Snider D
Chest. 1984 Sep;86(3 Suppl):10S-13S. doi: 10.1378/chest.86.3.10s.
There is no solid evidence that pregnancy has an adverse effect on tuberculosis. With early diagnosis and prompt, adequate chemotherapy, the outcome of pregnancy in a woman with tuberculosis is likely to be good. Routine therapeutic abortion is not indicated. Data in the literature do not support the notion that pregnancy is a major risk factor for the development of tuberculosis, although no well-designed studies have been conducted. Screening of pregnant patients for tuberculosis should be based on consideration of other proved risk factors not on the fact of pregnancy. Preventive therapy should be given during the second and third trimesters of pregnancy to selected patients at high risk of progressive disease developing. Treatment of disease should be instituted promptly when disease is detected. The preferred regimens are INH-EMB, INH-RIF, or INH-EMB-RIF, although other drugs may be needed if the disease is recurrent or if there is resistance to these primary drugs. Mothers taking antituberculosis drugs can nurse their infants with little risk. With proper medical management, both tuberculosis and pregnancy can be expected to reach a happy conclusion in virtually all cases.
没有确凿证据表明妊娠会对结核病产生不良影响。通过早期诊断以及及时、充分的化疗，患结核病的女性妊娠结局可能良好。不建议进行常规治疗性流产。尽管尚未开展精心设计的研究，但文献数据并不支持妊娠是结核病发病的主要危险因素这一观点。对孕妇进行结核病筛查应基于对其他已证实的危险因素的考量，而非基于妊娠这一事实。对于有发展为进展性疾病高风险的特定孕妇，应在妊娠中期和晚期给予预防性治疗。一旦发现疾病，应立即开始治疗。首选方案是异烟肼 - 乙胺丁醇、异烟肼 - 利福平或异烟肼 - 乙胺丁醇 - 利福平，不过如果疾病复发或对这些一线药物耐药，可能需要使用其他药物。服用抗结核药物的母亲可以哺乳，风险很小。通过适当的医疗管理，几乎所有情况下结核病和妊娠都有望有一个良好的结局。
