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

PLoS Negl Trop Dis. 2023 Sep 29;17(9):e0011544. doi: 10.1371/journal.pntd.0011544. eCollection 2023 Sep.

Abstract

Background: We 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.

Methods: We 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.

Findings: Between 2017 and 2021, 233 pregnant women were evaluated at the University Hospital of Maringá; 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.

Interpretation: The 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brazil / epidemiology
  • Child
  • Cohort Studies
  • Female
  • Humans
  • Infant
  • Neutropenia*
  • Pregnancy
  • Pregnancy Complications, Infectious* / drug therapy
  • Pregnancy Complications, Parasitic* / drug therapy
  • Prospective Studies
  • Toxoplasma*
  • Toxoplasmosis* / drug therapy
  • Toxoplasmosis, Congenital* / drug therapy
  • Toxoplasmosis, Congenital* / epidemiology

Grants and funding

This work was supported by the State University of Maringá to AGGFS, RGF and ALFG. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.