Abstract:

Objective: To evaluate the clinical characteristics and maternal and neonatal outcomes of pregnancies complicated by tuberculosis following in vitro fertilization-embryo transfer (IVF-ET). Methods: A retrospective analysis was conducted on clinical data from 28 cases of pregnancies complicated by tuberculosis after IVF-ET, admitted to the Public Health Clinical Medical Center between May 2012 and May 2024. The clinical characteristics and maternal and neonatal outcomes were descriptively analyzed. Results: The mean age of the 28 patients was (31.1±3.6) years, with a median gestational period of 108.0 days (interquartile range: 84.0-141.0 days). Among these cases, 9 (32.1%) were in early pregnancy and 19 (67.9%) were in the mid-trimester. The primary clinical manifestations included fever (27 cases), cough (24 cases), shortness of breath (20 cases), and vaginal bleeding (17 cases). Hematogenous disseminated pulmonary tuberculosis was observed in 27 patients (96.4%), while 15 patients (53.6%) had extrapulmonary tuberculosis, and 14 (50.0%) were diagnosed with tuberculous meningitis. Additionally, 10 patients (35.7%) presented with three or more types of tuberculosis simultaneously. Among the 28 patients, 13 (46.4%) tested positive for tuberculosis etiology, and 2 patients had drug-resistant tuberculosis (rifampicin-resistant and pre-extensively drug-resistant tuberculosis). Laboratory examinations showed a mean hemoglobin level of (98.6±12.4) g/L, a mean serum albumin level of (30.7±4.6)g/L, and a median CD4⁺ T-cell count of 212.5 cells/μl (interquartile range: 125.0-319.5 cells/μl). Of the 28 patients, 3 (10.7%) required tracheal intubation with invasive mechanical ventilation, while 13 (46.4%) used non-invasive ventilatory support. By July 2024, 21 patients (75.0%) had successfully completed treatment, 1 patient had died, and 6 patients were still undergoing treatment, all of whom were showing improvement. Adverse reactions were noted in 13 patients (53.8%) during treatment, including 7 cases (25.0%) of liver function injury, 4 cases (14.3%) of bone marrow suppression, 2 cases (7.1%) of drug-induced rash, and 1 case (3.6%) of drug fever. A total of 43 fetuses were conceived by the 28 patients, with 5 resulting in spontaneous abortions, and the remainder undergoing elective termination. Conclusion: The majority of pregnant patients with tuberculosis following in vitro IVF-ET present with fever and respiratory symptoms, and the incidence of severe tuberculosis is notably high. Most patients achieve a favorable prognosis with prompt and effective anti-tuberculosis treatment. Emphasis should be placed on prenatal tuberculosis screening and close postpartum monitoring to enhance diagnostic accuracy.

Key words: In vitro fertilization, Embryo transfer, Tuberculosis, Clinical characteristics, Prognosis