Leprosy in Pregnancy: A Systematic Review of Maternal Characteristics, Complications, and Neonatal Outcomes

Background:

Nearly 40% of leprosy cases occur in females. Although relatively uncommon in pregnancy, immunological changes during gestation and the puerperium may exacerbate leprosy and influence maternal and neonatal outcomes. To date, no systematic review has synthesized the evidence on leprosy in pregnancy. Purpose: To describe maternal clinical and obstetric characteristics, pregnancy complications, neonatal outcomes, and laboratory findings in pregnant women with leprosy.

Methods:

We systematically searched electronic databases from inception to August 2025 for studies reporting leprosy in pregnancy or puerperium using specific terms and inclusion/exclusion criteria. Data were extracted and presented descriptively.

Results:

Eighteen case reports and case series described a total of 21 individual patients, while an additional eight original articles were included. Most patients were aged 20–39 years (85.7%), with multibacillary leprosy predominating (80.9%) of cases. Erythema nodosum leprosum was more frequent during pregnancy (14.3%), while reversal reactions predominated in the puerperium (9.5%). Leprosy in pregnancy was most frequently reported in the third trimester (52.4%). Cesarean section was slightly more frequent than vaginal delivery (33.3% vs 23.8%). Overall, maternal and neonatal outcomes were generally favorable, although complications included intrauterine growth restriction, hematologic abnormalities, preterm delivery, neonatal skin discoloration, and hyperbilirubinemia. One infant was diagnosed with leprosy at six months. Slit-skin smears were occasionally positive with a high bacteriological index, and acid-fast bacilli were detected in the placentas of mothers with leprosy.

Conclusion:

Leprosy in pregnancy most often affects women of reproductive age with the multibacillary type, typically presenting in the third trimester. While maternal and neonatal outcomes are generally favorable, complications may occur, underscoring the importance of continuing multidrug therapy with close monitoring. Further multicenter studies are required to better define transmission risks and optimize management strategies