title: Association between prenatal treatment and clinical manifestations of congenital toxoplasmosis in infancy: a cohort study in 13 European centres.
abstract: OBJECTIVE
  To determine the effectiveness of prenatal treatment for clinical manifestations of congenital toxoplasmosis.
  
  
  METHODS
  We prospectively identified 255 live-born infants with congenital toxoplasmosis using prenatal or neonatal screening. We determined the effect of prenatal treatment on the risks of intracranial or ocular lesions in infancy, accounting for gestational age at maternal seroconversion.
  
  
  RESULTS
  Prenatal treatment within 4 wk of seroconversion reduced the risk of intracranial lesions compared with no treatment (odds ratio, OR 0.28; 95% CI: 0.08-0.75), but there was no significant effect when initiated after 4 wk (OR 0.76; 95% CI: 0.35-1.59; overall p-value 0.19). Compared to spiramycin alone, no treatment doubled the risk of intracranial lesions (OR 2.33; 95% CI: 1.04-5.50), but the risk did not differ with pyrimethamine-sulphonamide treatment (overall p-value 0.52). There was no consistent relationship between the type or timing of treatment and the risk of ocular lesions. Gestational age at maternal seroconversion was inversely associated with the risk of intracranial but not ocular lesions.
  
  
  CONCLUSIONS
  Only early versus no prenatal treatment for intracranial lesions showed a statistically significant benefit. A large randomized controlled trial and/or meta-analysis of individual patient data from cohort studies is required to confirm these findings.
authors.affiliation: Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
authors.forename: Luuk
authors.initials: L
authors.lastname: Gras
authors.forename: Martine
authors.initials: M
authors.lastname: Wallon
authors.forename: Arnold
authors.initials: A
authors.lastname: Pollak
authors.forename: Mario
authors.initials: M
authors.lastname: Cortina-Borja
authors.forename: Birgitta
authors.initials: B
authors.lastname: Evengard
authors.forename: Michael
authors.initials: M
authors.lastname: Hayde
authors.forename: Eskild
authors.initials: E
authors.lastname: Petersen
authors.forename: Ruth
authors.initials: R
authors.lastname: Gilbert
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D005060:Europe; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D015997:Neonatal Screening; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy*; D011296:Prenatal Diagnosis; D011446:Prospective Studies; D011739:Pyrimethamine / Q000627:therapeutic use; D015572:Spiramycin / Q000627:therapeutic use; D014125:Toxoplasmosis, Congenital / Q000175:diagnosis / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D000981:Antiprotozoal Agents; D015572:Spiramycin; D011739:Pyrimethamine