Tuberculosis is the leading infectious disease in the world. In developing countries and certain areas of industrialized countries, rates of tuberculosis are highest among women and men of childbearing age. True congenital tuberculosis is rare; the greatest threat to the neonate is the acquisition of tuberculosis infection shortly after birth, which tends to progress rapidly to serious tuberculosis disease in a large proportion of untreated infants. Effective methods for prevention and treatment of the disease are available and inexpensive but still are not used appropriately in most parts of the developing world. The clinician caring for pregnant women should be aware of the risk factors for tuberculosis infection and disease and should test women and families according to risk.