《结核病母婴传播防治指南》解读

doi:10.19982/j.issn.1000-6621.20260197

摘要/Abstract

摘要：

妊娠期结核病及母婴传播防控是全球结核病防治体系中的重点与难点问题,尤其在结核病高负担地区,随着辅助生殖技术的快速发展,其临床诊治与公共卫生管理面临更大挑战。本文围绕最新发布的《结核病母婴传播防治指南》(以下简称“指南”),系统阐述了孕前结核病筛查、妊娠期活动性结核病的诊断与规范化治疗、结核分枝杆菌潜伏感染的管理、新生儿结核病的评估与处置,以及不孕与胚胎移植相关防控等关键内容。指南提出在高危人群中开展孕前筛查;妊娠期疑似病例优先采用痰分子生物学检测,确诊结核病后应立即启动兼顾疗效与胎儿安全的抗结核治疗,并实行多学科管理;妊娠期结核病孕妇分娩后,新生儿在排除活动性结核病后可考虑预防性治疗并随访;拟行体外受精-胚胎移植者需先完成结核病评估与防控;强调新生儿暴露后应及时评估,结合分子检测辅助诊断,合理实施预防性治疗与卡介苗接种,并落实产后隔离与哺乳管理。通过推广先进诊断技术、强化医务人员培训、落实多学科协作与患者教育,可实现妊娠期结核病的早期发现与干预,降低母婴不良结局,推动结核病母婴防控策略在临床与公共卫生层面的有效实施。

关键词: 结核, 妊娠并发症, 感染性, 诊断技术和方法, 预防和防护用药, 生殖技术, 辅助

Abstract:

Prevention and control of tuberculosis (TB) during pregnancy and mother-to-child transmission (MTCT) are key and challenging issues in the global TB prevention and control system. Especially in TB high burden areas, with the rapid development of assisted reproductive technology, its clinical diagnosis, treatment and public health management face greater challenges. Focusing on the newly released Guidelines for the prevention and management of mother-to-child transmission of tuberculosis (hereinafter referred to as “the Guidelines”), this paper systematically elaborates on key contents including pre-pregnancy TB screening, diagnosis and standardized treatment of active TB during pregnancy, management of latent tuberculosis infection, evaluation and management of neonatal TB, as well as prevention and control related to in vitro fertilization and embryo transfer (IVF-ET). The Guidelines recommend pre-pregnancy screening among high-risk populations. For suspected cases during pregnancy, sputum molecular biological testing is prioritized. Once TB is confirmed, anti-tuberculosis treatment balancing efficacy and fetal safety should be initiated immediately, with multidisciplinary management implemented. After delivery of pregnant women with gestational TB, neonates may receive preventive treatment and follow-up after excluding active TB. Individuals planning IVF-ET should complete TB assessment and prevention first. It is emphasized that early evaluation, molecular testing-assisted diagnosis, rational preventive treatment and appropriate timing of Bacillus Calmette-Guérin vaccination should be carried out for neonates after exposure, with postpartum isolation and breastfeeding management implemented. By promoting advanced diagnostic technologies, strengthening healthcare worker training, implementing multidisciplinary collaboration and patient education, early detection and intervention of gestational TB can be achieved, adverse maternal and neonatal outcomes can be reduced, and the effective implementation of TB MTCT prevention and control strategies at both clinical and public health levels can be promoted.

Key words: Tuberculosis, Pregnancy complications, infectious, Diagnostic techniques and procedures, Protective agents, Reproductive techniques, assisted

中图分类号:

王小敏, 徐鹏, 陈珍妍, 龙玉娇, 王瑾, 刘晗, 高文英, 方木通. 《结核病母婴传播防治指南》解读[J]. 中国防痨杂志, 2026, 48(8): 1113-1119. doi: 10.19982/j.issn.1000-6621.20260197

Wang Xiaomin, Xu Peng, Chen Zhenyan, Long Yujiao, Wang Jin, Liu Han, Gao Wenying, Fang Mutong. Interpretation of the Guidelines for the prevention and management of mother-to-child transmission of tuberculosis[J]. Chinese Journal of Antituberculosis, 2026, 48(8): 1113-1119. doi: 10.19982/j.issn.1000-6621.20260197

