DR. R. NARASIMHAN
When tuberculosis occurs during pregnancy, it can endanger the lives of both the mother and the baby.
Tuberculosis and pregnancy are two different kinds of stresses that women experience. Their simultaneous occurrence would result in so much strain that it tends to impact the growing foetus as well. TB can affect organs and TB of certain organs poses a diagnostic challenge. India accounts for 30 per cent of all cases of TB in the world. The disease kills many women in the reproductive age and statistics show that if one takes combined mortality rate during pregnancy TB would rank first.
Can TB occur during pregnancy?
TB can occur in pregnancy, as it is an infectious disease caused by Mycobacterium tuberculosis.
What are the difficulties in diagnosing TB during pregnancy?
TB is mainly diagnosed by bacteriology and X-rays. During pregnancy, X-rays have to be taken carefully as they are harmful to the foetus. If the X-ray is essential, the abdomen should be covered with a metal shield. It is a precaution all women should observe when asked to take X-rays during pregnancy. Getting a bacteriological diagnosis is still more difficult, as they cannot cough to bring out sputum. Even in those who give sputum the chances of picking up bacilli is only 30 per cent.
How does TB affect pregnancy?
Since it is an infectious disease, late diagnosis and non-diagnosis can affect both the baby and the mother. In the mother, the disease can become extensive and spread to the baby resulting in a condition called congenital TB.
Is there any difference in the treatment regimen?
No there is no difference between the two groups.
Can all drugs be given safely during pregnancy?
It depends on the stage at which the diagnosis is made. For example, if the diagnosis is made in the first two months, the priority will be to treat TB rather than maintaining pregnancy. At this point, when organogenesis occurs, the effect of drugs on the foetus is debatable. On the contrary when diagnosis is made in the second or third trimester all the drugs can be given safely as none of the drugs cross the placenta. This will prevent extension of the disease in the mother and also the spread to the baby.
The writer is a Senior Respiratory Physician based in Chennai. E-mail: email@example.com