Rationale Studies investigating the risk of active tuberculosis (TB) in association with pregnancy have not been conclusive. We aimed to investigate this risk in a large retrospective register-based cohort study in Sweden. Methods Data from women of 15–49 years of age who had given birth in Sweden between 2005 and 2013 were extracted from the national childbirth register and linked to the national TB register. Cohort time was divided into three exposure periods: during pregnancy, six months (180 days) postpartum and time neither pregnant nor postpartum. We calculated incidence rates (IRs) per 100 000 person-years for each period and incidence rate ratios (IRRs) with IRs neither pregnant nor postpartum as the reference. Results The cohort included 649 342 women, of whom 553 were registered as cases of active TB, 389 when neither pregnant nor postpartum, 85 during pregnancy and 79 when postpartum. Overall IRs were 9, 12 and 17 cases per 100 000 person-years, respectively, giving IRR 1.4, 95% CI 1.1–1.7 (during pregnancy) and IRR 1.9, 95% CI 1.5–2.5 (when postpartum). Stratification by TB incidence in country of origin showed that the increased risk was concentrated amongst women from countries with a TB incidence of 100 or higher, where IRs per 100 000 person-years were 137 (when neither pregnant nor postpartum), 182 (during pregnancy) and 233 (when postpartum). Conclusion We show a significant increase in risk of active TB during both pregnancy and postpartum in women from high incidence countries and recommend TB screening in pregnant women belonging to this risk group. There is an increased risk of active TB in women during pregnancy and postpartum. We recommend screening for latent TB in pregnant women from TB risk groups and for clinicians to use a low threshold for suspecting active TB in pregnancy and postpartum http://bit.ly/34pqXT8

中文翻译：

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怀孕和产后活动性结核病风险增加：瑞典的一项基于登记的队列研究

基本原理 调查与妊娠相关的活动性结核病 (TB) 风险的研究尚未得出结论。我们的目的是在瑞典进行的一项基于登记册的大型回顾性队列研究中调查这种风险。方法 2005 年至 2013 年间在瑞典分娩的 15-49 岁妇女的数据从国家分娩登记册中提取，并与国家结核病登记册相关联。队列时间分为三个暴露期：怀孕期间、产后六个月（180 天）和既不怀孕也不产后的时间。我们计算了每个时期每 100 000 人年的发病率 (IRs) 和发病率比 (IRRs)，以既未怀孕也未产后的 IRs 作为参考。结果 该队列包括 649 342 名女性，其中 553 名登记为活动性结核病例，未孕未产389例，孕中85例，产后79例。总体 IR 分别为每 10 万人年 9、12 和 17 例，IRR 为 1.4，95% CI 1.1-1.7（怀孕期间）和 IRR 1.9，95% CI 1.5-2.5（产后）。按原籍国结核病发病率分层显示，增加的风险集中在结核病发病率为 100 或更高的国家的妇女中，其中每 100 000 人年的 IRs 为 137（既未怀孕也未产后）、182（怀孕期间） ) 和 233（产后）。结论 我们发现高发国家女性在孕期和产后患活动性结核病的风险显着增加，并建议对属于这一风险组的孕妇进行结核病筛查。妇女在怀孕期间和产后患活动性结核病的风险增加。