TB contributes to 6–15% of all maternal mortality and leads to adverse pregnancy outcomes (187). A national registry study found incidence rate ratios for TB in pregnant and postpartum women of 1.4 and 1.9, respectively, compared with non-pregnant women (188). TB in pregnancy is associated with adverse maternal outcomes and complications during birth, such as pre-eclampsia, eclampsia, vaginal bleeding, hospitalization and miscarriage. Perinatal outcomes include a two-fold increased risk of premature birth, low birthweight and intrauterine growth retardation, and a six-fold increased risk of perinatal death (189–191). Maternal TB more than doubles the risk of vertical transmission of HIV (192), and increases the risk of mortality not only in the newborn but also in other young children living in the household (193). The increase in TB incidence in the postpartum period is likely due to delays in early detection during pregnancy as a result of related physiological and immunological changes (194).
In the absence of systematic collection of data on TB in pregnancy, modelling studies have estimated that more than 215 000 TB cases occur annually among pregnant and postpartum women, with the vast majority of cases occurring in Africa and South-East Asia (195). This may be an underestimate because the study assumed equivalent sensitivity of screening algorithms and diagnostic tests in pregnant and postpartum women as in non-pregnant adults.
The symptoms of TB disease in pregnancy are similar to those in non-pregnant women. Pregnancy may mask true weight loss, however, and failure to gain weight is an important symptom to consider. PTB is the most common form of TB disease in pregnancy. Disseminated TB occurs in 5–10% of pregnant women with TB disease and is a particular risk factor for congenital TB in newborns. All pregnant women in regions endemic for TB and HIV should be screened for symptoms of TB. It is equally important that pregnant women with presumptive TB are tested for HIV (6).
As maternal TB increases the risk of vertical transmission of HIV, TB treatment must be started promptly to prevent transmission. The treatment of TB in pregnant women is the same as for non-pregnant women. All pregnant women with TB/HIV coinfection are eligible for ART and should be treated according to the most recent WHO guidelines (78).