Tuberculosis in pregnancy and the puerperium.

Incidence of tuberculosis and pregnancy The occurrence of pregnancy in patients with tuberculosis is increasing in developed countries as a result of changes in the case mix and age distribution of cases of tuberculosis, with an increasing proportion coming from ethnic minority groups. In 1988 over 50% of cases in England and Wales were in the white ethnic group. Most of the white women were aged over 50 years, with only a minority of cases in the 15–40 age range in whom pregnancy is most likely. Since 1988 the proportion of white ethnic cases has declined, reaching 43% in 1993 and down to 37% in 1998, with still only a minority of cases of child bearing age. An increasing proportion—and now the majority—of cases of tuberculosis are from minority ethnic groups. In 1998 over 56% of cases were born abroad, with 39% coming from the Indian subcontinent and 13% of black African ethnic origin. The cases of tuberculosis in all these ethnic minority groups have a very diVerent age distribution from those of UK origin, with a median age usually under 30 years compared with over 50 years in the white population. The increase in the number of patients with tuberculosis who become pregnant is therefore due to the increasing proportion of women of child bearing age. Similar trends have been reported in the USA 5 and in most developed countries in Europe. In developing countries the rise in tuberculosis is also predominantly aVecting the young, mainly the 15–44 age group, fuelled in sub-Saharan Africa by HIV co-infection. This review considers aspects of tuberculosis in pregnancy and does not cover reduced fertility from genital tuberculosis, although this is an important cause of infertility, especially in developing countries.