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Latent TB in Pregnancy — SCE Infectious Diseases MCQ

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ModerateTuberculosisLatent TB in PregnancySCE Infectious Diseases

A 34-year-old healthcare worker develops a positive IGRA after occupational exposure to a patient with smear-positive pulmonary TB. She is currently 8 weeks pregnant. Her chest X-ray is normal. She has no symptoms. What is the recommended management of her latent TB?

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Correct answer: E — Defer latent TB treatment until after delivery (or the second trimester at earliest); monitor clinically

In pregnancy with latent TB (positive IGRA, asymptomatic, normal CXR), treatment is generally deferred until after delivery due to the hepatotoxicity risk of Isoniazid (which is increased in pregnancy/postpartum). If the risk of progression is very high (recent conversion, HIV co-infection, very young children), treatment with Isoniazid monotherapy can be started from the second trimester. Rifampicin is generally avoided in the first trimester though it is not formally teratogenic. Clinical monitoring with monthly symptom review is appropriate.

Reference: NICE NG33 2016 – TB; BHIVA 2025 – HIV in pregnancy (TB section)