Maternal Tuberculosis and Infant Gut and Immune Development: Implications for Maternal-Child Health

BACKGROUND: Maternal tuberculosis (TB) during pregnancy involves chronic infection, immune activation, and antimicrobial therapy, which may alter the maternal gut, vaginal, and breast milk microbiomes and influence neonatal immune development. METHODS: We conducted a narrative review of studies identified through PubMed and GoogleScholar addressing the maternal TB-microbiome-infant immunity axis. Where evidence from pregnant women with TB was limited, findings were extrapolated from non-pregnant TB populations, antibiotic exposure studies, and broader maternal-infant microbiome research. RESULTS: Maternal TB and its treatment may alter gut, vaginal, and breast milk microbiomes and the immune-metabolic composition of milk. These changes could influence perinatal microbial transmission, mucosal maturation, and infant immune responses, including vaccine responsiveness, BCG immunogenicity, and IGRA conversion. Treatment timing, antibiotic exposure, and maternal nutrition may modify these effects. CONCLUSION: Understanding the maternal TB-microbiome-immune axis may help optimize infant immune outcomes. Longitudinal mother-infant studies, multi-omic analyses, and mechanistic models are needed to clarify these interactions and evaluate microbiome informed strategies, including nutritional optimization, targeted probiotics/prebiotics, and antibiotic stewardship.