Global estimates of tuberculosis incidence during pregnancy and postpartum: a rapid review and modelling analysis
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Introduction
Despite known maternal, perinatal and infant health risks of tuberculosis during pregnancy, global estimates of incidence remain limited. Existing estimates are outdated, and do not include the postpartum period, HIV co-infection, age, or specific changes in risk, limiting our understanding of the true scale of disease in this understudied population.
Methods
We estimated the global incidence of tuberculosis among pregnant and postpartum women using a mathematical modelling approach. We leveraged age- and sex-stratified tuberculosis incidence data from the World Health Organization (WHO) and applied risk ratios derived from a systematic literature review of tuberculosis risk during pregnancy and the postpartum period.
Findings
Compared to non-pregnant women without HIV, tuberculosis incidence rate ratios (IRRs) were 1.34 (95% CI:1.1-1.54) during pregnancy and 1.91 (1.53-2.39) during postpartum among HIV-negative women. For women living with HIV, IRRs were 5.73 (2.64-10.94) during pregnancy and 3.58 (0.85-9.63) postpartum. We estimated 239,300 pregnant women (95% UI:216,100-262,100) and 97,600 postpartum women (90,000-105,200) developed tuberculosis disease globally in 2023, with HIV contributing to 21% and 11% of cases respectively. The WHO Southeast Asian Region had the highest incidence (115,900 pregnant [97,300-134,500]; 51,800 postpartum [45,700-57,800] cases), followed closely by the African Region (115,500 pregnant [101,600-129,400]; 42,700 postpartum [38,100-47,200] cases).
Interpretation
Pregnant and postpartum women face substantial tuberculosis risk yet remain underrepresented in global estimates. Our findings underscore the need for improved surveillance and targeted interventions to reduce tuberculosis incidence in this group.
Funding
MRC
