Treating Tuberculosis in Pregnant Women

Topic Overview

It is important for pregnant women with an active tuberculosis (TB) infection to receive treatment, because the TB infection is dangerous to the developing fetus.^{footnote 1}

• Treatment usually involves isoniazid, rifampin, and ethambutol for 9 months. If the TB bacteria cannot be killed by any of these first-line medicines, then other medicines and a longer treatment time may be needed.
• The World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Diseases (IUATLD) recommend pyrazinamide for treatment of pregnant women who have TB. But pyrazinamide is seldom used in the United States because of safety concerns.
• Streptomycin is not used to treat TB in pregnant women, because it may cause birth defects.
• Medical experts also recommend that pregnant or breastfeeding women take vitamin B6 (pyridoxine) during treatment for TB.
• The safety of second-line medicines for a developing fetus is not known. So a pregnant woman infected with drug-resistant TB bacteria or a pregnant woman who has both TB and HIV infections should talk to her doctor about the safest treatment options.

Women being treated for active TB with first-line medicines can continue to breastfeed. The small amounts of medicine that get into the breast milk do not appear to harm a baby. Medical experts recommend that breastfeeding women should also take vitamin B6 during TB treatment.