The Impact of Pregnancy on Tuberculosis Treatment Outcomes: An Analysis of Brazilian National Surveillance Data 2016-2022

Background More than 200 000 pregnant people fall ill with tuberculosis (TB) annually. Little is known about the impact of pregnancy on TB outcomes. Methods This study used surveillance data from Brazil's Ministry of Health. We included women aged 11-49 years newly diagnosed with drug-susceptible TB disease between 2016 and 2022, treated with a first-line anti-TB regimen, and with a known treatment outcome. Using multivariable regression, we estimated the age-stratified effect of pregnancy on (1) loss to follow-up and (2) death during TB treatment. Results Of 96 868 women with TB, 1870 (1.9%) were pregnant, 79 361 (81.9%) were not pregnant, and 15 637 (16.1%) had unknown pregnancy status. Among pregnant women, 1432 (76.6%) experienced treatment success, 358 (19.1%), lost to follow-up, and 80 (4.3%) died. Among nonpregnant women, 79 262 (83.4%) experienced treatment success, 11 582 (12.2%) were lost to follow-up, and 4154 (4.4%) died. In adolescents, pregnancy conferred higher odds of loss to follow-up (adjusted odds ratio [aOR], 1.78; 95% confidence interval [CI]: 1.29-2.44) and death (aOR, 2.35; 95% CI: 1.27-4.37). Compared to nonpregnant women of the same age, pregnant women aged 20-29 and 30-39 years experienced more loss to follow-up (respectively: aOR, 1.39; 95% CI: 1.17-1.66 and aOR 1.79; 95% CI, 1.42-2.25), while those aged 40-49 years were more likely to die (aOR, 1.66; 95% CI: 1.04-2.66). Conclusions Our analysis revealed a significant association between pregnancy and poor TB treatment outcomes, highlighting the need for care providers to offer enhanced support and monitoring for pregnant women undergoing TB treatment. Further research is needed to identify the underlying reasons for these findings.