Treat tuberculosis in pregnancy using first-line agents, but wait for second-line agents

Beware of false-positive skin tests in pregnant women vaccinated with BCG (Bacille Calmette Guerin vaccine for tuberculosis [TB]), in those previously treated for TB infection, or in those previously infected with other Mycobacterium species. False negatives can occur in those with compromised immune systems (eg, HIV) or due to technical errors.

TB still causes a significant amount of morbidity and death, and India ranks number one worldwide in these deaths.

Key Point: Six months of treatment with INH, pyridoxine, rifampin, pyrazinamide, and ethambutol, directly observed, can treat pregnant women with TB. Lactating women can safely breastfeed while undergoing treatment.

“Tuberculosis is one of leading causes of maternal mortality in India, and every year about 2 million people are diagnosed with it,” according to Dhiraj Gada, MD, director, GadaLife ART Center, Indore, India, and a member of mdCurrent-India’s Ob/Gyn Editorial Advisory Board. “Its diagnosis in pregnancy may be extremely challenging, as the initial symptoms may be masked—for example, weight loss due to TB may be masked by weight gain due to pregnancy.”

Pregnant women suggestive of TB infection should receive...

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