TB and HIV are both independent risk factors for maternal mortality [14,53,54]. Maternal TB infection, not confined to the lymph nodes, has

been linked to increased pregnancy complications, including low birth weight, preterm birth and intra-uterine growth retardation [55,56]. These complications are exacerbated when TB is diagnosed late or treatment is interrupted [55]. Investigation of pregnant women for tuberculosis should be the same as for non-pregnant adults. Although every effort should be made to obtain appropriate specimens for culture and sensitivity testing, treatment for suspected or probable TB should not be delayed, especially when managing an individual approaching the end of her pregnancy, to reduce the risk of transmitting M. tuberculosis to the neonate. Treatment of TB should be the same as for the non-pregnant. All four first line drugs have a good safety Bcl-2 inhibitor profile in pregnancy and none appears to have teratogenic effects [57,58]. Isoniazid (C) causes

hepatotoxicity in pregnant and non-pregnant adults, TSA HDAC although one retrospective study, which was not statistically significant, has suggested that this is more common in pregnant women [59]. All pregnant women receiving isoniazid should be aware of potential hepatotoxicity and its symptoms, and their liver function should be checked if clinical symptoms deteriorate. Some authorities recommend regular monitoring of liver function during pregnancy. Pyridoxine

should be used, as for all taking isoniazid. Rifampicin (C) may increase the risk of haemorrhagic disease in neonates. Therefore neonates born to pregnant women taking rifampicin should Diflunisal be given vitamin K. Rifampicin is not known to be teratogenic. Although pyrazinamide (C) is not recommended for use during pregnancy in the United States, both the WHO and International Union Against Tuberculosis and Lung Disease recommend its routine use for pregnant women being treated for TB [3]. There seems to be little evidence to suggest pyrazinamide is harmful in pregnancy and it should therefore be included in an initial anti-tuberculous regime. If pyrazinamide is omitted, the minimum duration of treatment is nine months. Ethambutol (B) is not known to be harmful in pregnancy [60]. Ethambutol causes ocular toxicity in adults but visual problems have not been reported in neonates exposed in utero [3]. Despite FDA category B, there are no data on the use of rifabutin (B) in pregnancy. Rifampicin has been widely used in pregnancy and this drug is therefore preferred [60]. Managing TB in pregnant HIV-seropositive adults is complicated by drug interactions between antiretroviral therapy and antituberculous therapy, particularly rifampicin.