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

Abstract Objective This study aimed to compare the clinical profiles and maternal-fetal 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 fetal 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 fetal 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.