PPD Testing During Breastfeeding
PPD testing is completely safe and appropriate for breastfeeding patients, with no contraindications or documented harm to the infant. 1
Safety Evidence
The CDC guidelines explicitly address this clinical scenario and provide clear guidance:
Pregnancy is not a contraindication to PPD testing, with thousands (potentially millions) of pregnant women having been safely tested with no documented episodes of fetal harm. 2
The same safety principles apply to breastfeeding patients, as the tuberculin skin test involves intradermal injection of a small amount of purified protein derivative that does not enter breast milk or pose any risk to the nursing infant. 1
Breastfeeding should not exclude any woman from PPD testing as part of contact investigations, routine screening programs, or diagnostic evaluation for tuberculosis exposure. 2, 1
Clinical Application
When PPD testing is indicated for a breastfeeding patient, proceed without delay:
The test involves intradermal injection of 0.1 mL of PPD (5 TU) into the forearm, creating a 6-10 mm wheal. 2
Results should be read by trained personnel at 48-72 hours, measuring only induration (not erythema) in millimeters. 2
Standard interpretation criteria apply to breastfeeding women based on their risk factors: ≥5 mm for high-risk groups (HIV-infected, close TB contacts), ≥10 mm for intermediate risk, and ≥15 mm for low-risk populations. 2
Important Considerations
Do not delay or defer PPD testing in breastfeeding women who require evaluation:
The CDC explicitly recommends against postponing necessary tuberculosis screening in pregnant or breastfeeding women. 1
If tuberculosis exposure has occurred or symptoms are present, prompt testing is essential for both maternal health and infant protection. 1
A positive PPD test in a breastfeeding woman should prompt chest radiography with appropriate shielding to exclude active disease, followed by treatment or prophylaxis as indicated. 1
The tuberculin skin test does not interfere with breastfeeding and breastfeeding does not affect test interpretation. 2, 1