A retrospective cohort study of tuberculosis disease between in vitro fertilisation-embryo transfer and natural pregnancy in Shenzhen China

OBJECTIVE: This study aimed to compare the clinical profiles and maternal-foetal outcomes of tuberculosis (TB) disease in pregnant women following in vitro fertilization and embryo transfer (IVF-ET) versus natural conception (NC), and identify the associated high-risk factors. METHODS: A retrospective analysis included 133 pregnant women with TB disease, stratified into IVF-ET (n = 16) and NC (n = 117) groups. Clinical, radiological, and laboratory parameters were evaluated, and logistic regression identified risk factors for stillbirth or preterm birth. RESULTS: The IVF-ET group exhibited significantly more severe TB manifestations, including higher rates of bilateral pulmonary lesions (100.0% vs 39.3%), miliary TB (93.8% vs 5.1%), and TB meningitis (37.5% vs 3.4%), alongside prolonged hospitalization (median 18.0 vs 9.0 days, P < 0.001). These patients also demonstrated lower lymphocyte, CD4, and CD3 cell counts, as well as lower plasma albumin levels. Adverse foetal outcomes were more frequent in the IVF-ET group (stillbirth: 62.5% vs 1.7%; preterm birth: 31.2% vs 8.5%, both P < 0.001). IVF-ET was the strongest independent predictor of adverse outcomes (adjusted OR=59.42, P = 0.002), with the predictive model achieving an AUC of 0.868 (optimism-corrected AUC of 0.817). CONCLUSION: Tuberculosis following IVF-ET is associated with exacerbated disease severity and adverse foetal outcomes, accompanied by reduced cellular immune status and a poorer nutritional-inflammatory profile at presentation (e.g., lower CD3+/CD4+ T-cell counts and albumin levels). Pre-IVF TB screening and heightened vigilance during pregnancy are critical for risk mitigation.