TB in pregnancy

Treatment of TB should be initiated in pregnancy when there is moderate to high suspicion of disease because active infection during pregnancy poses a risk to the fetus that is greater than the risk of adverse drug effects. The initial regimen should include isoniazid, rifampin and ethambutol. Each of these drugs crosses the placenta, but none is teratogenic. Pyrazinamide is also probably safe in pregnancy and some Medical Letter consultants would use it in addition to or as a substitute for ethambutol, depending on results of susceptibility testing. If pyrazinamide is not used, treatment should be continued for at least 9 months.

Limited data is available on the treatment of MDRTB in pregnancy. Regimens using combinations of amikacin, ethionamide, PAS, cycloserine, capreomycin and fluoroquinolones have been successful without causing fetal adverse effects, although these drugs are not generally considered safe in pregnancy.