Leprosy in Pregnancy

Abstract

Women undergo physiological immunosuppression from ovulation until menstruation and in pregnancy until 6 weeks postpartum. This affects the course of leprosy in the mother. Leprosy, in turn, can affect the baby’s health. In a cohort study, relapse, reactivation, and new leprosy peaked in the third trimester, dropping sharply after parturition. Incidence of first-time ENL peaked in the first trimester, and again in the third trimester, remaining high for 6 months postpartum. First-time reversal reaction started abruptly at 6 weeks postpartum and remained high for the first year after childbirth. Recurrent ENL and reversal reaction caused continuing nerve damage for 2 years postpartum. New nerve damage occurred in almost half of all women during pregnancy and lactation. Insidious silent neuritis was the most dangerous. Women of reproductive age should therefore be followed up annually after completion of treatment. M. leprae can cross the placenta. Maternal leprosy affects fetal growth and well-being. Using the Ridley–Jopling classification, a cohort study reported a gradient of birth weights, with babies of mothers with TT and BT leprosy weighing significantly more than those of mothers with BL and LL leprosy. Twenty percent of babies of BL and LL mothers had Apgar scores of 4 or less at 1 min. Child mortality for the first 2 years was 22%, 12%, 10%, and 10% for babies of LL, BL, TT & BT, and healthy mothers, respectively.