Chapter 31 : Pregnancy: Maternal, Fetal, and Neonatal Considerations

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:
Zoom in

Pregnancy: Maternal, Fetal, and Neonatal Considerations, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555817138/9781555815134_Chap31-1.gif /docserver/preview/fulltext/10.1128/9781555817138/9781555815134_Chap31-2.gif


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 BCG vaccination). The major side effect of isoniazid (INH) is hepatitis, which occurs most frequently in persons over 35 years of age.

Citation: Fleece D, Aronoff S. 2011. Pregnancy: Maternal, Fetal, and Neonatal Considerations, p 476-480. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch31
Highlighted Text: Show | Hide
Loading full text...

Full text loading...


1. Adhikari, M. 2009. Tuberculosis and tuberculosis/HIV co-infection in pregnancy. Semin. Fetal Neonatal Med. 14: 234240.
2. American Thoracic Society. 1986. Treatment of tuberculosis and tuberculosis infection in adults and children. Am. Rev. Respir. Dis. 134: 355363.
3. Beitzke, H. 1935. Ueber die angeborene tuberkuloese infection. Ergeb. Ges. Tuberk. Forsch. 7: 130.
4. Cantwell, M. F.,, Z. M. Shehab,, A. M. Costello,, L. Sands,, W. F. Green,, E. P. Ewing, Jr.,, S. E. Valway,, and I. M. Onorato. 1994. Brief report: congenital tuberculosis. N. Engl. J. Med. 330: 10511054.
5. Carter, E. J.,, and S. Mates. 1994. Tuberculosis during pregnancy. The Rhode Island experience, 1987 to 1991. Chest 106: 14661470.
6. Centers for Disease Control. 1990. Screening for tuberculosis and tuberculous infection in high-risk populations. Recommendations of the Advisory Committee for Elimination of Tuberculosis. MMWR Recommend. Rep. 39 (RR-8): 17.
7. Centers for Disease Control. 1990. The use of preventive therapy for tuberculous infection in the United States. Recommendations of the Advisory Committee for Elimination of Tuberculosis. MMWR Recommend. Rep. 39 (RR-8): 912.
8. Centers for Disease Control and Prevention. 2000. Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society. MMWR Recommend. Rep. 49 (RR-6): 151.
9. Centers for Disease Control and Prevention. 2003. Treatment of tuberculosis, American Thoracic Society. CDC and Infectious Diseases Society of America. MMWR Recommend. Rep. 52 (RR-11): 177.
10. Centers for Disease Control and Prevention. 2009. Reported Tuberculosis in the United States, 2008. U.S. Department of Health and Human Services, Atlanta, GA.
11. Covelli, H. D.,, and R. T. Wilson. 1978. Immunologic and medical considerations in tuberculin-sensitized pregnant patients. Am. J. Obstet. Gynecol. 132: 256259.
12. Figueroa-Damian, R.,, and J. L. Arredondo-Garcia. 2001. Neonatal outcome of children born to women with tuberculosis. Arch. Med. Res. 32: 6669.
13. Good, J. T., Jr.,, M. D. Iseman,, P. T. Davidson,, S. Lakshminarayan,, and S. A. Sahn. 1981. Tuberculosis in association with pregnancy. Am. J. Obstet. Gynecol. 140: 492498.
14. Grisolle, A. 1850. De l’influence que la grossesse et la phthisie pulmonaire exercent reciproquement l’une sur l’autre. Arch. Gen. Med. 22: 41.
15. Hamadeh, M. A.,, and J. Glassroth. 1992. Tuberculosis and pregnancy. Chest 101: 11141120.
16. Hammer, G. S.,, and S. Z. Hirshman. 1985. Infections in pregnancy, p. 14–15. In S. H. Cherry,, R. L. Berkowitz, and, N. G. Kase (ed.), Medical, Surgical, and Gynecological Complications of Pregnancy, 3rd ed. Williams and Wilkins, Baltimore, MD.
