The diagnosis of tuberculosis in pregnancy is made by history taking, physical examination, and testing, with special attention to women in high-risk groups. Women at high risk include those who are from endemic areas, those infected with HIV, drug users, health care workers, and close contacts of people with tuberculosis. Chest radiographs should not be obtained as a routine screening measure in pregnancy but should be used only in patients with a positive test or with suggestive findings in the history and physical examination. Abdominal shielding must be used if a chest radiograph is obtained. Both tuberculin skin testing and interferon gamma release assays are acceptable tests in pregnancy.
Decisions on treatment depend on whether the patient has active disease or is at high risk for progression to active disease. Pregnant women with latent disease not at high risk for disease progression can receive treatment postpartum, which does not preclude breastfeeding. The concentration of medication in breast milk is neither toxic nor adequate for treatment of the newborn. Isoniazid, ethambutol, and rifampin are used to treat tuberculosis (see Chapters 9 and 33). Because isoniazid therapy may result in vitamin B6 deficiency, a supplement of 50 mg/day of vitamin B6 should be given simultaneously. There is concern that isoniazid, particularly in pregnant women, can cause hepatitis. Liver biochemical tests should be performed regularly in pregnant women who receive treatment. Streptomycin, ethionamide, and most other antituberculous drugs should be avoided in pregnancy. If adequately treated, tuberculosis in pregnancy has an excellent prognosis.
et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis. 2016;63:e147.