Congenital toxoplasmosis: systematic review of evidence of efficacy of treatment in pregnancy

Objective To summarise the evidence that treating toxoplasmosis in pregnanc y reduces the risk of congenital toxoplasma infection and improves infant o utcomes. Design Systematic review of studies comparing at least two concurrent group s of pregnant women with proved or likely acute toxoplasma infection in whi ch treatments were compared with no treatment and outcomes in the children were reported. Subjects Studies were identified from Medline (1966-97), Pascal (1990-7), E mbase (1993-7), and Biological abstracts (1993-5) plus contact with experts in the field, including the European Research Network on Congenital Toxopl asmosis. Main outcome measure Proportion of infected children at 1 year born to infe cted pregnant women who were or were not treated. Results Out of 2591 papers identified, nine met the inclusion criteria, The re were no randomised comparisons, and control groups were generally not di rectly comparable with the treatment groups. Congenital infection was commo n in treated groups, five studies showed that treatment was effective and f our that it nas not. Conclusion It is unclear whether antenatal treatment in women with presumed toxoplasmosis reduces congenital transmission of Toxoplasma gondii. Screen ing is expensive, so the effects of treatment and impact of screening progr ammes need to be evaluated. In countries where screening or treatment is no t routine, these technologies should not be introduced outside carefully co ntrolled trials.