The considerable influx of women into the United States from Asia, Africa, Mexico, and Central America has been accompanied by an increased frequency of tuberculosis in pregnancy. Sackof and coworkers (2006) reported positive tuberculin test results in half of 678 foreign-born women attending prenatal clinics in New York City. Almost 60 percent were newly diagnosed. Pillay and colleagues (2004) stress the prevalence of tuberculosis in HIV-positive pregnant women. At Jackson Memorial Hospital in Miami, Schulte and associates (2002) reported that 21 percent of 207 HIV-infected pregnant women had a positive skin test result. Recall also that silent endometrial tuberculosis can cause tubal infertility (Levison, 2010; Raviglione, 2015).
Without therapy, active tuberculosis appears to have adverse efects on pregnancy (Mnyani, 2011). Several studies indicate that outcomes are dependent on the site of infection and gestational age at diagnosis. J ana and colleagues (1994) from India and Figueroa-Damian and Arrendondo-Garcia (1998) from Mexico City noted that active pulmonary tuberculosis was associated with increased incidences of preterm delivery, low-birthweight and growth-restricted newborns, and perinatal mortality. Others have found similar efects (EI-Messidi, 2016; Lin, 2010; Sobhy, 2017). From her review, Eferen (2007) cited twofold greater rates of low birthweight, preterm delivery, and preeclampsia. The perinatal mortality rate was increased almost tenfold. Adverse outcomes correlate with late diagnosis, incomplete or irregular treatment, and advanced pulmonary lesions. Conversely, treated tuberculosis is associated with good pregnancy outcomes (Nguyen, 2014; Taylor, 2013).
Extrapulmonary tuberculosis is less common. Jana and coworkers (1999) reported outcomes in 33 pregnant women with renal, intestinal, and skeletal tuberculosis, and a third had low-birthweight newborns. Llewelyn and associates (2000) reported that nine of 13 pregnant women with extrapulmonary disease had delayed diagnoses. Prevost and Fung Kee Fung (I999) reviewed 56 cases of tuberculous meningitis in which a third of mothers died. Spinal tuberculosis may cause paraplegia, but vertebral fusion may prevent it from becoming permanent (Badve, 2011; Nanda, 2002). Psoas abscess develops in 5 percent of those with spinal infections (Nigam, 2013). Other presentations include widespread intraperitoneal tuberculosis simulating ovarian carcinomatosis and degenerating leiomyoma, and hyperemesis gravidarum from tubercular meningitis (Kutiu, 2007; Moore, 2008; Sherer, 2005).
Two types of tests are used to detect latent or active tuberculosis. One is the time-honored tuberculin skin test (TSj) and the others are inteeron-gamma release assays IGRAs)} which are becoming preferred (Getahun, 2015; Horsburgh, 2011). IGRAs are blood tests that measure interferon-gamma release in response to antigens present in M tuberculosis, but not bacille Calmette-Guerin (BCG) vaccine (Levison, 2010). he CDC (2005b, 2010b) recommends either skin testing or IGRA testing of gravidas who are in any of the high-risk groups. For those who have received BCG vaccination, IGRA testing is used (Mazurek, 2010).