Hidden toll: tuberculosis in pregnancy and after birth

Tuberculosis during pregnancy and the months after childbirth can harm mothers, babies and infants, but until now the global scale of this problem has been unclear. Existing estimates were out of date and often left out the postpartum period, HIV co‑infection, age differences and how risk changes around pregnancy. To fill that gap, Nyashadzaishe Mafirakureva and colleagues carried out a modelling study to produce updated global estimates of tuberculosis incidence among pregnant and postpartum women. The team combined published evidence about how pregnancy and the postpartum period alter tuberculosis risk with official disease data to build a clearer picture. Their goal was to make visible an understudied population so health systems and policy makers know where to focus screening, prevention and care. The work was supported by the MRC and set out to answer practical questions about how many women develop tuberculosis while pregnant or after giving birth, and how much HIV contributes to those cases. By making these estimates, the researchers aimed to highlight gaps in surveillance and to push for better tracking and services for mothers and infants at risk.

The researchers used a mathematical modelling approach that combined age‑ and sex‑stratified tuberculosis incidence data from the World Health Organization (WHO) with risk ratios taken from a systematic literature review of tuberculosis risk during pregnancy and the postpartum period. They compared pregnant and postpartum women to non‑pregnant women without HIV and calculated incidence rate ratios (IRRs). For HIV‑negative women the IRRs were 1.34 (95% CI:1.1-1.54) during pregnancy and 1.91 (1.53-2.39) during postpartum. For women living with HIV the IRRs were 5.73 (2.64-10.94) during pregnancy and 3.58 (0.85-9.63) postpartum. Applying these risks to global WHO data, they estimated that in 2023 a total of 239,300 pregnant women (95% UI:216,100-262,100) and 97,600 postpartum women (90,000-105,200) developed tuberculosis disease. HIV accounted for about 21% of cases in pregnant women and 11% in postpartum women. Regionally, the WHO Southeast Asian Region had the highest incidence with 115,900 pregnant (97,300-134,500) and 51,800 postpartum (45,700-57,800) cases, followed closely by the African Region with 115,500 pregnant (101,600-129,400) and 42,700 postpartum (38,100-47,200) cases.

The findings make clear that pregnant and postpartum women face substantial tuberculosis risk yet are underrepresented in global estimates and surveillance. By quantifying both pregnancy and the postpartum period, and by separating people by HIV status and age, the study exposes how much disease may have been missed in past assessments. That matters for clinical care and public health planning: accurate numbers are essential for deciding where to screen pregnant women, how to target prevention and treatment, and how to protect newborns. The researchers argue for improved surveillance and targeted interventions to reduce tuberculosis incidence in this group, because better data and focused programs could help close a large blind spot in maternal and child health. Putting these estimates into practice would mean earlier diagnosis, better linkage to care, and tailored policies in the regions with the highest burden.