Tuberculosis During Pregnancy – Symptoms, Complications & Treatment

Tuberculosis is a known diagnosis caused by Mycobacterium tuberculosis and most commonly affects the lungs and overall health. The U.S. Centers for Disease Control and Prevention (CDC) says that some women may have inactive (latent) TB without symptoms, while others may develop active disease and show symptoms (1). However, TB during pregnancy can progress into a serious health issue that requires timely intervention and treatment without compromising the mother’s or the baby’s health. The careful management of pregnancy and TB ensures prevention or reduction of complications arising out of the illness. With medical advancements, TB is diagnosable and treatable. Read to learn about tuberculosis during pregnancy and how it can affect a pregnant woman’s health and her baby!

What Is Tuberculosis?

Pulmonary Tuberculosis, more commonly known as TB, is an infection caused by bacteria called Mycobacterium tuberculosis, which most commonly affects your lungs. Sometimes, it can also affect some other parts of your body, like kidneys, spine, uterus, bones, brain, and nervous system. Surprisingly, as the CDC suggests, the infection can affect several parts of the body at the same time, like TB affecting both the lungs and the lymph nodes (1).

It is important to know that not everyone infected by the TB bacteria gets sick or shows symptoms. This is the reason there are two types of diagnosis for this infection: Inactive TB (latent TB infection) and active TB disease.

Latent TB

Sometimes the immune system is unable to kill the bacteria entirely but manages to protect the body by building a defensive wall around the bacteria. The bacteria remain in the body but don’t cause any harm (2). These bacteria can, however, emerge when your immune system is weakened and cause symptoms of TB. This is known as latent TB.

Active TB

If the immune system in your body is unable to fight the bacteria, then a series of symptoms occur which are diagnosed as tuberculosis.

What Are the Causes of Tuberculosis During Pregnancy?

Tuberculosis (TB) is caused mainly by the bacterium Mycobacterium tuberculosis, that are released into the air by human beings. Human beings are the only known reservoirs of the TB bacterium; this means the bacterium cannot live outside of the human body. Every time a person harbouring the bacterium in their body spits, coughs, or sneezes, they expel the bacteria with the microscopic droplets that are exhaled into the air (3).

When a woman’s body is infected with tuberculosis, it can react to it in three ways:

1. Her immune system will kill the bacteria entirely.
2. The pregnant woman may suffer from latent TB.
3. She may suffer from active TB.

Common Symptoms of Active Tuberculosis in a Pregnant Woman

Most symptoms of tuberculosis include:

1. A persistent cough (usually more than 3 weeks long) that generates sputum or phlegm
2. Weight loss
3. Fever
4. Pain in the chest
5. Weakness and fatigue
6. Loss of breath
7. Loss of appetite
8. Night sweats
9. Nausea

Hormonal changes during pregnancy and the changes in the immune system may make the common symptoms of TB in pregnancy less prominent. This makes it difficult to diagnose TB, and it can even go undiagnosed until the time of delivery.

How Contagious Is Tuberculosis?

Only people who are suffering from active TB can spread the disease.

1. How Does TB Spread?

If a person suffering from active TB coughs or sneezes, the bacteria are expelled from the body along with the microdroplets of sputum, phlegm, etc., similar to the virus in the common cold. If a healthy person inhales these droplets, they can lead to active TB being triggered.

2. How Can You Catch TB?

While pregnant, you are at a high risk of contracting pulmonary TB if you have a weakened immune system or if you spend a lot of time with an infected person. However, just a brief exposure during pregnancy, like shaking hands, travelling in the bus, sharing food, or talking, will not lead to a TB infection. In fact, these things cannot cause TB in any healthy individual; it is a misconception that TB can be contracted through touch or by sharing food, talking, etc.

There is a higher risk of you catching TB if:

1. There are many TB cases near or around you.
2. You remain close to a person with active TB.
3. You have a disease that compromises your immune system, leaving you more susceptible to contracting TB.
4. You are a smoker.
5. You have poor health or low standard of living conditions.

