We conducted a case-control study at three main inner-city hospitals in Birmingham, UK between 2004 and 2006, to determine the risk of adverse perinatal outcomes in pregnant women with tuberculosis (TB) (n = 24), compared with healthy pregnant controls (n = 72). The incidence of TB was 62/100,000 pregnancies, with 54.2% cases having pulmonary TB (41.7% extra-pulmonary; 4.2% both). Infants of mothers with TB had a significantly lower mean birth weight compared with controls (2,735 g vs 3,135 g; p = 0.03). Mean birth weight was lower in pulmonary TB than in the extra-pulmonary TB. Multivariate analysis showed that low birth weight was associated with pre-term delivery (p < 0.001). We conclude that pregnant women with TB are at higher risk of low birth weight due to higher odds of pre-term delivery.