Guidelines for the prevention and management of mother-to-child transmission of tuberculosis.

Tuberculosis (TB) during pregnancy poses substantial risks to both the mother and the fetus/infant. Protecting maternal and child health and interrupting mother-to-child transmission (MTCT) are therefore critical components of TB control. However, the evidence base remains limited, and practical guidance across the preconception, pregnancy, postpartum, and neonatal periods is still fragmented. To address this gap, a multidisciplinary panel of experts in TB, obstetrics and gynecology, pediatrics, infectious diseases, imaging, and disease control and prevention was convened. This panel developed standardized, evidence-based recommendations guided by a structured methodology. The guideline was registered on the Practice Guideline Registration and Transparency (PREPARE) platform, developed with reference to the World Health Organization (WHO) Handbook for Guideline Development, reported according to the Reporting Items for Practice Guidelines in Health Care (RIGHT) checklist, and informed by systematic evidence retrieval and Grading of Recommendations Assessment, Development and Evaluation (GRADE)-based assessment. This guideline addresses preconception TB screening, diagnosis and treatment of TB during pregnancy, neonatal assessment, breastfeeding management, and infection prevention and control. Imaging plays a pivotal role in TB screening and diagnosis; accordingly, the guideline systematically outlines the appropriate use and selection of chest radiography, ultrasonography, hysterosalpingography, computed tomography (CT), and magnetic resonance imaging (MRI) for TB evaluation across the preconception, pregnancy, postpartum, and neonatal periods. It further emphasizes the role of imaging in risk stratification, early diagnosis, assessment of disease extent, and neonatal evaluation, and includes pregnancy-specific recommendations on the use of non-contrast MRI. At the same time, the guideline provides evidence-informed recommendations for women with TB infection before conception and for infertile women planning assisted reproductive technologies. Through expert consensus, 15 core recommendations were formulated to support clinical decision-making for healthcare professionals involved in TB care and maternal-child health.