TB: Pregnant women, unborn babies not exempted!

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“When I was pregnant, I was coughing a lot, with blood in it. I was also experiencing headache and experiencing high body temperature,” said Mrs Dorcas Daniel, keeping an eye on her twin girls playing beside her.

“I was very concerned after the tests at the health centre in Iseyin. I was diagnosed with TB even though I was seven months pregnant. I was concerned that my babies would die too.”

Mrs Daniel started TB treatment at the maternity centre, and was later referred to Chest Hospital in Ibadan when her health was not improving.

At Ibadan, tests were carried out and appropriate treatment was given for four days after which she was asked to go back to Iseyin to continue her TB treatment and have the delivery of her twin babies.

Mrs Daniel continued taking her TB medication and wearing nose masks when breast feeding her babies or coming close to them. Also, the baby girls were kept in a separate room from her when they are sleeping to protect them from contracting TB.

She was also asked to eat a healthy diet to support her recovery and also taught proper coughing etiquette to prevent spreading the illness to family and friends.

“Pregnant women with TB need not be afraid. They need to take their TB drugs daily. If they comply with all the instructions they were given, there will be no problem. Initially, I was afraid that something would happen to my unborn babies. The medicines helped me so much; in fact, I had my babies at home,” said Mrs Daniel.

A persistent cough and high body temperature during pregnancy made Mrs Daniel to visit the health facility where she was tested and treated for TB. Today, she and her girls are healthy. Early intervention kept her children safe from the preventable disease.

Many women are not as fortunate. In 2014, TB killed an estimated 480,000 women—placing the disease among the top five causes of death for women of childbearing age.

In Oyo State, USAID Breakthrough Action Nigeria is working in partnership with the Ministry of Health and other partners to increase TB testing and treatment. It also reaches pregnant women with TB care.

When a mother has TB, it is dangerous not only for her but also for her baby. It’s much worse to leave it untreated. Women infected with TB are twice as likely to have a premature or underweight baby, and the baby can be born with congenital TB.

When it is a multidrug-resistant TB, which is resistant to the two most potent drugs used to treat TB disease, it further exacerbates the risk that pregnant women can face.

A baby who is infected with TB after birth has a high chance of quickly developing the disease.

“World Health Organization (WHO) says that after seven months, we can place them on TB treatment. She was the first mother to take the treatment in Oyo State. When she gave birth, she called to tell me she had an easy delivery, too,” Mrs Abimbola Oyebamiji, Monitoring and Evaluation officer of the Tuberculosis and Leprosy Control unit of the Oyo State Ministry, said.

Mrs Oyebamiji said that pregnant women are not exempted from contracting TB and they will develop symptoms of TB disease such as loss of appetite, cough, weight loss, fever, night sweats, chills, and fatigue.

However, she said that many pregnant women are undiagnosed or misdiagnosed because TB disease symptoms are similar to typical complaints early in pregnancy.

According to her, “If she is not in her early pregnancy state, but is coughing; and instead of gaining weight, is losing it with a persistent fever, body weakness, falling sick and vomiting, it is time to check up for other things, especially TB.”

Moreover, she declared that although dealing with a TB diagnosis in pregnancy is not easy, there is a greater risk to the pregnant woman and her baby if TB disease is not treated.

Babies born to women with untreated TB disease may have lower birth weight than those babies born to women without TB. Rarely, a baby may be born with TB.

Also, a mother with untreated TB at the time of delivery when breastfeeding or in direct contact with her newborn can infect her baby, usually if she has a cough.

The first comprehensive review of treatment outcomes for multidrug-resistant tuberculosis in pregnant women has confirmed also that TB treatment during pregnancy is safe for mother and baby. It is associated with favourable pregnancy outcomes and high treatment success.

The study found that seven out of 10 pregnant women were cured of their multidrug-resistant tuberculosis and delivered healthy babies after taking a medication that had previously been considered unsafe in pregnancy.

Published in JAMA Network Open, the study examined the experiences of 275 pregnant women with multidrug-resistant tuberculosis living in South Africa, Peru, Brazil, Iran and Uganda.

The study shows that the treatment must start as soon as possible during pregnancy. However, further research on the use of Linezolid in pregnancy is needed because long-term use can increase the risk of gastrointestinal disorders, ototoxicity, and psychiatric disorders.

Anyone can catch TB, but it is possible that pregnant women have a slightly higher risk of TB. TB can be cured with special antibiotics, which can be given safely even during pregnancy. It is very important to complete the whole course to cure the TB to prevent the infection returning in a form that is resistant to the usual drugs and is much harder to treat.

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