Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis, which most commonly affects the lungs. Given your husband’s diagnosis, prompt medical evaluation and careful coordination with healthcare providers are required before attempting to conceive. This guidance addresses the risk of transmission, steps to determine your current health status, and medical considerations for navigating pregnancy in this unique circumstance.
Understanding Tuberculosis Transmission and Infection
TB is transmitted through the air when a person with active TB disease in their lungs coughs, speaks, sneezes, or sings. These actions release tiny, bacteria-containing droplets into the air, which others can inhale. Living in close quarters with an infected spouse places you at a high risk for exposure.
Once the bacteria are inhaled, a person develops either Latent TB Infection (LTBI) or Active TB Disease (ATBD). In most cases, the immune system contains the bacteria, resulting in LTBI, where the bacteria remain alive but inactive. People with LTBI are not contagious, show no symptoms, and cannot spread the infection.
Active TB Disease occurs when the immune system cannot contain the bacteria, allowing them to multiply and cause illness. Only individuals with ATBD are contagious and capable of transmitting the bacteria. An estimated 5% to 15% of those with LTBI will progress to ATBD at some point in their lifetime, particularly if their immune system weakens.
Determining Your Current Health Status
The immediate action is to determine your infection status following prolonged exposure to your husband. You must consult a healthcare provider for testing. Two primary tests check for TB infection: the Tuberculin Skin Test (TST), also known as the Mantoux test, and the Interferon-Gamma Release Assay (IGRA), a blood test. Both the TST and IGRA are safe during pregnancy and determine if you have been exposed to the bacteria.
A positive result on either test indicates Latent TB Infection (LTBI). However, these tests cannot distinguish between LTBI and Active TB Disease (ATBD). If your initial test is positive, your physician must order a chest X-ray to look for signs of active disease in your lungs.
The chest X-ray is necessary to rule out ATBD, the contagious and symptomatic form of the illness. If the X-ray is clear and you have no symptoms, the diagnosis is LTBI, meaning you are not contagious. If the X-ray shows changes consistent with TB and you have symptoms like a persistent cough, fever, or night sweats, your doctor will proceed with further testing, such as a sputum culture, to confirm Active TB Disease. This diagnostic path is necessary before conception planning can move forward, as the course of action for LTBI and ATBD are distinct concerning pregnancy.
Navigating Pregnancy with Tuberculosis
If you are found to have TB, the risks to you and the developing baby are significant, making immediate medical consultation necessary. Pregnancy itself may increase the risk of existing LTBI progressing to ATBD due to natural changes in the immune system. Untreated active TB disease poses a greater danger to both the mother and the fetus than the required treatment.
Active TB during pregnancy is associated with adverse outcomes, including an increased risk of maternal mortality and complications such as anemia or gestational hypertension. For the fetus, maternal TB increases the risk of intrauterine growth restriction, low birth weight, and premature birth. In rare instances, the bacteria can cross the placenta, leading to congenital TB in the newborn, which is often severe.
If you are diagnosed with Active TB Disease, treatment must begin immediately, regardless of the trimester. If you are diagnosed with Latent TB Infection, your doctor may recommend delaying treatment until after delivery to minimize the risk of liver toxicity, which can be higher during pregnancy. However, if your LTBI diagnosis is recent and linked to your husband’s infectious period, your physician may recommend starting treatment immediately due to the higher risk of progression.
Timing Conception Around TB Treatment
The decision to conceive must be carefully timed and coordinated with both your infectious disease specialist and your obstetrician. Your husband must be declared non-contagious by his physician before you consider trying for pregnancy. A person with ATBD generally becomes non-contagious after two to three weeks of effective treatment.
If you have Latent TB Infection and require preventive treatment, the standard first-line medications, such as isoniazid, are considered safe for use during pregnancy and are not associated with fetal malformations. Women taking isoniazid should also take a daily pyridoxine (Vitamin B6) supplement to reduce the risk of peripheral neuropathy. Some newer or shorter-course preventive regimens, like those containing rifapentine, have not been adequately studied for safety during pregnancy and are avoided.
For both partners, completing the full course of prescribed TB treatment is important to prevent recurrence and the development of drug-resistant strains. If you complete treatment for LTBI before conception, healthcare providers advise waiting at least two to three months after the last dose before attempting to become pregnant. This coordinated approach ensures safety for you and your future baby.