Clinical Presentation, Disease Severity, and Pregnancy Outcomes among Women with Active Tuberculosis: A Comparative Cohort Study

Abstract

Background: Tuberculosis (TB) during pregnancy continues to pose a significant maternal and public health challenge, especially in high-burden regions. Physiological and immunological changes associated with pregnancy can modify TB presentation and increase disease severity. Objective: To compare the clinical presentation, disease severity, laboratory and radiological findings, and pregnancy outcomes among pregnant and non-pregnant women with active TB. Methodology: This prospective comparative cohort study cohort study was conducted from January 2024 to June 2025. A total of 190 women with active TB were enrolled, including 60 pregnant and 130 non-pregnant women matched by age and admission period. We prospectively collected demographic, clinical, laboratory, radiological, treatment, and outcome data. Categorical variables were analyzed using the chi-square or Fisher’s exact test, while continuous variables were compared using the independent-samples t-test or Mann-Whitney U test, as appropriate. Results: Pregnant women had significantly higher frequencies of fever (71.7% vs. 35.4%, p<0.001), dyspnoea (43.3% vs. 19.2%, p=0.001), and neurological symptoms (33.3% vs. 13.1%, p=0.003). ICU admission was also significantly more frequent among pregnant women (18.3% vs. 3.0%, p<0.001). TB-related mortality was higher among pregnant women (11.6% vs. 3.8%), although the difference was not statistically significant (p=0.065). Among pregnant women, spontaneous abortion occurred in 33.3%, stillbirth in 5.0%, preterm birth in 20.0%, and low birth weight in 15.0%. Conclusion: Active TB during pregnancy is associated with more severe clinical manifestations and adverse maternal and pregnancy outcomes. In high-burden settings, early diagnosis, prompt treatment, and integrated maternal and fetal monitoring are essential.