Tuberculosis and pregnancy--a provincial study (1990-1996)

Several studies suggest that physiological changes in pregnancy mimic early symptoms of tuberculosis. If true, this could influence the diagnostic delay of the disease and the outcome of pregnancy.

From the register of the Public Health Centre, all female patients with culture-proven tuberculosis aged between 22 and 35 years in the Province of Zeeland in the period 1990-1996 have been identified. Data on symptoms, delay, therapy and outcome of the pregnancy have been collected. Risk factors for an early diagnosis have been identified.

In nearly one-third of the patients with tuberculosis (n = 14), it has been possible to make a presumptive diagnosis on the basis of a chest X-ray only. Patients with tuberculosis associated with pregnancy are more likely than their non-pregnant counterparts to have non-specific symptoms which are, at most, moderate (p = 0.002). Diagnosis has also been hampered by non-cavernous, smear-negative presentation of the disease. In addition, women with pulmonary tuberculosis associated with pregnancy are more likely to postpone having a chest X-ray taken (p = 0.02), which contributes to the delay.

As the clinical features of tuberculosis in pregnancy are moderate, a high index of clinical suspicion is necessary. Nevertheless, the favourable outcome suggests that (if all risk factors are taken into account) lung tuberculosis in pregnant women in The Netherlands can be discovered sufficiently early within the limits of the current screening programme to prevent harm to mother or child.