Effects of TB on Pregnancy

The best way to describe tuberculosis during pregnancy is that it is a double-edged sword where one end is the harm TB can cause to the baby, and the other is the progression of the disease.

A large portion of the population suffers from TB. It can lead to maternal mortality, which is the third leading cause of death in pregnant women between the ages of 15 and 45. Thus, the effects of tuberculosis in pregnancy should not be casually ignored.

Effects on the Mother

• Increased chances of maternal morbidity (4)
• TB increases the chances of miscarriage (5)
• Stunted growth of the baby
• Premature labour
• Low birth weight
• Increased chances of neonatal mortality
• Late diagnosis of the disease can further increase the chances of preterm labour by ninefold

Effects on the Foetus

The complications of TB in pregnancy also gravely affect the baby in several ways. Some of these are as follows:

• The disease can spread from the mother to the baby through the umbilical cord. This is called congenital tuberculosis. Congenital TB is defined as TB caused in infants at the time of birth (typically during passage through the birth canal, or while the baby is in the mother’s womb). However, unlike other congenital diseases, the symptoms of congenital TB are often not specific, and many mothers do not show any kind of symptoms (specific or general) (8).
• Low birth weight of the newborn baby (6)
• Can cause swelling in the liver or the spleen
• Can cause respiratory problems
• Fever
• Affects the lymph nodes and hampers proper functioning

How to Diagnose Tuberculosis During Pregnancy?

If you have a cough with sputum production for over three weeks, the basic diagnosis includes testing of the sputum to see if there are any disease-causing bacteria. This test can identify most forms of TB. The doctors need two samples of your sputum for this, so you can be called again.

This is generally followed by a chest X-ray, blood test, and skin test. Make sure you go ahead with all the tests recommended by the doctor, as the potential harm to the baby due to TB is much higher than any test. All of these methods help determine if you have active TB.

Tests Done During Tuberculosis

A skin test called the Mantoux test is done by injecting a small amount of Tuberculin in the epidermis of your skin. If there is swelling in this area within 48 to 72 hours, it means that the test is positive for latent TB. This tuberculosis test in pregnancy is done to determine whether you have latent TB.

Treating TB During Pregnancy

Both pregnancy and tuberculosis need close attention. It is important that you pay attention to the management of tuberculosis in pregnancy to avoid harming yourself and the baby. Similar to any other bacterial infection, TB is also treated with a course of antibiotics. It can be cured entirely if detected at an early stage and if you complete the course of antibiotics without any interruptions. The course can last anywhere between 6 and 9 months, but can also extend further depending on the severity of the disease.

You will feel better a few weeks after the medication, but this doesn’t mean that you are completely cured of the disease. The bacteria can still be alive and can even cause a relapse. Some other times, the bacteria can develop resistance to the medication, making it more difficult to cure the disease.

Make sure you start receiving treatment as soon as possible to avoid harming both you and your newborn. Make sure you also do the following:

1. Eat a healthy and balanced diet.
2. Breathe as much fresh air as possible.
3. Don’t miss any doctor’s appointments.
4. Mention any side effects to your doctor, like headaches, changes in vision, nausea, etc.

TB Medication to Avoid During Pregnancy

It can be difficult to stick to the treatment due to fear of the medication harming the baby or pregnancy-related nausea. However, most first line medication for TB are safe for treatment during pregnancy. These include Isoniazid, Ethambutol, Rifampicin, and Pyrazinamide.

However, there are some side effects of TB drugs in pregnancy, as they could affect the pregnancy. It is recommended that you avoid streptomycin if you are pregnant. This is effective in treating TB but can result in loss of hearing or balance in your child. This is common in at least one out of six babies.

You must also take extreme care if you are undergoing treatment with Isoniazid. It can cause drug-induced hepatitis, which can hinder the treatment of tuberculosis. If you are affected by hepatitis, then your liver function is closely monitored, and some drugs like Methadone are used to allow your liver to function properly. Isoniazid can, however, be taken without any harm along with a dose of Vitamin B6.

