Global estimates of tuberculosis incidence during pregnancy and postpartum

Background

Tuberculosis (TB) incidence peaks among women of reproductive age (15–49 years), encompassing all individuals who can become pregnant. Pregnancy and the postpartum period are associated with an increased risk of progression to active TB disease compared with non-pregnant periods. Maternal TB is linked to severe adverse outcomes, including low birthweight, preterm birth, stillbirth, maternal mortality, and infant mortality. Postpartum TB, in particular, contributes substantially to maternal and infant deaths, especially among women living with HIV.

Despite these risks, tuberculosis preventive treatment (TPT) is rarely used during pregnancy due to persistent safety concerns, even though it is not contraindicated. TB diagnosis during pregnancy is challenging because TB symptoms (e.g., fatigue, shortness of breath) overlap with normal pregnancy-related changes, and physiological adaptations such as gestational weight gain may mask typical disease manifestations. Furthermore, pregnancy status is not routinely recorded in TB surveillance systems, and TB cases are not systematically captured in maternal health registers, leading to under-recognition of the burden of TB during pregnancy and the postpartum period.

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Who

Women of reproductive age (15–49 years) globally, including both HIV-negative women and women living with HIV.
The study population was derived from global demographic and disease datasets rather than a single cohort. Evidence inputs included six published observational studies (two case–control and four retrospective cohort studies) contributing to the meta-analysis, as well as an additional cohort dataset of women living with HIV from South Africa (the ORCHID trial).

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What

The study estimated global and country-specific TB incidence during pregnancy and the postpartum period, stratified by age and HIV status.

Key findings:

• Pregnancy and the postpartum period were associated with increased TB risk compared with non-pregnant periods.

• Among HIV-negative women, the pooled incidence rate ratio (IRR) was 1.34 during pregnancy and 1.91 postpartum.

• Among women living with HIV, TB risk was substantially higher, with IRRs of 5.73 during pregnancy and 3.58 postpartum (based on ORCHID data).

• In 2023, an estimated 239,500 pregnant women and 97,600 postpartum women developed active TB globally, accounting for approximately 9% of TB incidence among women aged ≥15 years.

The authors conclude that TB during pregnancy and postpartum represents a substantial and under-recognised global burden with major implications for maternal, neonatal, and infant health.

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When

Included studies were published between 1996 and 2020, with observation periods spanning 1992 to 2014.
Modelled TB burden estimates were generated for the year 2023.

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Where

The analysis was global, producing country- and region-specific estimates.
Meta-analysis data were drawn from six countries: the Dominican Republic, Malawi, Mongolia, South Africa, Sweden, and the United Kingdom.
The highest estimated TB burden among pregnant and postpartum women occurred in the WHO African Region, followed by the WHO South-East Asia Region.

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Why

The study addressed a critical gap in global TB burden estimation, as routine TB surveillance systems do not disaggregate incidence by pregnancy or postpartum status. Improved estimates are needed to better characterise TB risk during these periods and to inform integrated TB, maternal, and HIV health strategies, particularly in high HIV-prevalence settings.

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How

The authors used a multi-step analytical approach:

• A rapid literature review and meta-analysis using a PECOS framework to estimate IRRs for TB during pregnancy and postpartum.

• Conversion of odds ratios to IRRs when required, with pooling via inverse-variance weighting and heterogeneity assessed using I² and τ² statistics.

• A mathematical modelling framework integrating age- and sex-disaggregated TB incidence data from the World Health Organization, fertility and population data from the UN World Population Prospects 2024, and HIV prevalence data from UNAIDS.

• Estimation of person-time at risk assuming 9 months of pregnancy and 3 months postpartum.

• Disaggregation of TB incidence by HIV status and adjustment using meta-analytic IRRs, with uncertainty propagated across all model inputs.

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Overall Interpretation

Pregnant and postpartum women—particularly those living with HIV—face a markedly elevated risk of tuberculosis. Pregnancy and the postpartum period represent critical but under-addressed windows for TB prevention, screening, and integrated maternal–TB–HIV care at the global level.

Source: Mafirakureva, N., Cartledge, A., Bradshaw, I., Bekker, A., Salazar-Austin, N., Meehan, S.A., Myer, L., Odayar, J., Rangaka, M.X. and Dodd, P.J., 2026. Global estimates of tuberculosis incidence during pregnancy and postpartum: a rapid review and modelling analysis. The Lancet Global Health.