Respiratory infections

In general, pneumonia in pregnancy is not more common than in the non-pregnant patient, but may be associated with increased complications. The pregnant patient is susceptible to the usual bacterial organisms that cause pneumonia. However, due to alterations in cell-mediated immunity, certain pulmonary infections may be more common or more severe, eg. influenza, varicella, and coccidioidomycosis.

Due to reluctance to perform X-rays in pregnancy, the diagnosis and treatment of pneumonia may be delayed, adversely affecting outcome. Antibacterial therapy is similar to treatment in the nonpregnant patient, but tetracyclines, quinolones and metronidazole should be avoided if possible. Erythromycin, azithromycin, and β-lactam antibiotics have a very good safety profile.

Pregnant women should receive influenza vaccination, due to the increased severity of illness in these patients. In most influenza pandemics, including the 2009 H1N1, pregnant women had a disproportionately high incidence of severe disease and respiratory failure. Early treatment with oseltamivir (Tamiflu) is beneficial.

The incidence of tuberculosis does not appear to be increased in pregnancy. Isoniazid, rifampin, and ethambutol have acceptable safety profiles in pregnancy and are the regimen recommended by the CDC. There is less clinical experience with pyrazinamide in pregnancy, but this drug is recommended by the WHO. Streptomycin should be avoided.

Infection Therapy
Bacterial pneumonia Similar to non-pregnant patient, eg:

Hospitalized patient: ceftriaxone

ICU patient: ceftriaxone and azithromycin

Avoid tetracyclines and quinolones if possible

Tuberculosis   Isoniazid, rifampin, ethambutol

Pyrazinamide recommended by some authorities

Avoid Streptomycin

Fungal Amphotericin B

Limited data in pregnancy for newer drugs

Viral Influenza – oseltamivir

Varicella – acyclovir


Brito V, Niederman MS.  Pneumonia complicating pregnancy. Clin Chest Med. 2011 Mar;32(1):121-32

ANZIC Influenza Investigators and Australasian Maternity Outcomes Surveillance System. Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study. BMJ. 340:c1279, 2010

Broussard RC, Payne K, George RB: Treatment with acyclovir of varicella pneumonia in pregnancy. Chest 99:1045, 1991.

Knight M, Kurinczuk JJ, Nelson-Piercy C, Spark P, Brocklehurst P; UKOSS. Tuberculosis in pregnancy in the UK. BJOG. 116(4):584-8, 2009

Special Pregnancy Program

Referrals »

Fetal Medicine: 416-586-4800 x 7756
Fax: 416-586-3216

Maternal Medicine: 416-586-4800 x 7000
Fax: 416-586-5109

Main clinic hours: Monday to Friday, 8am to 4pm

Prenatal Diagnosis & Medical Genetics

Referrals »

phone: 416-586-4800 x 4523
fax numbers:
416-586-4723 or 416-586-8384

Perinatal Mental Health

Referrals »

Phone: 416-586-4800 x 8325
Fax: 416-586-8596