Gestational toxoplasmosis treatment changes the child's prognosis: A cohort study in southern Brazil

BackgroundWe evaluate the drug treatment for pregnant women with acute toxoplasmosis to reduce the risk of congenital infection, side effects (prenatal and postnatal treatment in children) and the hazard of discontinuing the infant's medication.MethodsWe conducted a prospective cohort study to assess the risks of congenital toxoplasmosis among children born to acutely infected women with and without treatment. We examined the relationship between exposed and infected children, number of infant neutrophils, prenatal and postnatal treatment. Factor analysis of mixed data (FAMD) was used to analyze the data. All children started treatment at the hospital.FindingsBetween 2017 and 2021, 233 pregnant women were evaluated at the University Hospital of Maringa; ninety-four met criteria for acute gestational toxoplasmosis. We followed up 61 children; eleven (18%) had the infection confirmed and 50 (82%) were free of toxoplasmosis (exposed). Children born to untreated mothers have 6.5-times higher risk of being infected; the transmission rate among untreated mothers was 50% versus 8.3% among treated ones. Three decreasing values of immunoglobulin G were a security parameter for stopping the child's medication in the exposed group (50/61). Neutropenia was the leading side effect among children and the infected had a 2.7 times higher risk. There was no correlation between maternal use of pyrimethamine and children's neutropenia.InterpretationThe follow-up of women with acute T. gondii infection and their children, through a multidisciplinary team, availability of anti-T. gondii serology and pre- and post-natal treatments reduced the risk of toxoplasmosis transmission. South America is the region with the highest burden of congenital toxoplasmosis and with the most pathogenic genotypes. Brazil is considered a country with a high prevalence of toxoplasmosis and a hotspot for outbreaks. The outcome of congenital transmission is influenced by factors such as T. gondii genotype, strain virulence, maternal immune status, maternal parasitemia, gestational age at the time of infection, and prenatal treatment. The last point mentioned is still controversial and raises several concerns, such as the financial impact of the monitoring and treatment of pregnant women and their children, the side effects of the medications used, and the benefit of investing in public health policies to mitigate toxoplasmosis. Information on the effectiveness of prenatal treatment is limited since it is challenging to carry out randomized studies. In the present manuscript, we evaluated the benefit of drug treatment for pregnant women with acute toxoplasmosis as a protective factor in reducing the risk of congenital infection. Also, we evaluated the side effects of prenatal and postnatal drug use in children and assessed the risk of discontinuing the medication in infants. We used the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) to report this study.

Automated summary

In this study, we evaluated the drug treatment for pregnant women with acute toxoplasmosis to reduce the risk of congenital infection, side effects, and the hazard of discontinuing the infant's medication.