Tuberculosis during pregnancy is a serious condition and may be transmitted to the fetus, potentially leading to congenital tuberculosis. In addition, pregnant women with tuberculosis are at increased risk of pregnancy related complications such as severe preeclampsia, contributing to higher mortality rates in both the mother and the fetus.
What is tuberculosis?
Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, primarily affecting the lungs. It is transmitted through the air when an infected individual coughs, sneezes, or expels respiratory droplets.
Beyond pulmonary involvement, Mycobacterium tuberculosis can disseminate via the bloodstream or lymphatic system to other organs, including the kidneys, spine, and brain, resulting in extrapulmonary tuberculosis.
If not diagnosed and treated promptly, tuberculosis can be life-threatening. Clinically, tuberculosis is classified into two main forms: latent tuberculosis, in which individuals are infected but asymptomatic and not contagious, and active tuberculosis, which presents with clinical symptoms and has a high potential for transmission.
High risk populations for tuberculosis include:
- Individuals with household contact with a person diagnosed with tuberculosis
- Those who have lived, worked, or stayed for an extended period in regions with a high prevalence of tuberculosis
- Underweight individuals
- People with substance dependence, including drug use and alcohol abuse
- Pregnant women
What causes tuberculosis in pregnant women?
Compared to other populations, pregnant women are considered at higher risk of developing tuberculosis. The underlying reasons include:
- Hormonal changes: Fluctuations in estrogen and progesterone levels during pregnancy lead to significant physiological changes. If exposed to infectious sources during this period, Mycobacterium tuberculosis may more easily invade and establish infection.
- Placental hormonal effects: Placental hormones increase metabolic activity and fluid retention in pelvic organs, the reproductive system, skin, and muscles. These changes may also affect lung tissue and fibrotic areas, making them more susceptible to bacterial infiltration and proliferation.
- Immunosuppression: Throughout pregnancy, the maternal immune system is relatively suppressed to protect the fetus. This reduced immune defense makes pregnant women more vulnerable to infections, including tuberculosis. Additionally, early pregnancy is often associated with fatigue, poor appetite, and nutritional deficiencies, further facilitating the development of tuberculosis.
What are the symptoms of tuberculosis during pregnancy?
Tuberculosis in pregnant women often presents with nonspecific and less typical symptoms, which can be easily mistaken for other respiratory conditions. Some key clinical signs that should be noted include:
- Persistent cough lasting more than 3 weeks. Pregnant women may also experience dyspnea during coughing and chest discomfort
- Prolonged low grade fever, typically occurring in the late afternoon or evening, with high fever being less common in mild cases
- Night sweats, which may be mistaken for common pregnancy related sweating
- Loss of appetite, sometimes accompanied by altered taste sensation
- Unintentional and rapid weight loss, exceeding 1.6 kg per week
- Generalized fatigue and malaise
- Hemoptysis and uncontrolled coughing episodes
- Persistent lymphadenopathy, particularly in the cervical region, and occasionally in other lymph node groups
If any of the above symptoms are observed, pregnant women should promptly consult a specialist or visit the nearest healthcare facility for evaluation.
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Diagnosis of tuberculosis in pregnant women
In addition to clinical manifestations, tuberculosis in pregnant women is confirmed through diagnostic testing, typically using the following two methods:
- Tuberculin skin test: A small amount of purified tuberculin is injected intradermally into the patient’s forearm. The development of localized induration and erythema at the injection site within 48 hours indicates prior exposure to Mycobacterium tuberculosis.
- Interferon gamma release assays: This blood test requires a single blood sample, with results typically available within 24 hours. A positive result indicates infection with Mycobacterium tuberculosis, while a negative result suggests no evidence of infection.
In addition to the two tests mentioned above, patients may require further diagnostic investigations. In certain cases, chest radiography may be indicated to detect tuberculosis. Pregnant women should inform their physician about their pregnancy status in advance and request appropriate protective measures, such as abdominal lead shielding, to minimize fetal exposure to X-ray radiation.
Complications of tuberculosis in pregnant women
Tuberculosis during pregnancy may lead to serious complications affecting both the mother and the fetus, including:
- Increased neonatal mortality: Tuberculosis can be transmitted from mother to fetus even with treatment. The mortality rate of congenital tuberculosis has been reported to be as high as 18.7 percent, and may be even higher in preterm or low birth weight infants.
- Preterm birth and low birth weight: Pulmonary tuberculosis increases the risk of premature delivery and infants born with low birth weight.
- Congenital tuberculosis: Maternal infection during pregnancy may result in vertical transmission, leading to congenital tuberculosis in the newborn. Clinical manifestations in infants may include fever, respiratory distress, hepatomegaly, lethargy, and irritability.
- Pregnancy related complications: If tuberculosis occurs during the third trimester, the risk of pregnancy related complications such as preeclampsia may increase significantly, with maternal mortality risk reported to rise up to fourfold.
Due to these serious risks, women diagnosed with active tuberculosis are generally advised to defer pregnancy until completion of appropriate treatment.
Management of tuberculosis in pregnant women
The first step in managing tuberculosis during pregnancy is a thorough clinical evaluation, including assessment for pulmonary tuberculosis to establish an accurate diagnosis. Pregnant women will also be indicated for appropriate diagnostic tests to determine the extent and severity of infection.
Management of tuberculosis in pregnant women
Pregnant women diagnosed with tuberculosis should be treated strictly under the supervision of a specialist.
Initial treatment typically includes a combination regimen of isoniazid, rifampicin, and ethambutol administered continuously for the first 2 months.
Adequate nutritional support is essential, with a diet rich in protein, vitamins, and essential minerals to support immune function and recovery.
A balanced lifestyle with appropriate rest and activity should be maintained throughout treatment.
After delivery, if the mother still requires ongoing tuberculosis treatment, temporary separation from the newborn may be recommended to minimize the risk of transmission. Breastfeeding is generally not advised in cases of active pulmonary tuberculosis.
Infants born to mothers with tuberculosis during pregnancy should be closely monitored for signs of congenital infection and receive early Bacillus Calmette–Guérin vaccination to prevent primary tuberculosis.
Pregnant women should not self-medicate without medical approval. Any medication used during pregnancy must be carefully evaluated to ensure safety for the fetus.
Tuberculosis screening and vaccination services at Hong Ngoc General Hospital
Hong Ngoc General Hospital is proud to be a trusted medical institution with high standards of clinical excellence. The hospital is supported by a team of experienced specialists, dedicated nursing staff, and a modern medical equipment system. In addition, Hong Ngoc provides comprehensive services for screening, consultation, and treatment in a safe, sterile, and high quality healthcare environment.
Services available at Hong Ngoc General Hospital include:
- Comprehensive maternity care packages: These programs provide expectant mothers with peace of mind throughout pregnancy, including prenatal screening, diagnostic testing, and vaccination against infectious diseases before pregnancy, including tuberculosis vaccination. Regular follow-up examinations are conducted to ensure early detection of any abnormalities.
- Comprehensive vaccination programs: These programs offer a wide range of vaccines for all age groups, including Bacillus Calmette–Guérin vaccination for tuberculosis prevention in children.
Note: The information provided in this article by Hong Ngoc General Hospital is for reference purposes only and does not replace professional medical diagnosis or treatment. Patients should not self-medicate. For an accurate diagnosis and appropriate treatment plan, individuals are advised to visit a hospital for direct consultation with a qualified physician.
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