Association between prenatal treatment and clinical manifestations of congenital toxoplasmosis in infancy: a cohort study in 13 European centres.
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.
Gras
Luuk
L
Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
Wallon
Martine
M
Pollak
Arnold
A
Cortina-Borja
Mario
M
Evengard
Birgitta
B
Hayde
Michael
M
Petersen
Eskild
E
Gilbert
Ruth
R
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*
D000900:Anti-Bacterial Agents; D000981:Antiprotozoal Agents; D015572:Spiramycin; D011739:Pyrimethamine