2025-26 Project (Paixao Cruz & Moreira Pescarini & Cerqueira Silva)

Maternal Tuberculosis and Offspring Health: A Nationwide Study in Brazil

SUPERVISORY TEAM

Supervisor

Dr Enny Paixao Cruz at LSHTM
Email: enny.cruz@lshtm.ac.uk

Co-Supervisor

Dr Julia Moreira Pescarini at LSHTM
Email: julia.pescarini1@lshtm.ac.uk

Co-Supervisor

Dr Thiago Cerqueira Silva at LSHTM
Email: thiago.silva@lshtm.ac.uk

PROJECT SUMMARY

Project Summary

The main adverse pregnancy outcomes associated with TB include maternal and neonatal mortality, miscarriage, small-for-gestational-age infants, and low birth weight. However, most available evidence is derived from studies with small sample sizes, lacking comparison groups or sufficient control for confounding factors, and rarely stratified by HIV status and drug resistance. Furthermore, prior studies have generally had short follow-up periods, primarily focused on the neonatal stage, leaving long-term outcomes for fetuses exposed to TB in utero largely unknown. 

1. Investigate the socioeconomic risk markers of TB during pregnancy, comparing pregnant women with and without TB in Brazil. 

2. Estimate the association between exposure to TB during pregnancy and adverse birth outcomes and investigate if the risk varies by HIV status and drug resistance. 

3. Estimate the long-term morbidity and mortality among children exposed in utero to TB and investigate if the risk varies by HIV status and drug resistance.

Project Key Words

TB, infectious disease, adverse pregnancy outcomes, offspring

MRC LID Themes

  1. Infectious Disease
  2. Health Data Science
  3. Global Health

Skills

MRC Core Skills

  1. Quantitative skills

Skills we expect a student to develop/acquire whilst pursuing this project

In pursuing this project, the student will develop quantitative skills related to the epidemiologic analysis of large electronic health record datasets and interdisciplinary skills related to investigating health over the life course. The student will have opportunities to participate in specialized training via short courses (e.g., Advanced Course in  Epidemiological Analysis; Causal Inference in Epidemiology and standard accredited modules at LSHTM. 

Over the course of their studies, the student will gain experience in critical thinking, coordination of international collaborations, acquisition of ethical approval, conduct of systematic reviews/meta analyses, engagement with local stakeholders and policymakers, and dissemination of research findings via participation in international conferences and publication in peer-reviewed journals

Routes

Which route/s are available with this project?

  • 1+4 = Yes
  • +4 = Yes

Possible Master’s programme options identified by supervisory team for 1+4 applicants:

  • LSHTM – MSc Epidemiology
  • LSHTM – MSc Medical Statistics

Full-time/Part-time Study

Is this project available for full-time study? Yes
Is this project available for part-time study? Yes

Location & Travel

Students funded through MRC LID are expected to work on site at their primary institution, meeting – at the minimum – the institutional research degree regulations and expectations. Students may also be required to travel for conferences (up to 3 over the duration of the studentship), and for any required training (for research degree study). Other travel expectations and opportunities highlighted by the supervisory team are noted below.

Primary location for duration of this research degree: LSHTM, London

Travel requirements for this project: Travel to Brazil, CIDACS/FIOCRUZ

Eligibility/Requirements

Particular prior educational requirements for a student undertaking this project

  • Minimum LSHTM institutional eligibility criteria for doctoral study.
  • MSc (or equivalent) in epidemiology, medical  statistics, or a related field

Other useful information

  • Potential Industrial CASE (iCASE) conversion? = No

PROJECT IN MORE DETAIL

Scientific description of this research project

In 2021, an estimated 10.6 million people developed tuberculosis (TB), and 1.6 million died from this preventable disease. While TB is more common among men, women account for approximately 30% of cases, with a higher prevalence during reproductive years. Globally, an estimated 216,500 pregnant women had active TB in 2011, with the risk being 2.56 times higher among those co-infected with HIV.  The main adverse pregnancy outcomes associated with TB include maternal and neonatal mortality, as well as complications such as miscarriage, small-for-gestational-age infants, and low birth weight. However, most available evidence is derived from studies with small sample sizes, lacking comparison groups or sufficient control for confounding factors, and rarely stratified by HIV status and drug resistance. Furthermore, prior studies have generally had short follow-up periods, primarily focused on the neonatal stage, leaving long-term outcomes for fetuses exposed to TB in utero largely unknown. 

Therefore, this project aims to investigate whether TB during pregnancy affects the offspring’s health. Specifically, we seek to: 
1. Investigate the socioeconomic risk markers of TB during pregnancy, comparing pregnant women with and without TB in Brazil. 
2. Estimate the association between exposure to TB during pregnancy and adverse birth outcomes and investigate if the risk varies by HIV status and drug resistance. 
3. Estimate the long-term morbidity and mortality among children exposed in utero to TB and investigate if the risk varies by HIV status and drug resistance. 

The doctoral candidate will use data on the CIDACS birth cohort ((N=28,631,394 liveborn children, 2001-2018), a Brazilian population-based cohort derived from linked data [national birth registration (SINASC) and social records (CadUnico)]. The student will construct directed acyclic graphs (DAGs) to understand the relationship between TB and offspring health. The consideration of potential confounders will be informed by the existing literature and knowledge of the supervisory team and collaborators. The student will use several statistical modelling and triangulate results from different epidemiological methods, including negative control.    

Ethical approval to set up the CIDACS Birth Cohort-Brazil has been obtained (Federal University of Bahia, CAAE 18022319.4.0000.5030). The data for the proposed analyses are held securely at CIDACS-Fiocruz in Salvador, Brazil and can be accessed at the LSHTM via a VPN connection.

Further reading

Relevant preprints and/or open access articles:
(DOI = Digital Object Identifier)

Additional information from the supervisory team

The supervisory team has provided a recording for prospective applicants who are interested in their project. This recording should be watched before any discussions begin with the supervisory team.

PaixaoCruz-MoreiraPescarini-CerqueiraSilva recording

MRC LID LINKS

Comments are closed.