Obstetrics & Gynecology · Medical Literature
Pregnancy Outcomes in Patients with Tuberculosis: A Systematic Review and Meta-analysis.
Abstract
Tuberculosis (TB) is an important global health problem, especially for pregnant women, a vulnerable group. This systematic review and meta-analysis was conducted in this group to obtain cumulative results in a collective effort toward the World Health Organization (WHO) End TB Strategy. The databases Ovid MEDLINE, Embase, PubMed, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials were searched for the last 10 years till 14th January 2025. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in this analysis. Pregnancy outcomes in terms of maternal complications and perinatal complications, including observed mortality, were considered for analysis. A total of 9,873 records were identified through database searching, and 15 studies, including 3,045 pregnant women with TB, were selected for final analysis. The pooled mean maternal age was 27.6 years, and more than half of TB cases were diagnosed antenatally. Among pregnancy-related complications, fetal growth restriction, pregnancy-induced hypertension, oligohydramnios, and gestational diabetes were seen in 19, 15, 11, and 10% of cases, respectively. Low birth weight, preterm birth, small for age, and low Apgar score (<7) had pooled prevalences of 30, 22, 20, and 13%, respectively. Maternal mortality and neonatal mortality showed pooled prevalences of 0.05 [95% confidence interval (CI): 0.03-0.08] and 5% (95% CI: 3-8%), respectively. Low to moderate heterogeneity was found among observations. This systematic review and meta-analysis showed continued maternal and perinatal adverse outcomes in pregnant women with TB even in the current era, highlighting the need to optimize healthcare.
Clinical relevance
In pregnant women with tuberculosis, what are the pooled prevalences of maternal complications (including fetal growth restriction, pregnancy-induced hypertension, oligohydramnios, and gestational diabetes) and perinatal complications (including low birth weight, preterm birth, small for gestational age, low Apgar score, neonatal mortality, and maternal mortality)? __SNAPSHOT__ {"studyDesign":"Systematic review and meta-analysis of observational studies; random-effects models used for pooled prevalence estimation; PRISMA guidelines followed; PROSPERO-registered (CRD420251040280)","setting":"International; multi-database search (Ovid MEDLINE, Embase, PubMed, ScienceDirect, Scopus, Cochrane CENTRAL); studies published within the 10 years prior to January 14, 2025; likely predominance of low- and middle-income, TB-endemic settings based on available population","sampleSize":"n = 3,045 pregnant women with TB across 15 included studies (screened from 9,873 initial records)","population":"Pregnant women with confirmed tuberculosis (pulmonary and/or extrapulmonary); pooled mean maternal age 27.6 years; more than half of TB cases diagnosed antenatally; specific inclusion/exclusion criteria for individual studies not fully detailed in abstract alone","intervention":"Presence of tuberculosis (active disease) during pregnancy — exposure variable in an observational synthesis","comparator":"Not applicable — this is a single-arm prevalence meta-analysis; no TB-negative control group was incorporated into the primary pooled analyses","primaryOutcome":"Pooled prevalences of maternal complications (fetal growth restriction, pregnancy-induced hypertension, oligohydramnios, gestational diabetes) and perinatal complications (low birth weight, preterm birth, small for gestational age, low Apgar score <7, neonatal mortality, maternal mortality)","followUp":"Not reported (varies by included study; follow-up duration of individual studies not specified in the abstract)","fundingSource":"Not reported"}
Key findings
Among 3,045 pregnant women with TB across 15 studies, the pooled prevalences of maternal complications were: fetal growth restriction 19%, pregnancy-induced hypertension 15%, oligohydramnios 11%, and gestational diabetes 10%. Perinatal outcomes were substantially adverse: low birth weight 30%, preterm birth 22%, small for gestational age 20%, and low Apgar score (<7) 13%. Mortality outcomes were quantified with confidence intervals: maternal mortality had a pooled prevalence of 0.05 (95% CI: 0.03–0.08) — interpretable as approximately 5% when expressed as a proportion, though the abstract uses a decimal format suggesting 5 per 100 — and neonatal mortality showed a pooled prevalence of 5% (95% CI: 3–8%). Low-to-moderate heterogeneity was reported across outcome analyses. No comparative odds ratios, risk differences, NNT, or NNH were calculable from the abstract data because this is a single-arm prevalence synthesis without an internal control group. These absolute prevalence figures cannot be directly attributed to TB causation without a concurrent TB-negative comparator arm. Note: The maternal mortality figure is reported in the abstract as '0.05 [95% CI: 0.03–0.08],' which is ambiguous in its unit (proportion vs. percentage); this is reproduced as reported and flagged as requiring clarification from the full text.
