TB Testing and Treatment During Pregnancy and Breastfeeding

Safety of TB Testing in Pregnancy

The American Thoracic Society recommends that the tuberculin skin test (TST) has no adverse effects on the pregnant mother or fetus and has been extensively studied with an excellent safety record 2, 1
Pregnancy does not alter the interpretation of TST results—the standard classification scheme (≥5 mm for high-risk, ≥10 mm for moderate-risk, ≥15 mm for low-risk individuals) remains valid 2, 1
The American College of Chest Physicians suggests that while one older study suggested decreased lymphocyte reactivity to tuberculin during pregnancy, multiple other studies have not confirmed any effect of pregnancy on skin test responses 2, 1

The Centers for Disease Control and Prevention recommends that pregnant women should be targeted for TB testing only if they have specific risk factors—universal screening is not recommended 2, 1

The Centers for Disease Control and Prevention recommends that if a pregnant woman tests positive for TB, a chest radiograph with appropriate abdominal shielding should be performed immediately to exclude active disease, even during the first trimester 3, 1
The American Thoracic Society suggests that if the chest radiograph is normal and no symptoms are present, the woman has latent TB infection (LTBI) and treatment decisions should be individualized based on her risk profile 1
For high-risk women (recent infection, HIV-positive, or other conditions promoting progression), the American College of Chest Physicians recommends that treatment should not be delayed based on pregnancy alone, though careful monitoring for isoniazid hepatotoxicity is essential 2, 1

The American Academy of Pediatrics recommends that TB testing is safe during breastfeeding and poses no risk to the nursing infant 4, 5
The American College of Chest Physicians suggests that the small amounts of anti-TB medications that pass into breast milk do not cause toxicity in newborns, so breastfeeding should not be discouraged in women being treated for TB 4, 5, 6
However, the American Academy of Pediatrics recommends that medications in breast milk should not be considered effective treatment or prophylaxis for the infant 4, 5
Women taking isoniazid while breastfeeding should receive pyridoxine supplementation (25 mg/day) as recommended by the American College of Chest Physicians 4, 5

The Centers for Disease Control and Prevention recommends that treatment of active TB during pregnancy should be initiated immediately when diagnosed, as untreated TB poses significant morbidity and mortality risks that far exceed medication risks 4, 7