How to Prevent Tuberculosis While Pregnant?

Since TB is an airborne disease, pregnant women can easily catch it by coming in contact with an infected person. Thus, pregnant women can take some preventive measures to reduce the chances of infection.

• Proper Hygiene: Avoiding crowded places and covering the nose with a mask can help pregnant women move safely in a crowded environment. 
• Exposure to Natural Light: The UV rays are highly beneficial, not just raising the vitamin D levels in the body but also in killing tuberculosis bacteria.
• Strengthen Your Immune System: Eating a balanced diet with lean meat, protein, healthy fats, and calories ensures a good immune system to fight off tuberculosis during pregnancy. 
• Precautions in Hospital: When visiting the hospital for routine checkups, wearing masks, discussing the possibilities of TB with the doctor, and having necessary vaccinations during pregnancy help to a great extent in preventing tuberculosis when pregnant.

Can TB Affect the Baby’s Development?

Tuberculosis transfers from the mother to the baby through the umbilical cord in only a few cases where the disease is left untreated. But if the disease is diagnosed, it can be treated with proper medication. But if the baby gets TB, then it can cause a lot of harm to the baby. Not only does TB lead to miscarriage and preterm labour, but it also causes a series of issues in the baby too. Some of these include stunted growth, enlargement of the spleen or liver, fever, and respiratory issues.

When to Consult a Doctor?

It is advised that you consult a doctor if you experience any of the following symptoms:

• A persistent cough lasting two or three weeks
• Phlegm or blood along with cough
• Have had close contact with a person diagnosed with active TB
• Ongoing fever with night sweats
• Sudden weight loss 

FAQs

1. Can TB testing cause any side effects?

Yes, a TB test for pregnancy may cause some side effects, but they are usually temporary and harmless. A TB skin test may cause swelling, tenderness, or discolouration at the injection site. A TB blood test, on the other hand, may result in slight bruising or tenderness at the site where the blood is drawn.

2. Can TB medication affect breast milk?

Some TB medications can pass into breast milk in very small quantities. This amount does not cause toxicity in nursing infants. Another side effect of TB medication during breastfeeding is that certain medications, like rifampin, may cause the breast milk to become orange-discoloured (7). This is an expected side effect and a harmless one.

3. What to do if I get TB during pregnancy?

TB in pregnant women is treatable with antibiotics. Your doctor may prescribe you certain medications for TB that are safe for pregnancy. It is important that the pregnant woman completes her 6-month medication course; otherwise, the TB may return in a resistant form and become difficult to cure.

4. Can TB bacteria pass from mother to the baby in the womb?

Yes, there are chances of transmission of the infection from the mother with active tuberculosis to the fetus in the womb through utero or during delivery (8). It is called congenital tuberculosis.

Tuberculosis in pregnancy can be harmful to the health of both the mother and the baby, and it is necessary that you take good care. Make sure you avoid exposure to this disease by keeping away from people who are infected with TB. After all, prevention is always better than cure. However, if you do catch the disease, don’t worry about tuberculosis pregnancy risk as yet. There are several ways you can get treated, and the best way to make the treatments effective is to remain positive at all times. Increased stress levels can not only affect your child but can also hinder the treatment.

Also Read:

Jaundice in Pregnancy
Cholestasis of Pregnancy
Itching on Stomach while Pregnant

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Sources References

1. CDC – Tuberculosis in Pregnancy

2. California Department of Public Health – Tuberculosis in Pregnancy

3. MedlinePlus – Tuberculosis

4. Wiley Online Library – Tuberculosis in pregnancy

5. National Library of Medicine – Tuberculosis in Pregnancy

6. Indian Journal of Obstetrics and Gynecology Research – A case report on tuberculosis in pregnancy revealing the need for an effective multidisciplinary approach and the importance of tailored therapy

7. CDC – Latent TB Infection Treatment and Breastfeeding

8. ScienceDirect – Congenital Tuberculosis