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Congenital toxoplasma infection: monthly prenatal screening decreases transmission rate and improves clinical outcome at age 3 years.
[congenital toxoplasmosis]
Toxoplasma
infection
during
pregnancy
exposes
the
fetus
to
risks
of
congenital
infection
and
sequelae
that
depend
heavily
on
gestational
age
(
GA
)
at
time
of
infection
.
Accurate
risk
estimates
by
GA
are
necessary
to
counsel
parents
and
improve
clinical
decisions
.
We
analyzed
data
from
pregnant
women
diagnosed
with
acute
Toxoplasma
infection
in
Lyon
(
France
)
from
1987
to
2008
and
assessed
how
the
risks
of
congenital
toxoplasmosis
and
of
clinical
signs
at
age
3
years
vary
depending
on
GA
at
the
time
of
maternal
infection
.
Among
2048
mother-infant
pairs
,
93
.
2
%
of
mothers
received
prenatal
treatment
and
513
(
24
.
7
%
)
fetuses
were
infected
.
Because
of
a
significant
reduction
in
risk
since
1992
when
monthly
screening
was
introduced
(
59
.
4
%
vs
46
.
6
%
at
26
GA
weeks
;
P
=
.
038
)
,
probabilities
of
infection
were
estimated
on
the
basis
of
maternal
infections
diagnosed
after
mid-
1992
(
n
=
1624
)
.
Probabilities
of
congenital
infection
were
<
10
%
for
maternal
infections
before
12
weeks
of
gestation
,
rose
to
20
.
0
%
at
19
weeks
,
and
then
continued
increasing
to
52
.
3
%
and
almost
70
%
at
28
and
39
GA
weeks
,
respectively
.
Because
of
a
significant
reduction
in
risk
of
clinical
signs
of
congenital
toxoplasmosis
in
infected
children
born
from
mothers
diagnosed
after
1995
when
polymerase
chain
reaction
testing
on
amniotic
fluid
was
initiated
(
87
/
794
vs
46
/
1150
;
P
=
.
012
)
,
probabilities
of
clinical
signs
at
3
years
were
estimated
based
on
1015
maternal
infections
diagnosed
after
1995
including
207
infected
children
,
with
symptoms
in
46
(
22
.
2
%
)
.
These
analyses
demonstrated
that
introduction
of
monthly
prenatal
screening
and
improvement
in
antenatal
diagnosis
were
associated
with
a
significant
reduction
in
the
rate
of
congenital
infection
and
a
better
outcome
at
3
years
of
age
in
infected
children
.
Our
updated
estimates
will
improve
individual
management
and
counseling
in
areas
where
genotype
II
Toxoplasma
is
predominant
.
