Leprosy & Pregnancy: Presented By:-Bhawna Joshi MSC. 1 Yeae
Leprosy & Pregnancy: Presented By:-Bhawna Joshi MSC. 1 Yeae
Leprosy & Pregnancy: Presented By:-Bhawna Joshi MSC. 1 Yeae
PREGNANCY
PRESENTED BY:-
Definition of leprosy
• A chronic infectious disease caused by a
mycobacterium (Mycobacterium leprae)
affecting especially the skin and peripheral
nerves and characterized by the formation of
nodules or macules that enlarge and spread
accompanied by loss of sensation with eventual
paralysis, wasting of muscle, and production of
deformities.
Course of leprosy in pregnancy
• It depends upon the changes occurring in a pregnant lady
1. Metabolic changes:
Due to several metabolical changes occurring during pregnancy , there
occurs a state of relative & absolute malnutrition ( deficiency of proteins,
vitamins, iron & other minerals)
Worsening of leprosy
2. Altered secretion of steroids:
levels of free cortisol & 17- hydroxycorticosteroid increases during pregnancy
Exacerbation of leprosy, TB
3. Altered immunological response:
1. Fetus:
• Only few obstetric complications have been consistently reported in women
with leprosy
• Babies born to mothers with LL hansen’s weigh significantly less at birth than
babies born to mothers with tuberculoid leprosy & normal healthy controls
• This may be due to fetoplacental inadequacy in women with LL hansen’s
2. placenta:
• Though the morphology & immunohistology of placenta is normal, the
placental weight & placental coefficient ( ratio of baby weight to placental
weight) is lower in women with leprosy ( more marked in LL hansen’s )
3. Infants, childhood, adolescence:
• 80% of babies born to LL mothers have been found to be severely
underweighted
• Infants born to LL mothers have a higher incidence of respiratory
problems
• Newborns of mothers on MDT may present with intercurrent disease such as
exfoliative dermatitis in first hours of life (due to dapsone) & brownish
discoloration (due to clofazimine)
Drug Therapy of leprosy
during pregnancy
• Drugs are best avoided in pregnancy, but the benefits of treating leprosy
during pregnancy far outweighs the risks of the drugs.
• WHO recommends that pregnant women with leprosy should continue to
take the standard MDT
• Drugs which can be administered are dapsone, rifampicin, clofazimine,
corticosteroids, NSAID’S for reactions
• Drugs which are avoided are quinolones, minocycline, thalidomide
Side effects of drugs on fetus
1. Dapsone - hemolytic anemia, hyperbilirubinemia
2. Rifampicin - hemorrhagic disease of new born ( parenteral vit K)
3. Clofazimine – fetal discoloration, sometimes death ( perinatal center)
4. Quinolones – arthropathies , osteochondrosis
5. Corticosteroids – risk of oral clefts ( avoid in 1st trimester)
6. NSAID’S – premature closure of ductus arteriosus , renal adverse effects,
premature birth ( avoid in 3rd trimester )
7. Thalidomide – phocomelia
MANAGEMENT
• The patient should be counseled to complete the course of ALT during
pregnancy & emphasize on the safety of these drugs
• She should be counseled about the possibility of reactions during
pregnancy
& lactation and advise them to take medical help immediately
• If possible, the patients on ALT during pregnancy should be managed at a
perinatal center with adequate neonatal care facilities
MDT DRUGS
• The drugs used in MDT are a combination of Rifampicin, clofazimine, and
dapsone for MB patients.
• A combination of rifampicin and dapsone is used for PB patients.
MB-MDT regimen
Monthly treatment : day 1
• Rifampicin 600mg
• Clofazimine 300mg
• Dapsone 100mg
Daily treatment : day 2 to 28
• Clofazimine 50mg
• Dapsone 100mg
Duration of treatment :12 blister packs to be taken monthly within a maximum period
of 18 months
Introduction
FETUS:
Under weight infant
Low apgar score
Perinatal death
IUGR
Preterm labour.
• New born baby is at risk of postnatally acquired TB if mother has still TB at the time
of birth.
Effect of pregnancy on TB:
During pregnancy
Supervision and joint care with obstetrician and chest
physician is necessary.
In the first trimester anti-TB drug should be continued. The
choice of drug and the dosage may have to be modified.
Morning sickness may pose some difficulties.
In 2nd and 3rd trimester, the status should be reviewed.
Women will need advice regarding workload, diet and rest.
Treatment with iron, folic acid and vitamin is necessary to
improve general condition/health.
During labour