Effect of prenatal treatment on mother to child transmission of Toxoplasma gondii: retrospective cohort study of 554 mother-child pairs in Lyon, France.
BACKGROUND
The aim of prenatal serological screening for toxoplasmosis is to identify and treat maternal infection as soon as possible in order to prevent transmission of the parasite to the fetus. However, despite widespread provision of prenatal toxoplasma screening across Europe, the effectiveness of prenatal treatment is uncertain. The study aimed to determine the effect of the timing and type of prenatal treatment on mother to child transmission of Toxoplasma gondii.


METHODS
A cohort of 554 infected pregnant women were identified in Lyon, France between 1987 and 1995 and their children were followed to determine congenital infection status. We determined the effect of prenatal treatment on transmission by examining the effect of the delay between maternal seroconversion and start of treatment. We also compared the effect of the type of treatment and no treatment on the risk of mother to child transmission. Analyses were adjusted for gestation at maternal seroconversion.


RESULTS
Compared to treatment within 4 weeks from seroconversion, the adjusted odds ratios (OR) for mother to child transmission after a treatment delay of 4-7 weeks was 1.29 (95% CI : 0.61, 2.73) and after more than 8 weeks, 1.44 (95% CI : 0.60, 3.31). The adjusted OR associated with spiramycin alone compared with pyrimethamine-sulfadiazine treatment was 0.91 (95% CI : 0.45, 1.84) and the OR for no treatment compared with pyrimethamine-sulfadiazine treatment was 1.06 (95% CI : 0.37, 3.03).


CONCLUSIONS
The authors hypothesize that the absence of an effect of prenatal treatment is due to transmission before the start of treatment.
Gilbert
R E
RE
Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK.
Gras
L
L
Wallon
M
M
Peyron
F
F
Ades
A E
AE
Dunn
D T
DT
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D016013:Likelihood Functions; D018942:Macrolides; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy* / Q000453:epidemiology; D011295:Prenatal Care; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors; D014123:Toxoplasmosis / Q000188:drug therapy* / Q000635:transmission; D014125:Toxoplasmosis, Congenital / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000981:Antiprotozoal Agents; D018942:Macrolides