Practice implications
This systematic review documents a high burden of adverse maternal and perinatal outcomes in pregnant women with TB across the contemporary literature (studies from the prior decade). The findings confirm that TB complicating pregnancy is associated with clinically significant rates of low birth weight (30%), preterm birth (22%), small for gestational age (20%), fetal growth restriction (19%), and non-trivial neonatal mortality (~5%). These data are consistent with prior meta-analytic evidence demonstrating elevated risks of these outcomes in TB-affected pregnancies. However, critical limitations of interpretation apply: (1) This is a single-arm prevalence synthesis — without a concurrent TB-negative control group within these pooled analyses, the excess risk attributable specifically to TB over background population rates cannot be quantified from this study alone. (2) The study does not establish causation, nor does it quantify the independent contribution of TB severity, HIV co-infection, anti-TB treatment status, gestational age at diagnosis, or socioeconomic confounders. (3) Applicability is likely strongest to TB-endemic, low- and middle-income settings; generalizability to low-burden, high-income settings is uncertain. (4) Women with drug-resistant TB, HIV co-infection, or treated vs. untreated disease were likely heterogeneously represented across the 15 included studies, limiting subgroup conclusions. (5) Only an abstract was available for analysis; full text review is required to assess individual study quality, heterogeneity sources, publication bias evaluation (e.g., funnel plots), and risk-of-bias assessments. Practice should not change based on this study in isolation, but the data reinforce the clinical imperative for early TB detection and treatment in antenatal care, particularly in high-burden settings. __LIMITATIONS__ Single-arm design: no integrated TB-negative comparator group; excess attributable risk cannot be derived from pooled prevalences alone.,Only 15 studies with 3,045 participants included — modest sample for a global condition with heterogeneous presentations across settings.,Low-to-moderate heterogeneity reported, but sources of heterogeneity (TB type, HIV co-infection status, treatment regimen, gestational age at diagnosis, geographic setting) are not fully characterized in the abstract.,Potential for publication bias and selective outcome reporting across included observational studies; funnel plot analysis and assessment cannot be verified from the abstract alone.,Likely geographic and socioeconomic selection bias toward TB-endemic, lower-income settings; generalizability to high-income or low-TB-burden settings is limited.,Observational study designs of included studies are susceptible to confounding by indication and unmeasured covariates (HIV status, nutrition, TB treatment adequacy, socioeconomic status).,Ambiguity in reporting of the maternal mortality estimate (stated as '0.05 [95% CI: 0.03–0.08]' — unit unclear in the abstract; full text required for clarification).,Search limited to the past 10 years (to January 2025), which may exclude relevant historical data; restricted to indexed databases, potentially missing grey literature.,No subgroup analyses reported in the abstract for drug-susceptible vs. drug-resistant TB, pulmonary vs. extrapulmonary disease, or treated vs. untreated patients.,Funding source not reported; potential for conflict of interest cannot be assessed. __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ This PRISMA-compliant meta-analysis of 15 observational studies (n = 3,045) demonstrates that tuberculosis complicating pregnancy is associated with high pooled prevalences of adverse perinatal outcomes — including low birth weight (30%), preterm birth (22%), and neonatal mortality (~5%) — as well as meaningful maternal complications such as fetal growth restriction (19%) and pregnancy-induced hypertension (15%). Because this is a single-arm prevalence synthesis without an integrated control group, excess risk attributable to TB over background rates cannot be precisely quantified from this analysis alone. Clinicians managing pregnant patients with TB in endemic settings should anticipate a high-risk obstetric profile warranting intensified surveillance for fetal growth, hypertensive disorders, and neonatal morbidity, with prompt initiation of guideline-concordant anti-TB therapy remaining the cornerstone of risk reduction.