参考文献 49

[1]	Jana N, Vasishta K, Jindal S K, et al. Perinatal outcome in pregnancies complicated by pulmonary tuberculosis[J]. Int J Gynaecol Obstet, 1994, 44(2): 119-124. doi:1016/0020-7292(94)90064-7.
[2]	Gupta A, Nayak U, Ram M, et al. Postpartum tuberculosis incidence and mortality among HIV-infected women and their infants in Pune, India, 2002-2005[J]. Clin Infect Dis, 2007, 45(2):241-249. doi:10.1086/518974. pmid: 17578786
[3]	Shao Y, Hageman J R, Shulman S T. Congenital and Perinatal Tuberculosis[J]. Neoreviews, 2021, 22(9):e600-e605. doi:10.1542/neo.22-9-e600. pmid: 34470761
[4]	Shenoi A, Kavitha H R. Perinatal Tuberculosis[J]. Pediatr Inf Dis, 2019, 1(1):30-33. doi:10.5005/jp-journals-10081-1107.
[5]	Hirsch-Moverman Y, Hsu A, Abrams E J, et al. Guidelines for tuberculosis screening and preventive treatment among pregnant and breastfeeding women living with HIV in PEPFAR-supported countries[J]. PLoS One, 2024, 19(4):e0296993. doi:10.1371/journal.pone.0296993.
[6]	Sobhy S, Babiker Z, Zamora J, et al. Maternal and perinatal mortality and morbidity associated with tuberculosis during pregnancy and the postpartum period: a systematic review and meta-analysis[J]. BJOG, 2017, 124(5):727-733. doi:10.1111/1471-0528.14408.
[7]	World Health Organization. Optimal and early inclusion of pregnant and lactating women in tuberculosis research: consensus statement [EB/OL].[2026-04-01].https://iris.who.int/handle/10665/381875.
[8]	Lima T, Trigo S, Silveira E, et al. Navigating Tuberculosis in Pregnancy and Lactation: A Review of Maternal and Neonatal Considerations[J]. Diseases, 2026, 14(3):102. doi:10.3390/diseases14030102.
[9]	Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis[J]. Lancet Glob Health, 2014, 2(6):e323-e333. doi:10.1016/S2214-109X(14)70227-X.
[10]	World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience[EB/OL]. [2026-04-01]. https://apps.who.int/iris/handle/10665/250796.
[11]	Rahari D S, Nurdiati D S, Thobari J A, et al. Pregnant women and healthcare workers’ perceptions on tuberculosis and screening: a cross-sectional study in Indonesia[J]. Int Health, 2025, 17(3):334-341. doi:10.1093/inthealth/ihae069.
[12]	中华医学会结核病学分会, 中国研究型医院学会结核病学专业委员会, 国家感染性疾病临床医学研究中心/深圳市第三人民医院. 结核病母婴传播防治指南[J]. 新发传染病电子杂志, 2026, 11(1):1-12. doi:10.19871/j.cnki.xfcrbzz.2026.01.001.
[13]	World Health Organization. Recommendations on Antenatal Care for a Positive Pregnancy Experience[R]. Geneva: World Health Organization, 2016.
[14]	World Health Organization. Consolidated Guidelines on Tuberculosis. Module 2: Screening-Systematic Screening for Tuberculosis Disease[R]. Geneva: World Health Organization, 2021.
[15]	Miele K, Bamrah Morris S, Tepper N K. Tuberculosis in pregnancy[J]. Obstet Gynecol, 2020, 135(6):1444-1453. doi:10.1097/AOG.0000000000003890. pmid: 32459437
[16]	Baquero-Artigao F, Del Rosal T, Falcón-Neyra L, et al. Update on the diagnosis and treatment of tuberculosis[J]. An Pediatr (Engl Ed), 2023, 98(6): 460-469. doi:10.1016/j.anpede.2023.03.009.
[17]	World Health Organization. WHO Consolidated Guidelines on Tuberculosis: Module 3: Diagnosis-Rapid Diagnostics for Tuberculosis Detection, Third Edition[R]. Geneva: World Health Organization, 2024.
