Prenatal Treatment for Serious Neurological Sequelae of Congenital Toxoplasmosis: An Observational Prospective Cohort Study
Open Access
- 12 October 2010
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLoS Medicine
- Vol. 7 (10), e1000351
- https://doi.org/10.1371/journal.pmed.1000351
Abstract
The effectiveness of prenatal treatment to prevent serious neurological sequelae (SNSD) of congenital toxoplasmosis is not known. Congenital toxoplasmosis was prospectively identified by universal prenatal or neonatal screening in 14 European centres and children were followed for a median of 4 years. We evaluated determinants of postnatal death or SNSD defined by one or more of functional neurological abnormalities, severe bilateral visual impairment, or pregnancy termination for confirmed congenital toxoplasmosis. Two-thirds of the cohort received prenatal treatment (189/293; 65%). 23/293 (8%) fetuses developed SNSD of which nine were pregnancy terminations. Prenatal treatment reduced the risk of SNSD. The odds ratio for prenatal treatment, adjusted for gestational age at maternal seroconversion, was 0.24 (95% Bayesian credible intervals 0.07–0.71). This effect was robust to most sensitivity analyses. The number of infected fetuses needed to be treated to prevent one case of SNSD was three (95% Bayesian credible intervals 2–15) after maternal seroconversion at 10 weeks, and 18 (9–75) at 30 weeks of gestation. Pyrimethamine-sulphonamide treatment did not reduce SNSD compared with spiramycin alone (adjusted odds ratio 0.78, 0.21–2.95). The proportion of live-born infants with intracranial lesions detected postnatally who developed SNSD was 31.0% (17.0%–38.1%). The finding that prenatal treatment reduced the risk of SNSD in infected fetuses should be interpreted with caution because of the low number of SNSD cases and uncertainty about the timing of maternal seroconversion. As these are observational data, policy decisions about screening require further evidence from a randomized trial of prenatal screening and from cost-effectiveness analyses that take into account the incidence and prevalence of maternal infection. Please see later in the article for the Editors' SummaryKeywords
This publication has 29 references indexed in Scilit:
- Primary skeletal muscle cells trigger spontaneous Toxoplasma gondii tachyzoite-to-bradyzoite conversion at higher rates than fibroblastsInternational Journal of Medical Microbiology, 2009
- Ocular Sequelae of Congenital Toxoplasmosis in Brazil Compared with EuropePLoS Neglected Tropical Diseases, 2008
- Evaluation of Neuromotor Function in Infancy–A Systematic Review of Available MethodsJournal of Developmental & Behavioral Pediatrics, 2008
- Association between prenatal treatment and clinical manifestations of congenital toxoplasmosis in infancy: A cohort study in 13 European centresActa Paediatrica, 2005
- Association between congenital toxoplasmosis and preterm birth, low birthweight and small for gestational age birthBJOG: An International Journal of Obstetrics and Gynaecology, 2004
- Fetal toxoplasmosis and negative amniocentesis: necessity of an ultrasound follow‐upPrenatal Diagnosis, 2003
- Effect of timing and type of treatment on the risk of mother to child transmission of Toxoplasma gondiiBJOG: An International Journal of Obstetrics and Gynaecology, 2003
- Inference for a linear regression model with an interval‐censored covariateStatistics in Medicine, 2003
- Bayesian Measures of Model Complexity and FitJournal of the Royal Statistical Society Series B: Statistical Methodology, 2002
- Termination of pregnancy for maternal toxoplasmosisThe Lancet, 1994