Tuberculosis in pregnancy NCT Position Statement

Position statement

Tuberculosis in pregnancy
It is important that ethnic minority women, particularly new migrants to the UK, are offered a full medical assessment in pregnancy and that health professionals remain alert to the diagnosis of TB, particularly as symptoms may mimic the physiological changes that occur during pregnancy. As the commonly used treatments for TB are safe in pregnancy for both mother and baby, there is clear evidence that screening and treatment for those who need it are of benefit. Screening early in pregnancy is essential to reduce maternal and fetal health risks associated with late diagnosis. Breastfeeding is the healthiest option for babies whose mother is being treated for TB, unless the mother has tuberculosis mastitis. Women being treated for TB should be given positive encouragement and support to breastfeed. The concentration of therapeutic drugs found in breastmilk is considered too small to harm the baby. If tuberculosis mastitis is diagnosed, alternative feeding methods should be discussed with the mother.

NCT is here to support parents. We dont tell them what to do or think - through our classes, branches and helplines, our volunteers and qualified staff give parents accurate impartial information so that they can decide what is best for their family. Through us, they can join a support network of other parents nearby, which can be a lifeline in the early years. We are the UKs largest parenting charity and, being independent, we have an influential voice in campaigning and lobbying on the issues that parents care about. For more information visit www.nct.org.uk
NCT, Alexandra House, Oldham Terrace, London W3 6NH NCT is a registered charity (England & Wales ): 801395, (Scotland) SCO41592

Background information to this position statement

The incidence of TB in the UK is increasing1 and it is estimated that in the UK, TB is present in 4.2 per 100,000 maternities 2 If diagnosed early in pregnancy the outcome for women is the same as for nonpregnant women and the outcome for the baby is very good. However recent reports from the confidential enquires into maternal deaths in the UK suggest that the number of women who die from TB is increasing.1 Late diagnosis and treatment is also shown to affect the babys health, with higher incidences of prematurity, low birth weight and neonatal mortality reported.3 TB in pregnancy in the UK appears to be exclusively limited to ethnic minority women and almost exclusively to those born outside the UK. Screening for TB is recommended in all individuals who migrate to the UK from countries with high prevalence of TB. Although pregnancy does not alter the response to the tuberculin skin test used to screen for TB3,4 recent research has found that the skin test does not seem to be undertaken routinely in migrant pregnant women.2 For many pregnant women coming from countries associated with poorer overall general health, the medical examination undertaken upon entry to the UK is the first contact they may have with health services. However the increased incidence of TB among pregnant ethnic minority women, and the reported delay in diagnosis highlights serious concerns about the delivery of, and access to, services and quality of care for this group. Several reports emphasise the importance of ethnic minority women, particularly migrant women, being offered a full medical assessment in pregnancy and health professionals remaining alert to the risk of TB, particularly as symptoms may mimic the physiological changes that occur during pregnancy.3,2,4 The Health Protection Agency state that the commonly used treatments for TB are safe in pregnancy for both mother and baby, so timely screening is essential to reduce maternal and fetal health risks associated with late diagnosis.3

NCT 2011

Tuberculosis in pregnancy NCT Position Statement

Breastfeeding is recognised as the healthiest way to feed a baby5. The concentrations of first-line anti-tuberculosis drugs in breastmilk are too small to produce toxicity in the nursing baby. For the same reason, drugs in breastmilk are not an effective treatment for TB disease in a baby. The baby cannot be infected via the mothers breastmilk unless the mother has tuberculosis mastitis.3 References 1. Lewis G. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving mothers' lives: reviewing maternal deaths to make motherhood safer - 2003-2005. The seventh report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. London: CEMACH; 2007. Available from: http://www.cemach.org.uk/Publications/CEMACHPublications/Maternal-and-Perinatal-Health.aspx Knight M, Kurinczuk JJ, Nelson-Piercy C, et al. Tuberculosis in pregnancy in the UK. BJOG 2009;116(4):584-8. Health Protection Agency. Pregnancy and tuberculosis: guidance for clinicians. London: Health Protection Agency; 2006. Available from: www.hpa.org.uk/web/HPAwebFile/ HPAweb_C/1194947408879 4. Bass JB. Tuberculosis in pregnancy. Available from: http://www.uptodate.com/patients/content/topic.do? topicKey=tubercul/5058 5. Chung M, Raman G, Trikalinos T, et al. Interventions in primary care to promote breastfeeding: an evidence review for the U.S. Preventive Services Task Force. Ann.Intern.Med 2008;149(8):565-82.

NCT is here to support parents. We dont tell them what to do or think - through our classes, branches and helplines, our volunteers and qualified staff give parents accurate impartial information so that they can decide what is best for their family. Through us, they can join a support network of other parents nearby, which can be a lifeline in the early years. We are the UKs largest parenting charity and, being independent, we have an influential voice in campaigning and lobbying on the issues that parents care about. For more information visit www.nct.org.uk
NCT, Alexandra House, Oldham Terrace, London W3 6NH NCT is a registered charity (England & Wales ): 801395, (Scotland) SCO41592

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NCT 2011