Tuberculosis and Pregnancy

Abstract

The prevalence of tuberculosis in women of childbearing age and during pregnancy is increasing both in developing countries and among ethnic immigrants in urban areas of developed countries (Centers for Disease Control and Prevention 1994, 1995; Ahmed et al. 1999; Hageman 1998). The morbidity and mortality among pregnant women with tuberculosis, the fetus, and the neonate have also increased, particularly among those co-infected with HIV (Adhikari et al. 1997). A high index of suspicion by attending clinicians and effective measures during the prenatal period are essential for reducing these risks (Starke 1997). Pregnancy as a predisposing or risk factor for the development of tuberculosis has never been proven, as suggested in the past (Snider 1984; Espinal et al. 1996). Pregnancy has no effect on the incidence or prognosis of tuberculosis. The effect of tuberculosis on the outcome of pregnancy, the fetus, and the neonate has lost most of its importance due to the existence of effective antituberculous agents. However, a delay in diagnosing active tuberculosis poses a real risk to the pregnant woman, fetus, and infant. Tuberculosis in pregnant women may be asymptomatic, particularly when it invades extrapulmonary sites in the body, and therefore presents a great risk of neonatal morbidity and mortality. Symptoms related to tuberculosis may be mild and mimic those caused by normal pregnancy such as dyspnea and fatigue (Gogus et al. 1993; Machin et al. 1992). The disease may first present in the neonate, and acute tuberculosis may later be discovered in the mother. (1980) reported that tuberculosis was initially presented and diagnosed in neonates in 15 of 26 cases, and subsequent investigations of their mothers detected active disease. Congenital and neonatal tuberculosis associated with undiagnosed and untreated mothers carries an infant mortality rate of 50% (Nemir and O’Hare 1985). Antenatal screening of pregnant women in endemic areas should include piain ehest radiography if pulmonary tuberculosis is suspected, with proper shielding of the abdomen.