Tuberculosis in pregnancy

Abstract

Key content Tuberculosis (TB) is an important global cause of maternal and neonatal morbidity and mortality. With increasing migration, cases of tuberculosis in pregnancy or the puerperium are increasing in resource‐rich nations with advanced health care systems. Diagnosis may be delayed given the overlap of some of the symptoms with that of pregnancy. Timely diagnosis is essential to initiate appropriate treatment and prevent maternal and neonatal morbidity and mortality. Learning objectives To understand the relevant global and UK epidemiology of the disease, including recent goals set by the World Health Organization and the UK. To review the pathophysiology of pulmonary and extrapulmonary TB, and of latent and active TB. To learn how to identify high‐risk women for antenatal assessment and gain an awareness of the screening tests available for latent TB. To gain awareness of the clinical symptoms, diagnosis and therapeutic management of active tuberculosis, including management of any drug resistance. To understand management of the neonate within high‐risk groups and where the mothers have diagnosed latent or active TB. Ethical issues Pregnant women with TB should be fully counselled about the benefits, risks, and alternate options of management. Should healthcare professionals with high risk of acquiring TB infection be exempt from managing TB infection? Management of TB in HIV‐positive women provides additional challenges. Breastfeeding issues around seropositive mothers should be considered.