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17-06-2012 | Gynaecology | Article

Prenatal treatment recommended for congenital toxoplasmosis

Abstract

Free abstract

MedWire News: Prenatal treatment for women with a positive prenatal diagnosis of congenital toxoplasmosis reduces the risk for serious neurologic sequelae (SNSD) in their unborn infants, results of a study show.

However, the benefit appeared to be highest when maternal infection was acquired during the first trimester, diminishing with later infection, report Ruth Gilbert (University College London, UK) in PLoS Medicine.

The team identified 293 children in whom congenital toxoplasmosis had been identified by prenatal screening (in France, Austria, and Italy) or by neonatal screening (in Denmark, Sweden, and Poland), and followed up the group for an average of 4 years.

Two-thirds (65%) of the cohort received prenatal treatment, and 8% of fetuses developed SNSD, defined as functional neurologic abnormalities, severe bilateral visual impairment, and/or pregnancy termination for confirmed congenital toxoplasmosis.

The proportion of live-born infants with intracranial lesions detected postnatally who developed SNSD was 31.0%.

Prenatal treatment reduced the risk for SNSD with an odds ratio (OR) of 0.24, after adjusting for gestational age at maternal seroconversion.

The number of infected fetuses needed to be treated to prevent one case of SNSD was three after maternal seroconversion at 10 weeks', and 18 at 30 weeks of gestation. Pyrimethamine-sulfonamide treatment did not reduce the risk for SNSD compared with spiramycin alone (OR=0.78).

Gilbert et al comment: "Whether the benefits of prenatal treatment translate into an effective prenatal screening program remains to be determined by a randomised controlled trial of prenatal screening.

"In the meantime, cost-effectiveness analyses that take into account regional variation in the prevalence of susceptible women could provide valuable information for policy makers and for research funders contemplating investment in a large trial."

By Andrew Czyzewski

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