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Chapter 31 : Pregnancy: Maternal, Fetal, and Neonatal Considerations
The issue of tuberculosis during pregnancy is not simply an historical inquiry but rather an increasingly familiar clinical problem facing industrial nations as well as the developing countries of the world. This chapter focuses on the maternal aspects of tuberculous infection, as well as transmission to the fetus, and newborn. The epidemiology of tuberculosis in pregnancy reflects that of tuberculosis at large. A number of reports from the 1950s, showed that pregnancy did not predispose women to progressive disease. In a report of 250 women with active tuberculosis in the pretreatment era, 83.9% remained stable during pregnancy and 9.1% improved. Although only 7% had evidence of progressive disease during pregnancy, an additional 8.2% experienced progression in the year following pregnancy. Pregnancy itself, however, may mimic and thus mask the symptoms of early tuberculosis, such as tachypnea and fatigue; this in turn may delay diagnosis and treatment. Infection of the reproductive organs may result in infertility as well as abdominal or tubal pregnancy. With early recognition and effective chemotherapy, however, there is no evidence of an adverse effect on pregnancy. The tuberculin skin test (Mantoux) is the test of choice for diagnosing tuberculosis infection in pregnant women. These tests have potential advantages in terms of logistics and accuracy (not subjectively interpreted and not affected by previous Mycobacterium bovis BCG vaccination). The major side effect of isoniazid (INH) is hepatitis, which occurs most frequently in persons over 35 years of age.