PRISMA checklist.

<div><p>Pregnancy may be associated with risk of developing tuberculosis (TB) in those infected with <i>Mycobacterium tuberculosis</i> (<i>Mtb</i>). The perinatal period could provide opportunities for targeted screening and treatment. This study aims to synthesise published literature on <i>Mtb</i> infection in pregnancy, relating to prevalence, natural history, test performance, cascade of care, and treatment. We searched Ovid MEDLINE, Embase+Embase Classic, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) on October 3, 2023, and 47 studies met the inclusion criteria. The prevalence of <i>Mtb</i> infection was as high as 57.0% in some populations, with rates increasing with maternal age and in women from high TB-incidence settings. Five studies quantified perinatal progression from <i>Mtb</i> infection to active TB disease, with two demonstrating increased risk compared to non-pregnant populations (IRR 1.3–1.4 during pregnancy and IRR 1.9–2 postpartum). Concordance between Tuberculin Skin Test (TST) and Interferon Gamma-Release Assay (IGRA) ranged from 49.4%-96.3%, with k-values of 0.19–0.56. High screening adherence was reported, with 62.0–100.0% completing antenatal TST and 81.0–100.0% of those positive having chest radiograph. Four studies of TB preventative treatment (TPT) did not find a significant association with serious adverse events. The antenatal period could provide opportunities for contextualised <i>Mtb</i> infection screening and treatment. As women with increased age and from high TB-incidence settings demonstrate higher prevalence and risk of disease, this cohort should be prioritised. TPT appears safe and feasible; however, further studies are needed to optimise algorithms, ensuring pregnant and postpartum women can make evidence-informed decisions for effective TB prevention.</p></div>