Effect of Tuberculosis in pregnancy

 Pregnant woman infected with Tuberculosis

In 2005.WHO was declared a public health emergency for Tuberculosis. TB become more complicated in case of maternal mortality & is among the three leading causes of death among  of women aged 13-45 years.

If you infected by TB during pregnancy & you don’s treated it early, there is an increased risk of:

·        A chance of Miscarriage.

·        Premature Baby.

·        Baby burn with low birth weight.

·        Baby born with TB.

So proper treatment is vary necessary for TB infected pregnant woman.

Diagnosis:

If pregnant women are coughing up sputum( Phlegm) for more than three weeks, it must be go for sputum test which pick up most form of TB. This may be followed by a chest X-ray. Skin test or a blood test.If you have no specific symptom of TB,you will be given the tuberculosis test, also called Mantoux Test.

Treatment for TB during pregnancy

TB can  be fully cured  by using full  course of medication  (antibiotics) without interruption of medication. The course can go for between six and  nine months. Occasionally  the treatment  might go on for longer, depending on the severity of the case. Your doctor will tell you when it is safe to stop your medication.

You may feel better within a few weeks of treatment, but the bacteria will still be alive. So it is very important to complete the full course of medication. If you don't take the drugs as exactly prescribed, there is a very strong chance of a relapse. And you could pass the infection on to your family members. You may also end up with drug-resistant forms of the disease which are more difficult to treat.

Using of Directly Observed Therapy, Short Course (DOTS) is better option for treatment of TB with Pregnancy. This therapy entails the use of combination therapy for at least 6 months, depending on the combination of antituberculous agents that are available. This combination includes isoniazide and rifampicin compulsorily, supported by ethambutol and pyrazinamide .For patients with drug-susceptible TB and, these regimens will cure around 90% of TB cases. The use of these first-line antituberculosis drugs in pregnancy is considered safe for the mother and the baby by The British Thoracic Society, International Union against Tuberculosis and Lung Disease, and the World Health Organization.

 

Isoniazide

INH is safe during pregnancy even in the first trimester, though it can cross the placenta and may be cause of INH-induced hepatotoxicity. Pyridoxine supplementation is recommended for all pregnant women taking INH at a dose of 50 mg daily.

Rifampicin

This is also believed to be safe in pregnancy, though there may be an increased risk of haemorrhagic disorders in the newborn (some authorities prescribe supplemental vitamin K (10 mg/day) for the last four to eight weeks of pregnancy.)

Ethambutol

It may cause retro bulbar neuritis (optic neuritis) in adults because it may interfere with ophthalmological development when used in pregnancy but this has not been demonstrated when the standard dose is used. This was also confirmed in experimental studies on some abort uses.

 Pyrazinamide

The use of pyrazinamide in pregnancy was avoided by many physicians for a long time due to unavailability of adequate data on its teratogenicity. Presently, many international organizations now recommend its use. There are no reports of significant adverse events from the use of this drug in the treatment of TB in pregnant women despite its use as part of the standard regimen in many countries.

Its use is particularly indicated in women with tuberculosis meningitis in pregnancy, HIV infection, and suspected INH resistance.

Streptomycin

The drug has been proven to be potentially teratogenic throughout pregnancy. It causes fetal malformations and eighth-nerve paralysis, with deficits ranging from mild hearing loss to bilateral deafness. Many centres are against the use of this drug in pregnancy.

Multidrug-Resistant Tuberculosis  in Pregnancy

Pregnant women with MDR-TB have much difficult to treatment. They may sometimes require treatment with second-line drugs, including cycloserine, ofloxacin, amikacin, kanamycin, capreomycin, and ethionamide. The safety of these drugs is unfortunately not well-established in pregnancy.

Ethionamide is associated with growth retardation, central nervous system and skeletal abnormalities in early pregnancy. Its use is, therefore, not recommended in pregnancy.

Therapeutic abortion has been proposed as an option of management for these women, as MDR-TB poses more risk to the woman and the society at large. Another option is to delay initiating treatment to the second trimester where possible. Individualized Treatment Regimen (ITR) using various combinations of the 2nd line antituberculosis  agents based on their susceptibility profile had, however, been tried in some pregnant women with no adverse obstetric outcome

The outlook for those patients is expected to improve as experience and knowledge in the management of the condition increases.

In addition to your antibiotics, it is important to take good care of yourself so that you strengthen your immune system:

• Eat a well balanced diet.
• Get plenty of fresh air.
• Don't miss antenatal visits of doctor.
• Report any side effects, such as vision changes, headaches or increased nausea to your doctor immediately.
  

As long as you are infectious, maintain good  personal hygiene. Ensure that you wash your hands regularly and cover your mouth and nose with a tissue when you cough or sneeze so that you do not spread the germs around. Make sure you dispose of your soiled tissues in a covered bin or sealed plastic bag.