Maternal and Neonatal Outcomes of Active Tuberculosis During Pregnancy: A Systematic Review
Suryanti Chan, Hamzah Hamzah, Anang Maulana Yusuf, Prananda Surya Airlangga, Mubarokah Mubarokah, Nia Desriva, Santi Hariani, Cinantya Paramita, Karlina Mahardieni, Yolanda Safitri, Susanti Susanti, Angelina SianeAbstract
Objective:
To provide a contemporary synthesis of maternal, obstetric, and neonatal outcomes associated with active tuberculosis (TB) during pregnancy and identify clinically relevant factors linked to poorer prognosis.
Methods:
A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Statement and prospectively registered in PROSPERO. PubMed and Scopus were searched from database inception to June 30, 2026. Observational studies evaluating maternal, obstetric, and neonatal outcomes among pregnant women with active TB were included. Methodological quality was assessed using the Newcastle-Ottawa Scale. Due to substantial clinical and methodological heterogeneity, findings were synthesized narratively following the Synthesis Without Meta-analysis guidelines.
Results:
Twelve observational studies met the inclusion criteria. Active maternal TB was consistently associated with adverse obstetric and neonatal outcomes, including preterm birth, low birth weight, small-for-gestational-age status, stillbirth, miscarriage, and neonatal mortality. Women who developed TB following in vitro fertilization and embryo transfer (IVF-ET) experienced more severe disease and worse pregnancy outcomes than those who conceived naturally. Among studies evaluating drug-resistant TB, maternal treatment outcomes were generally favorable with newer or repurposed regimens, although adverse pregnancy and infant outcomes remained a concern.
Conclusion:
Active TB during pregnancy is consistently associated with adverse maternal, obstetric, and neonatal outcomes, with the greatest burden observed among women with severe or disseminated disease, human immunodeficiency virus co-infection, drug-resistant TB, or TB following IVF-ET. Early detection, rapid diagnostic testing, timely and effective treatment, and multidisciplinary care are essential for reducing preventable maternal and neonatal morbidity. Further prospective, multicenter studies are needed to strengthen the evidence base and inform pregnancy-specific clinical guidelines.
Registration:
PROSPERO; CRD420261426021