[18]	Su Y, Kong X, Chen Z, et al. Adverse pregnancy outcomes and complications of tuberculosis in pregnant women[J]. Front Cell Infect Microbiol, 2025, 15:1550430. doi:10.3389/fcimb.2025.1550430.
[19]	Schaefer G, Zervoudakis I A, Fuchs F F, et al. Pregnancy and pulmonary tuberculosis[J]. Obstet Gynecol, 1975, 46(6):706-715. pmid: 1187077
[20]	Malhamé I, Cormier M, Sugarman J, et al. Latent Tuberculosis in Pregnancy: A Systematic Review[J]. PLoS One, 2016, 11(5):e0154825. doi:10.1371/journal.pone.0154825.
[21]	Hui S Y A, Lao T T. Tuberculosis in pregnancy[J]. Best Pract Res Clin Obstet Gynaecol, 2022, 85(Pt A):34-44. doi:10.1016/j.bpobgyn.2022.07.006. pmid: 36002371
[22]	National Tuberculosis Controllers Association. Latent Tuberculosis Infection: Clinical Recommendations. Version 2.0, May 2021[EB/OL].[2026-04-01]. https://www.tbcontrollers.org/docs/resources/tb-infection/LTBI_Clinical_Recommendations_Version_002052021.pdf.
[23]	Jones A J, Mathad J S, Dooley K E, et al. Evidence for implementation: Management of TB in HIV and pregnancy[J]. Curr HIV/AIDS Rep, 2022, 19(6):455-470. doi:10.1007/s11904-022-00641-x.
[24]	Loto O M, Awowole I. Tuberculosis in pregnancy: a review[J]. J Pregnancy, 2012: 379271. doi:10.1155/2012/379271.
[25]	World Health Organization. Treatment of Tuberculosis: Guidelines, 4th ed[R]. Geneva: World Health Organization, 2010.
[26]	Bothamley G. Drug treatment for tuberculosis during pregnancy: Safety considerations[J]. Drug Saf, 2001, 24(7): 553-565. doi:10.2165/00002018-200124070-00006.
[27]	Li C, Liu L, Tao Y. Diagnosis and treatment of congenital tuberculosis: a systematic review of 92 cases[J]. Orphanet J Rare Dis, 2019, 14(1):131. doi:10.1186/s13023-019-1101-x. pmid: 31182120
[28]	Baquero-Artigao F, Mellado Pena M J, Del Rosal Rabes T, et al. Spanish Society for Pediatric Infectious Diseases guidelines on tuberculosis in pregnant women and neonates (i): Epide-miology and diagnosis. Congenital tuberculosis[J]. An Pediatr (Barc), 2015, 83(4): 285. e1-285.e8. doi:10.1016/j.anpedi.2015.01.004.
[29]	World Health Organization. Operational Handbook on Tuberculosis.Module 5: Management of Tuberculosis in Children and Adolescents[R]. Geneva: World Health Organization, 2022.
[30]	World Health Organization. Practical Manual of Processing Stool Samples for Diagnosis of Childhood TB[R]. Geneva: World Health Organization, 2022.
[31]	Klinkenberg E, de Haas P, Manyonge C, et al. Lessons Learned from Early Implementation and Scale-up of Stool-Based Xpert Testing to Diagnose Tuberculosis in Children[J]. Emerg Infect Dis, 2025, 31(3):1-9. doi:10.3201/eid3103.241580. pmid: 40023826
[32]	Cantwell M F, Shehab Z M, Costello A M, et al. Brief report: congenital tuberculosis[J]. N Engl J Med, 1994, 330(15):1051-1054. doi:10.1056/NEJM199404143301505.
[33]	Hasan N, Nourse C, Schaaf H S, et al. Management of the infant born to a mother with tuberculosis: a systematic review and consensus practice guideline[J]. Lancet Child Adolesc Health, 2024, 8(5): 369-378. doi:10.1016/S2352-4642(23)00345-0.
[34]	Mittal H, Das S, Faridi M M. Management of newborn infant born to mother suffering from tuberculosis: Current recommendations & gaps in knowledge[J]. Indian J Med Res, 2014, 140(1):32-39. pmid: 25222775
