Pregnancy Outcomes in Women Screened for Tuberculosis Infection in Swedish Antenatal Care

Abstract

Background Tuberculosis (TB) disease has been associated with pregnancy complications. However, the potential impact of TB infection (TBI) on pregnancy outcome is unknown. To investigate this, we conducted a register-based study in immigrant women screened with QuantiFERON assays for TBI in antenatal care in Sweden. Methods Women with history of immigration from TB-endemic countries were eligible for inclusion if national identification numbers and available QuantiFERON results obtained during pregnancy 2014-2018 were available. QuantiFERON results were linked to data on maternal characteristics and pregnancy outcomes from the national Pregnancy and Patient Registers. TBI was defined as nil-corrected QuantiFERON result ≥0.35 IU/ml, in the absence of TB disease. Pregnancies in women with TB disease or HIV infection were excluded, as well as multiplex pregnancies, pregnancies resulting in miscarriage, and pregnancies occurring >10 years after immigration. Odds of defined adverse pregnancy outcomes were compared by maternal TBI status using mixed effects logistic regression with adjustment for maternal age and region of origin. Results In total, 7,408 women with 12,443 pregnancies were included. In multivariable analysis, stillbirth (adjusted Odds ratio [AOR] 1.90, 95% confidence interval [CI] 1.13-3.21, p=0.016), severe preeclampsia (AOR 1.62, 95% CI 1.03-2.56, p=0.036), low birthweight (<2500 grams; AOR 1.38, 95% CI 1.01-1.88, p=0.041) and emergency Caesarean section (AOR 1.28, 95% CI 1.02-1.63, p=0.033) were significantly associated with TBI. Conclusion Among immigrant women seeking antenatal care in Sweden, TBI was independently associated with adverse pregnancy outcomes. Further studies are needed to corroborate these findings and to explore mechanisms involved.