17. Hedvall, E. 1953. Pregnancy and tuberculosis. Acta Med. Scand. Suppl. 286: 1101.
18. Huebner, R. E.,, M. F. Schein,, and J. B. Bass, Jr. 1993. The tuberculin skin test. Clin. Infect. Dis. 17: 968975.
19. Jana, N.,, K. Vasishta,, S. K. Jindal,, B. Khunnu,, and K. Ghosh. 1994. Perinatal outcome in pregnancies complicated by pulmonary tuberculosis. Int. J. Gynaecol. Obstet. 44: 119124.
20. Lerner, B. H. 1994. Constructing medical indications: the sterilization of women with heart disease or tuberculosis, 1905-1935. J. Hist. Med. Allied Sci. 49: 362379.
21. Margono, F.,, J. Mroueh,, A. Garely,, D. White,, A. Duerr,, and H. L. Minkoff. 1994. Resurgence of active tuberculosis among pregnant women. Obstet. Gynecol. 83: 911914.
22. McKenzie, S. A.,, A. J. Macnab,, and G. Katz. 1976. Neonatal pyridoxine responsive convulsions due to isoniazid therapy. Arch. Dis. Child. 51: 567568.
23. Mehta, B. R. 1961. Pregnancy and tuberculosis. Dis. Chest 39: 505511.
24. Mofenson, L. M.,, E. M. Rodriguez,, R. Hershow,, H. E. Fox,, S. Landesman,, R. Tuomala,, C. Diaz,, E. Daniels,, and D. Brambilla. 1995. Mycobacterium tuberculosis infection in pregnant and nonpregnant women infected with HIV in the Women and Infants Transmission Study. Arch. Intern. Med. 155: 10661072.
25. Mondal, S. K.,, and T. K. Dutta. 2009. A ten year clinicopathological study of female genital tuberculosis and impact on fertility. JNMA J. Nepal Med. Assoc. 48: 5257.
26. Moulding, T. S.,, A. G. Redeker,, and G. C. Kanel. 1989. Twenty isoniazid-associated deaths in one state. Am. Rev. Respir. Dis. 140: 700705.
27. Osler, W. 1897. The Principles and Practice of Medicine. Appleton, New York, NY.
28. Present, P. A.,, and G. W. Comstock. 1975. Tuberculin sensitivity in pregnancy. Am. Rev. Respir. Dis. 112: 413416.
29. Pugh, D. L. 1955. The relation of child-bearing and child-rearing to pulmonary tuberculosis. Br. J. Tuberc. Dis. Chest 49: 206216.
30. Ratner, B.,, A. E. Rostler,, and P. S. Salgado. 1951. Care, feeding and fate of premature and full term infants born of tuberculous mothers. Am. J. Dis. Child. 81: 471482.
31. Schaefer, G.,, I. A. Zervoudakis,, F. F. Fuchs,, and S. David. 1975. Pregnancy and pulmonary tuberculosis. Obstet. Gynecol. 46: 706715.
32. Snider, D. E., Jr.,, and K. E. Powell. 1984. Should women taking antituberculosis drugs breast-feed? Arch. Intern. Med. 144: 589590.
33. Tanaka, A.,, K. Hirota,, K. Takahashi,, and Y. Numazaki. 1983. Suppression of cell mediated immunity to cytomegalovirus and tuberculin in pregnancy employing the leukocyte migration inhibition test. Microbiol. Immunol. 27: 937943.
34. Wilson, E. A.,, T. J. Thelin,, and P. V. Dilts, Jr. 1973. Tuberculosis complicated by pregnancy. Am. J. Obstet. Gynecol. 115: 526529.
35. World Health Organization. 2009. Global Tuberculosis Control: Epidemiology, Strategy, Financing. WHO Report 2009. World Health Organization, Geneva, Switzerland.


Generic image for table
Table 1.

Tuberculosis case rates per 100,000 population for women of children bearing age, United States, 2008

Citation: Fleece D, Aronoff S. 2011. Pregnancy: Maternal, Fetal, and Neonatal Considerations, p 476-480. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch31

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error