By Dr Ajay Phadke
The highest probability of women having tuberculosis (TB) is during the childbearing years of 15 (post-puberty) to 49 (up to menopause). During pregnancy, when the immune system is more susceptible to infections, chances of contracting this disease are even higher. TB in pregnancy can have serious consequences if it goes untreated.
Complications that have been reported in pregnant women with TB include spontaneous abortion, delayed growth of the baby in the womb, and suboptimal weight gain. Other complications include preterm labour, low birth weight and increased neonatal mortality. In very rare cases, the baby is born with the infection.
While treating TB in pregnancy is absolutely essential, the process can be a little tricky. Doctors and expecting mothers need to be extra cautious about getting the right treatment and maintaining the health of the baby as well as the mother. Treating a pregnant woman for tuberculosis may be a little complicated, but it’s not nearly as dangerous as leaving the infection untreated.
Timely diagnosis is critical
Late diagnosis is an independent factor, which may increase maternal morbidity about four folds, while the risk of preterm labour may be increased nine folds. Maternal morbidity is an overarching term that refers to any physical or mental illness or disability directly related to pregnancy and/or childbirth. Hence, early diagnosis is critical for treatment of TB in pregnant women.
GeneXpert is the recommended test for detection of TB. The GeneXpert is a molecular test which diagnoses the disease by detecting the presence of TB bacterial DNA, as well as testing for resistance to the commonly used drug Rifampicin for TB treatment. The test has been widely proven to be reliable and faster in delivering results.
Types of TB and treatment in pregnancy
In cases of Latent Tuberculosis, there are no visible symptoms and people with latent TB infection cannot spread it to others. However, there is a possibility of them developing TB in the future. A pregnant woman if diagnosed with Latent TB should hold off on treatment until about two or three months after she has had her baby.
Pregnant women who are diagnosed with Active Tuberculosis should be treated immediately to prevent serious complications.
Managing Tuberculosis during Pregnancy
While medication is unavoidable, certain key factors like sufficient nutrition to the mother must be ensured. According to the United Nations Multiple Micronutrient Preparation, all pregnant women and lactating mothers with active TB should receive multiple micronutrient supplements. These supplements contain iron and folic acid and other necessary vitamins and minerals, to complement their maternal micronutrient needs.
In accordance with WHO recommendations, for pregnant women with active TB in settings where calcium intake is low, calcium supplementation is recommended as a part of pre-birth care. This is critical for prevention of pre-eclampsia, particularly among those pregnant women at higher risk of developing hypertension.
Note to expecting mothers diagnosed with TB
· Do not ignore any side effects like headaches, changes in vision, nausea, etc. and inform your doctor about them.
· Avoid being in highly polluted or crowded places.
· Maintain a healthy diet as nutrition levels get significantly impacted.
· Don’t miss any doctor appointments and prescribed doses of medicines.
· New mothers who choose to breastfeed and are still undergoing treatment for tuberculosis can safely do so.
(The writer is MD, Pathology and Centre Head of SRL Dr Avinash Phadke Path Labs, Mumbai.)