Last update: Feb. 12, 2020

Maternal Tuberculosis

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
Read the Comment.

Infection caused by the bacillus Mycobacterium tuberculosis.

The World Health Organization and most specialized medical associations recommend continuing breastfeeding in all cases of maternal tuberculosis (TB). There is no need for mother-infant separation except in the case of multi-resistant TB. The mother should wear a mask during the first days of treatment and the infant must be diagnosed and administered prophylaxis with isoniazid or TB treatment (Mittal 2014, WHO 2007 and 1998).

According to Red Book 2012 and cited in Lawrence 2016 p427:
- Non-active maternal TB, without active lung lesions in the lung does not contraindicate breastfeeding or warrant separation.
- Active TB with pulmonary lesions requires separation and interruption of direct breastfeeding (but expressed breastmilk can be administered) up to 15 days after starting the treatment or analysis of negative sputum (Di Comité 2016, Baquero 2015). (Although it is most likely that the infant will already have been exposed and what is required is diagnosis and prophylaxis with isoniazid or simultaneous treatment to that of the mother)
- Only in the rare case of tuberculous mastitis are both direct breastfeeding and the administration of expressed milk contraindicated.

Except in cases of TB mastitis, Mycobacterum tuberculosis is not transmitted through breastmilk (Click 2018).

Breastfeeding is possible in mothers treated for multi-resistant TB (Drobac 2005).

The amount of isoniazid that the infant receives through breastmilk is negligible (Garessus 2019, Singh 2008).
Drugs for the treatment of TB are compatible with breastfeeding (Blumberg 2003, ATC 2003, WHO 2002, Tran 1998, Dautzenberg 1998, Snider 1994) and transfer in such small amounts that there is no need to modify the dose of the treatment or prophylaxis of TB of the infant (Partosch 2018, Blumberg 2003, ATC 2003).


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Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

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Maternal Tuberculosis belongs to this group or family:

References

  1. Garessus EDG, Mielke H, Gundert-Remy U. Exposure of Infants to Isoniazid via Breast Milk After Maternal Drug Intake of Recommended Doses Is Clinically Insignificant Irrespective of Metaboliser Status. A Physiologically-Based Pharmacokinetic (PBPK) Modelling Approach to Estimate Drug Exposure of Infants via Breast-Feeding. Front Pharmacol. 2019 Jan 22;10:5. Abstract
  2. Click ES, Ouma GS, DeGruy K, Murithi W, Okonji JA, McCarthy KD, Musau S, Okumu A, Alexander H, Posey J, Cain KP. No evidence of Mycobacterium tuberculosis in breast milk of 18 women with confirmed TB disease in Kisumu, Kenya. Int J Tuberc Lung Dis. 2018 Apr 1;22(4):464-465. Abstract
  3. Partosch F, Mielke H, Stahlmann R, Gundert-Remy U. Exposure of Nursed Infants to Maternal Treatment with Ethambutol and Rifampicin. Basic Clin Pharmacol Toxicol. 2018 Aug;123(2):213-220. Abstract
  4. Di Comite A, Esposito S, Villani A, Stronati M; Italian Pediatric TB Study Group. How to manage neonatal tuberculosis. J Perinatol. 2016 Abstract
  5. Lawrence RA, Lawrence RM. Breastfeeding. A guide for the medical profession. Eighth Edition. Philadelphia: Elsevier; 2016
  6. Baquero-Artigao F, Mellado Peña MJ, del Rosal Rabes T, Noguera Julián A, Goncé Mellgren A, de la Calle Fernández-Miranda M, Navarro Gómez ML; Working Group on gestational, congenital, and postnatal tuberculosis, Spanish Society of Pediatric Infectious Diseases (PFIC). Guía de la Sociedad Española de Infectología Pediátrica sobre tuberculosis en la embarazada y el recién nacido (ii): profilaxis y tratamiento. [Spanish Society for Pediatric Infectious Diseases guidelines on tuberculosis in pregnant women and neonates (ii): Prophylaxis and treatment]. An Pediatr (Barc). 2015 Abstract Full text (link to original source) Full text (in our servers)
  7. Mittal H, Das S, Faridi MM. Management of newborn infant born to mother suffering from tuberculosis: current recommendations & gaps in knowledge. Indian J Med Res. 2014 Abstract Full text (link to original source) Full text (in our servers)
  8. Red Book. Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2012 Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, Red Book 2012
  9. Singh N, Golani A, Patel Z, Maitra A. Transfer of isoniazid from circulation to breast milk in lactating women on chronic therapy for tuberculosis. Br J Clin Pharmacol. 2008 Abstract Full text (link to original source) Full text (in our servers)
  10. WHO: World Health Organization Stop TB Partnership Childhood TB Subgroup. Chapter 4: childhood contact screening and management. Int J Tuberc Lung Dis. 2007 Abstract Full text (in our servers)
  11. Drobac PC, del Castillo H, Sweetland A, Anca G, Joseph JK, Furin J, Shin S. Treatment of multidrug-resistant tuberculosis during pregnancy: long-term follow-up of 6 children with intrauterine exposure to second-line agents. Clin Infect Dis. 2005 Jun 1;40(11):1689-92. Epub 2005 Apr 18. Abstract Full text (link to original source) Full text (in our servers)
  12. ATC (American Thoracic Society); CDC; Infectious Diseases Society of America. Treatment of tuberculosis. MMWR Recomm Rep. 2003 Abstract Full text (link to original source) Full text (in our servers)
  13. Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN, Fujiwara P, Grzemska M, Hopewell PC, Iseman MD, Jasmer RM, Koppaka V, Menzies RI, O'Brien RJ, Reves RR, Reichman LB, Simone PM, Starke JR, Vernon AA; American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med. 2003 Abstract Full text (link to original source) Full text (in our servers)
  14. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  15. WHO. Breastfeeding and maternal tuberculosis. Division of Child Health and development. 1998 Full text (in our servers)
  16. Tran JH, Montakantikul P. The safety of antituberculosis medications during breastfeeding. J Hum Lact. 1998 Dec;14(4):337-40. Review. Abstract
  17. Dautzenberg B, Grosset J. [Tuberculosis and pregnancy]. Rev Mal Respir. 1988 Abstract
  18. Snider DE Jr, Powell KE. Should women taking antituberculosis drugs breast-feed? Arch Intern Med. 1984 Abstract

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