Antituberculous therapy in pregnancy. Risks to the fetus

Area of Science:

• Pharmacology
• Obstetrics
• Teratology

Background:

• Tuberculosis (TB) remains a global health concern, necessitating treatment during pregnancy.
• The safety of anti-TB medications during gestation requires careful evaluation to prevent adverse fetal outcomes.

Purpose of the Study:

• To assess the teratogenic potential of key anti-tuberculosis drugs: isoniazid, ethambutol, rifampin, and streptomycin.
• To establish evidence-based guidelines for managing active TB in pregnant individuals.

Main Methods:

• A retrospective survey of 1,939 births to mothers treated with isoniazid, ethambutol, rifampin, or streptomycin during pregnancy.
• Analysis of birth defect incidence in infants exposed to these medications in utero.

Main Results:

• Isoniazid, ethambutol, and rifampin were not associated with a significant increase in congenital malformations.
• Streptomycin exposure in utero correlated with a higher incidence of mild auditory and vestibular defects.

Conclusions:

• Isoniazid, ethambutol, and rifampin are considered relatively safe for treating TB during pregnancy.
• Streptomycin use in pregnancy should be approached with caution due to potential ototoxicity and vestibular effects.
• The findings support the development of guidelines for safe and effective TB treatment in pregnant women.