The diagnosis of tuberculosis in pregnancy is made by history taking, physical examination, and skin testing, with special attention to women from ethnic groups with a high prevalence of the disease (such as women from southeast Asia). Chest films should not be obtained as a routine screening measure in pregnancy but should be used only in patients with a skin test conversion or with suggestive findings in the history and physical examination. Abdominal shielding must be used if a chest film is obtained.
If adequately treated, tuberculosis in pregnancy has an excellent prognosis. There is no increase in spontaneous abortion, fetal problems, or congenital anomalies.
Treatment is with isoniazid and ethambutol or isoniazid and rifampin. Because isoniazid therapy may result in vitamin B6 deficiency, a supplement of 50 mg/d of vitamin B6 should be given simultaneously. Streptomycin, ethionamide, and most other antituberculous drugs should be avoided in pregnancy.
Revision date: July 3, 2011
Last revised: by Andrew G. Epstein, M.D.