Treatment for TB During Pregnancy

Untreated tuberculosis (TB) disease represents a greater hazard to a pregnant woman and her fetus than does its treatment. Treatment should be initiated whenever the probability of TB is moderate to high.

Infants born to women with untreated TB may be of lower birth weight than those born to women without TB and, in rare circumstances, the infant may be born with TB.
Although the drugs used in the initial treatment regimen for TB cross the placenta, they do not appear to have harmful effects on the fetus.

Treatment for Latent TB Infection and Pregnancy

For most pregnant women, treatment for latent TB infection can be delayed until 2–3 months post-partum to avoid administering unnecessary medication during pregnancy.
For women who are at high risk for progression from latent TB infection to TB disease, especially those who are a recent contact of someone with infectious TB disease, treatment for latent TB infection should not be delayed on the basis of pregnancy alone, even during the first trimester.

TB Treatment Regimens for Pregnant Women

TB Treatment Regimens for Pregnant Women
Diagnosis	Treatment
Latent TB Infection	4-month daily regimen of rifampin (RIF) (4R) 3-month daily regimen of isoniazid (INH) and RIF (3HR) 6- or 9-month daily regimen of INH (6H or 9H) , with pyridoxine (vitamin B6) supplementation The 3-month weekly INH and rifapentine (3HP) regimen is not recommended for pregnant women or women expecting to become pregnant during the treatment period because its safety during pregnancy has not been studied.
TB Disease	The preferred initial treatment regimen is INH, rifampin (RIF), and ethambutol (EMB) daily for 2 months, followed by INH and RIF daily, or twice weekly for 7 months (for a total of 9 months of treatment). Streptomycin should not be used because it has been shown to have harmful effects on the fetus. Pyrazinamide (PZA) is not recommended to be used because its effect on the fetus is unknown.
HIV-Related TB Disease	Treatment of TB disease for pregnant women co-infected with HIV should be the same as for nonpregnant women, but with attention given to additional considerations. For more information please review the Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents.

Contraindications

The following antituberculosis drugs are contraindicated in pregnant women:

Streptomycin
Kanamycin
Amikacin
Capreomycin
Fluoroquinolones

Drug-Resistant TB

Pregnant women who are being treated for drug-resistant TB should receive counseling concerning the risk to the fetus because of the known and unknown risks of second-line antituberculosis drugs.

Breastfeeding

Breastfeeding should not be discouraged for women being treated with the first-line antituberculosis drugs because the concentrations of these drugs in breast milk are too small to produce toxicity in the nursing newborn. For the same reason, drugs in breast milk are not an effective treatment for TB disease or latent TB infection in a nursing infant.

Breastfeeding women taking INH should also take pyridoxine (vitamin B6) supplementation. RIF can cause orange discoloration of body fluids, including breast milk. Orange discoloration of body fluids is expected and harmless. There currently is not enough data to indicate whether the 3HP regimen is safe for women to take while breastfeeding.