Perspectives on tuberculosis in pregnancy

• Tuberculosis (TB) has been recognized as a serious cause of morbidity and mortality in pregnancy for over a century.
• Efforts to research and roll out TB screening and treatment at antenatal clinics in high-burden populations has lagged behind similar efforts for HIV.
• Microbiological screening is important in pregnancy due to overlapping symptoms.
• There is a need for more data on optimal treatment strategies during pregnancy and the effects of infection and treatment on maternal and neonatal morbidity and mortality.

SummaryTuberculosis (TB) has been recognized as an important cause of morbidity and mortality in pregnancy for nearly a century, but research and efforts to roll out comprehensive TB screening and treatment in high-risk populations such as those with a high prevalence of HIV or other diseases of poverty, have lagged behind similar efforts to address HIV infection in pregnancy and the prevention of mother-to-child-transmission. Immunological changes during pregnancy make the activation of latent TB infection or de novo infection more likely than among non-pregnant women. TB treatment in pregnancy poses several problems that have been under-researched, such as contraindications to anti-TB and anti-HIV drugs and potential risks to the neonate, which are particularly important with respect to second-line TB treatment. Whilst congenital TB is thought to be rare, data from high HIV burden settings suggest this is not the case. There is a need for more studies screening for TB in neonates and observing outcomes, and testing preventative or curative actions. National tuberculosis control programmes (NTPs) should work with antenatal and national HIV programmes in high-burden populations to provide screening at antenatal clinics, or to establish functioning systems whereby pregnant women at high risk can drop in to routine NTP screening stations.