DR-TB Treatment in Pregnancy: General Considerations​

Pregnancy is not a contraindication for the treatment of Drug-resistant TB (DR-TB) but poses a great risk to both the mother and the foetus. All women of child-bearing age should be tested for pregnancy as part of the pre-treatment evaluation and whilst on treatment. Pregnant DR-TB patients need to be monitored carefully both in relation to the treatment and the progress of the pregnancy.

• Teratogenicity has been demonstrated with only some of the drugs used to treat DR-TB. It is demonstrated most commonly during the first trimester.
• Second-line injectables are contraindicated throughout the pregnancy due to their effect on the 8th cranial nerve (auditory) of the foetus.
• Ethionamide (Eto) is contraindicated during the first 32 weeks of pregnancy due to teratogenic effects.

DR-TB patients found to be pregnant prior to treatment initiation or whilst on treatment must be evaluated in consultation with a gynaecologist or obstetrician, considering factors such as:

• Risks and benefits of DR-TB treatment 
• Severity of DR-TB
• Gestational age
• Potential risk to the foetus

In pregnant women, strict counselling needs to be done for Medical Termination of Pregnancy (MTP), especially regarding:

1. The risk of delaying treatment
2. Potential effects of new drugs on the foetus including foetal abnormalities (if MTP not opted)
3. The need for more intense maternal-foetal-neonatal follow-up
4. Appropriate counselling and informed decision-making process for consent need to be undertaken in each case

Pregnant women with Multidrug-resistant TB (MDR-TB) should be jointly managed with obstetrician-gynaecologist (OB/GYN) and pulmonologist/ physician at the DR-TB centre. Further management of DR-TB patients who are pregnant prior to initiation of treatment or whilst on treatment is based on the duration of pregnancy.

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
• Consolidated Guidelines on Tuberculosis: Module 4 - Treatment: Drug-resistant TB Treatment, 2020.
• Technical and Operational Guidelines for TB in India, 2016.
• Companion Handbook to the WHO Guidelines for the Programmatic Management of Drug-resistant Tuberculosis, 2014.
• Collaborative Framework for Management of Tuberculosis in Pregnant Women, 2021. 

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