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

BACKGROUND Over 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 11-49 years old newly diagnosed with drug-susceptible TB disease between 2016-2022, 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 non-pregnant women, 79,262 (83.4%) experienced treatment success, 11,582 (12.2%) were lost to follow-up, and 4,154 (4.4%) died. In adolescents, pregnancy conferred higher odds of loss to follow-up (aOR 1.78, 95% CI: 1.29-2.44) and death (aOR 2.35, 95% CI: 1.27-4.37). Compared to non-pregnant women of the same age, pregnant women 20-29 and 30-39 years old 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 40-49 years old 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.