Certified Nurse Midwife, D., writes:
In regards to your article Is Tuberculosis Testing Safe During Pregnancy?, please review the CDC recommendations on Tuberculosis and PPD testing in pregnancy before you advise pregnant women not to be TB tested! PPD is not going to give someone TB. Untreated TB is much more dangerous for women and their babies than the TB testing or sheilded x-rays if needed. [sic] If a woman's employer is requesting testing, chances are she works in a health care field where her risk of exposure is higher, also.
It seems to me that you are dispensing medical advice; i.e., "don't take this test" and unnecessarily scaring women. If they read the advice on your website first, it would be difficult for me to convince a patient that the benefits outweigh the risks.
Dear D.,
Thank you for your inquiry. Let me first point out that my statement in regards to TB testing for pregnant women, found in the article Is Tuberculosis Testing Safe During Pregnancy?, reads, "Tuberculosis testing should be avoided during pregnancy if possible." I did not state that pregnant women should not be TB tested.
Secondly, If you read the package insert for TUBERSOL, the Tuberculin Purified Protein Derivative (PPD) test (Mantoux) manufactured by Aventis Pasteur, it states exactly what I've indicated in the article Is Tuberculosis Testing Safe During Pregnancy?, and that is "there is no sufficient evidence that TB testing during pregnancy is safe." Nor is there any documented evidence that TB testing is unsafe.
The TUBERSOL package insert states:
"Animal reproduction studies have not been conducted with TUBERSOL. However, the Advisory Coucil for Elimination of Tuberculosis states: Tuberculin skin testing is considered valid and safe throughout pregnancy. No teratogenic effects of testing during pregnancy have been documented.
What this means is although the manufacturer hasn't done reproductive studies, the ACET has deemed it "safe" since no "bad" effects have been documented."
Clearly, the physician must weigh the benefits with the risks, as they do with everything. Therefore, if the pregnant women lives or works in a high risk environment, it may be to her and her unborn baby's benefit to get TB tested. As I stated previously, TB testing should be discussed with the woman's doctor. Only a medical doctor can determine what is best.
Package inserts are written by the TB test manufacturer -- the ones who developed the TB test and know the most about the TB test. If they indicate that there is no evidence that the TB test is safe during pregnancy, I'm certainly not going to recommend it to pregnant women.
I'd also like to point out that I stated, "you should talk to your obstetrician / gynecologist before undergoing tuberculosis testing." Pregnant women should discuss TB testing with their doctor, which is exactly what any person should do before undergoing any test, treatment, or taking any drug.
In the article Is Tuberculosis Testing Safe During Pregnancy? I stated that "some studies have been done on the safety of the PPD test". This is 100% accurate. Although some studies have been done on the TB test, it is still unknown if it is safe for a pregnant woman and her unborn child to be TB tested.
The manufacturers of the TB test do not know if the TB test is safe because they haven't done sufficient studies on pregnant women to prove that it is safe. Pregnant women need to know the truth, and that is, they just don't know if it's safe. I'm certainly not going to tell women that it is safe when it really isn't known whether it is or not.
In regards to your statement, "If a woman's employer is requesting testing, chances are she works in a health care field where her risk of exposure is higher, also.", I can tell you that that is not always the case. I've received dozens of emails from pregnant women asking me about the safety of TB testing during pregnancy for employment purposes and most are not in the healthcare field or work in a high risk environment.
The problem is too many employers have not adapted to the targeted TB testing regimen recommended by the Center for Disease Control and Prevention (CDC). They still insist on testing everyone for one reason or another, and it's simply not necessary. Only high risk individuals should be TB tested -- as is stated by the CDC.
I don't "dispense medical advice", nor have I ever written or told anyone "don't take this test". I inform people of the facts.
Regards,
Stacey Lloyd
Lung Diseases Guide
About.com
Edited for publishing purposes
