[Tuberculosis and pregnancy].

Abstract

Tuberculosis is neither more frequent, nor more serious in pregnant than non-pregnant women. The risks for the child are threefold: a doubling in the mortality level on account of the illness in the mother if she is not treated; a risk of toxicity linked to the anti-tuberculous drugs and a risk of tuberculous infection at birth. Isoniazid (INH) and ethambutol have a weak toxicity. These two antibiotics can be prescribed during pregnancy (after confirming the absence of Vitamin B6 deficiency in the mother). Rifampicin is teratogenic in high doses in animals, but epidemiological studies do not reveal any notable risk in man. For prudence it is only prescribed in the first trimester of pregnancy, in confirmed cases of tuberculosis. The data on the teratogenicity of pyrazinamide is insufficient and it should not be used in pregnancy. Thus the treatment of tuberculosis in pregnancy will be rifampicin + isoniazid + ethambutol (the ethambutol being stopped after two months and the isoniazid and rifampicin after 9 months of treatment). At the moment of confinement, if maternal tuberculosis is confirmed bacteriologically at the time of microscopy, chemoprophylaxis will be started in the new born with isoniazid, in a dose of 5 mg/kg until the mother is bacteriologically negative on microscopic examination, the new born should then be vaccinated with BCG. If the treatment of the mother is correctly prescribed and followed breast-feeding is possible and no isolation of either mother or child is necessary. The amount of antibiotic that passes in the mothers milk is minimal and such specific nourishment should not be dispensed with if the treatment is necessary.