Treatment of toxoplasmosis during pregnancy: A multicenter study of impacton fetal transmission and children's sequelae at age 1 year

OBJECTIVE: Toxoplasmosis during pregnancy can cause fetal infection, with u npredictable sequelae in later life. We measured the effects of prenatal an tibiotic therapy on the fetomaternal transmission of Toxoplasma gondii and on the appearance of sequelae in the congenitally infected child at age 1 y ear. STUDY DESIGN: In a multicenter study we investigated consecutive women with Toxoplasma seroconversion during pregnancy. Data were obtained from 144 wo men recruited in 5 different Toxoplasma reference centers. Through multivar iate analysis we assessed the association between transmission and appearan ce of sequelae as a function of the following parameters: estimated gestati onal age at infection, administration of antibiotic therapy, duration of an tibiotic therapy, and time lapse between infection and the start of antibio tic therapy. RESULTS: Sixty-four of the 144 women (44%) gave birth to a congenitally inf ected infant. Multivariate analysis showed that transmission was predicted neither by whether antibiotics had been administered nor by the time lapse between infection and the start of antibiotic therapy, but only by the gest ational age at which maternal infection occurred (P <.0001). Sequelae were found in 19 children (13%), 9 of whom (6%) had severe sequelae. Administrat ion of antibiotics was predictive of the absence of sequelae (P =.026, odds ratio 0.30, 95% confidence interval 0.104-0.863), in particular the absenc e of severe sequelae (P -.007, odds ratio 0.14, 95% confidence interval 0.0 36-0.584). The sooner antibiotics were given after the infection, the less frequently sequelae were seen (P =.021). CONCLUSION: Prenatal antibiotic therapy after toxoplasmosis during pregnanc y had no impact on the fetomaternal transmission rate but reduced the rate of sequelae among the infected infants. The early start of treatment result ed in a significant reduction in the number of severely affected infants.