TB treatment, contraception, and pregnancy

In pregnant women, co-infection with HIV and tuberculosis has been associated with increased vertical transmission of both infections. Treatment of latent and active disease is therefore important for the health of both the mother and her infant.

Rifampicin interacts with oral contraceptive medications and may reduce their efficacy. The World Health Organization recommends that women taking oral contraceptions who need tuberculosis treatment should either take a contraceptive pill with a higher dose of oestrogen than normal (50µg), or use another form of contraception.

Pregnant women with active tuberculosis should be treated with isoniazid and rifampicin, which are safe during pregnancy. Pyrazinamide, although recommended by many authorities, has not been thoroughly studied in pregnancy, and should be used at the discretion of the treating physician. Ethambutol has not been recommended. Streptomycin should never be used during pregnancy as it might damage the baby's hearing.