[35]	Quach H K, Scott B L, Lopez-Domowicz D A, et al. Case Report: Congenital tuberculosis in a premature infant requiring extracorporeal membrane oxygenation[J]. J Extra Corpor Technol, 2023, 55(2):86-90. doi:10.1051/ject/2023007.
[36]	Algharably E A, Kreutz R, Gundert-Remy U. Infant exposure to antituberculosis drugs via breast milk and assessment of potential adverse effects in breastfed infants: critical review of data[J]. Pharmaceutics, 2023, 15(4): 1228. doi:10.3390/pharmaceutics15041228.
[37]	Maugans C, Loveday M, Hlangu S, et al. Best practices for the care of pregnant people living with TB[J]. Int J Tuberc Lung Dis, 2023, 27(5):357-366. doi:10.5588/ijtld.23.0031. pmid: 37143222
[38]	National Institute of Child Health and Human Development. Drugs and Lactation Database (LactMed^®) [Internet]; Bedaquiline[EB/OL]. [2026-04-01]. https://www.ncbi.nlm.nih.gov/books/NBK540691/.
[39]	Centers for Disease Control and Prevention. Treatment for TB During Pregnancy[EB/OL].[2026-04-01]. https://www.cdc.gov/tb/topic/treatment/pregnancy.htm.
[40]	World Health Organization. Latent tuberculosis infection: Updated and consolidated guidelines for programmatic management[R]. Geneva: World Health Organization, 2018.
[41]	Centers for Disease Control and Prevention. Tuberculosis Clinical Care and Treatment During Pregnancy[EB/OL].[2026-04-01]. https://www.cdc.gov/tb/hcp/clinical-care/pregnancy.html.
[42]	Theron G, Montepiedra G, Aaron L, et al. Individual and composite adverse pregnancy outcomes in a randomized trial on isoniazid preventative therapy among women living with human immunodeficiency virus[J]. Clin Infect Dis, 2021, 72(11):e784-e790. doi:10.1093/cid/ciaa1482.
[43]	Hook E B. Latent tuberculosis infection. N Engl J Med, 2022, 386(13):e33. doi:10.1056/NEJMc2200195.
[44]	Brown J, Clark K, Smith C, et al. Variation in C-reactive protein response according to host and mycobacterial characteristics in active tuberculosis[J]. BMC Infect Dis, 2016, 16:265. doi:10.1186/s12879-016-1612-1.
[45]	刘琳, 任甜甜, 刘学润, 等. 干细胞治疗女性不孕相关疾病的研究进展[J]. 中华生殖与避孕杂志, 2023, 43(3):321-327. doi:10.3760/cma.j.cn101441-20220130-00050.
[46]	Qiao J, Wang Y, Li X, et al. A Lancet Commission on 70 years of women’s reproductive, maternal, newborn, child, and adolescent health in China[J]. Lancet, 2021, 397(10293): 2497-2536. doi:10.1016/S0140-6736(20)32708-2.
[47]	Li X, Wei M, Zou J, et al. Infertility trends in China: analyzing temporal changes, public demand, and demographic differences based on Baidu index[J]. BMC Public Health, 2025, 25(1):2481. doi:10.1186/s12889-025-23655-7.
[48]	Xia L, Mijiti P, Liu X H, et al. Association of in vitro fertilization with maternal and perinatal outcomes among pregnant women with active tuberculosis: a retrospective hospital-based cohort study[J]. Front Public Health, 2022, 10:1021998. doi:10.3389/fpubh.2022.1021998.
[49]	Li S, Wang J, Wang X, et al. A retrospective cohort study of tuberculosis disease between in vitro fertilisation-embryo transfer and natural pregnancy in Shenzhen China[J]. Int J Infect Dis, 2026, 166:108530. doi:10.1016/j.ijid.2026.108530.