the available evidence regarding their excretion in breast milk remains limited; therefore, their use requires individualised risk-benefit assessment. Data on this specific population group are limited, as physiological changes during pregnancy alter the pharmacokinetics/pharmacodynamics (PK/PD) of drugs and the inclusion of pregnant women in clinical trials remains contentious. Routine TB screening in prenatal care, particularly in high-prevalence regions, is crucial to improving maternal and neonatal outcomes. This narrative review was based on a structured search of PubMed, Scopus, and Web of Science (January 2000-June 2025), using the keywords tuberculosis, Mycobacterium tuberculosis, pregnancy, and breastfeeding. Eligible articles included original studies, reviews, and international guidelines.