[Toxoplasma infections in early pregnancy: consequences and management].
OBJECTIVE
To assess the consequences for the fetus of maternal toxoplasma infection acquired during the first 8 weeks of gestation and to set guidelines on how to manage these maternal infections.


METHODS
Data were prospectively analyzed on 360 pregnancies followed-up in our department due to a toxoplasma infection during the 8 first weeks of pregnancy. Estimates of the risk of fetal infection were based on all cases, including those which could not be followed up until infection was ruled out or confirmed. Severity of infection was estimated based on ultrasound findings during pregnancy, neonatal and long-term postnatal clinical, neurological and ophthalmologic work up.


RESULTS
Out of the 360 included women, 336 gave birth to a live born child: 7 (2%) were infected, 302 (90%) were free of infection and follow-up was insufficient to conclude about the 27 (8%) remaining infants. The estimated risk of fetal infection ranged between 2 and 10% based on live born children and between 3 and 14% when the 24 interrupted pregnancies were included. At their last clinical evaluation at 70 months of age, all 7 children, including the 2 who had inactive peripheral eye lesions and the one who had a unique intracranial calcification were free of any ophthalmologic or neurological impairment.


CONCLUSIONS
Our study confirms that in the event of a maternal infection during the first 8 weeks of pregnancy the risk of fetal infection is low and results mainly in a spontaneous termination of pregnancy. Future parents should be assured that conversely to a common opinion, the prognosis of congenital toxoplasmosis in live-born children is good. For these early maternal infections as for those acquired later, we recommend immediate treatment with spiramycin, monthly ultrasound surveillance, amniocentesis and treatment with pyrimethamine and sulphamides if the PCR is positive. Abortion should be restricted to cases with ultrasound lesions
Wallon
M
M
Service de Parasitologie, Hospital de la Croix-Rousse, 69317 Lyon Cedex 04, France. wallon@wanadoo.fr
Gaucherand
P
P
Al Kurdi
M
M
Peyron
F
F
D000649:Amniocentesis; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D015997:Neonatal Screening / Q000379:methods; D011181:Postnatal Care / Q000379:methods; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000175:diagnosis* / Q000628:therapy*; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D011295:Prenatal Care / Q000379:methods; D011379:Prognosis; D011739:Pyrimethamine / Q000627:therapeutic use; D012307:Risk Factors; D015572:Spiramycin / Q000627:therapeutic use; D014123:Toxoplasmosis / Q000175:diagnosis* / Q000628:therapy* / Q000635:transmission; D014125:Toxoplasmosis, Congenital / Q000175:diagnosis* / Q000628:therapy* / Q000635:transmission; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
D000900:Anti-Bacterial Agents; D000981:Antiprotozoal Agents; D015572:Spiramycin; D011739:Pyrimethamine