Incidence of toxoplasmosis in pregnancy in Campania: A population-based study on screening, treatment, and outcome

Donadono, V.; Saccone, Gabriele; Maruotti, Giuseppe Maria; Berghella, Vincenzo; Esposito, Giuseppina; Sirico, Angelo; Tagliaferri, Salvatore; Ward, Andrew; Mazzarelli, Laura Letizia; Sarno, Laura; Agangi, Annalisa; Quaglia, F.; Zullo, Fulvio; Martinelli, Pasquale

doi:10.1016/j.ejogrb.2019.07.033

Cited by 19 publications

(27 citation statements)

References 26 publications

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“…The majority of diagnostic procedures are limited to amniocentesis and, in selected infections such as CMV, cordocentesis (Table 3) [48][49][50][51][52][53][54][55][56]. The total fetal risk related to amniocentesis in infected cohorts is estimated at 1.5%.…”

Section: Discussionmentioning

confidence: 99%

“…The possibility of an increased preterm birth mechanism associated with intrauterine viral infection in the late second and third trimester alone has limited data to support this perinatal risk [19,46,47]. Table 3 summarizes the published literature for maternal infection cohorts and the outcomes for unintended fetal loss and evaluations to determine the possibility of fetal VT [48][49][50][51][52][53][54][55][56]. The "pooled" procedure-related fetal loss risk estimate for infectious diagnostic amniocentesis procedures is estimated at 1.5% (18/1,187) -0.8% from varicella (1/127), 0% from HCMV (0/458), and 2.8% from toxoplasmosis (17/602).…”

Section: Questionmentioning

confidence: 99%

“…Prenatal diagnostic procedures in infected maternal pregnant cohorts[48][49][50][51][52][53][54][55][56] Reference Infection cohort Study, time period, location Unintended pregnancy loss and VT summary Weisz et al [48], 2011 varicella retrospective study (2001-2007), Israel AC in 19/20 cases at a mean of 22.2 ± 1.7 weeks with a mean infection age of 11 ± 3.5 weeks; no postprocedural losses reported; no VT reported Mouly et al [49], 1997 varicella prospective cohort, 1989-1994, France; congenital varicella 2.8% (3/107); postnatal varicella zoster infection 3.8% (3/78) AC 107; FBS 82; procedures at 21-26 weeks of gestation; AC with positive viral AF PCR was identified in 9/107 (8.4%) with maternal infection at <24 weeks; single IUD after AC (negative prenatal testing); no procedure-related VT STOP, surgical termination of pregnancy; TOP, termination of pregnancy; US, ultrasound; VT, vertical transmission.…”

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confidence: 99%

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Acute Perinatal Infection and the Evidenced-Based Risk of Intrauterine Diagnostic Testing: A Structured Review

Wilson

2020

Fetal Diagn Ther

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Background: The prevalence of perinatal infection from maternal exposure is increasing. The prevalence of acute maternal infections identifies cytomegalovirus, parvovirus B19, toxoplasmosis, and varicella as the most common organisms and in the order of frequency. Maternal informed consent and understanding is required before intrauterine testing for fetal infectious and possible genetic risk assessment. Methods: This structured review of the reproductive published literature focuses on the risks of amniocentesis and cordocentesis diagnostic procedure-related fetal loss rates and fetal vertical transmission (VT) rates from published infected pregnant cohorts. Results: The total postprocedure fetal loss rate for diagnostic amniocentesis procedures, in limited infectious cohorts, is 1.5% and does not appear to be increased compared to "noninfected" amniocentesis cohorts using an estimated background spontaneous fetal loss rate (no procedure) of 0.65%. The "pooled" unintended fetal loss rate is from small infected population cohorts, but can be used for counseling purposes. Postcordocentesis fetal loss risk, in an infected cohort, is not possible to estimate due to limited data. The "biological spontaneous fetal loss rate" risk with a perinatal infection (positive or negative fetal anomalies) and no diagnostic procedure before 20 weeks of gestation is reviewed. The risk of VT in acute infection cohorts as a result of the intra-amniotic diagnostic procedure is not found to be increased. Conclusion: The unintended "fetal loss" rate after amniocentesis for perinatal infected cohorts is similar to that of noninfected cohorts, but the estimate is based on limited infected cohorts. There was no procedure-based risk of fetal VT in the infected cohorts, but identification of postprocedure maternal bleeding into the amniotic cavity increases the potential risk. Maternal knowledge translation and an informed consent process with risk-benefit maternal/fetal risk counseling are required prior to any diagnostic amniocentesis procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Questionmentioning

confidence: 99%

mentioning

confidence: 99%

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Acute Perinatal Infection and the Evidenced-Based Risk of Intrauterine Diagnostic Testing: A Structured Review

Wilson

2020

Fetal Diagn Ther

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“…Among seven publications from the EMSCOT collaboration 12,27,[49][50][51][52][53][54] the one with most data on prophylactic treatment was retained 12 as well as the most recent of two publications by Valentini et al 15,16 We analyzed a total of 18 publications. 1,[10][11][12]15,26,[55][56][57][58][59][60][61][62][63][64][65] Because of the great heterogeneity of the data, as well some overlap, no attempt was made to perform a formal meta-analysis.…”

Section: Studies From 2001 To 2019mentioning

confidence: 99%

“…An update from the Lyon cohort 10 A few additional studies did not study transmission, 57 did not analyze transmission according to therapy, 56,62 did not report transmission according to therapy and timing, 58,64 or lacked untreated controls, 61 . 65…”

Section: Studies From 2001 To 2019mentioning

confidence: 99%

Congenital toxoplasmosis: What is the evidence for chemoprophylaxis to prevent fetal infection?

Mandelbrot

2020

Prenatal Diagnosis

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Although prenatal diagnosis and prenatal and neonatal therapy of congenital toxoplasmosis are available, there is controversy concerning the effectiveness of prophylaxis to prevent placental transmission. Experimental, parasitological, and clinical data suggest a "window of opportunity" following maternal infection. Among medications active against Toxoplasma gondii, mainly spiramycin (Spy) and pyrimethamine + sulfonamide combinations (P-S) have been evaluated. Results from observational studies suffered treatment bias, since prescriptions differed according to the gestational age at seroconversion, which is the major risk factor for transmission, and many lacked precise timing. Some large retrospective studies found no difference in transmission according to prophylactic treatment, but transmission was lower when treatment started promptly after maternal seroconversion. A few recent studies adjusting for timing of infection observed lower transmission in case of P-S than other or no prophylaxis. In the only randomized controlled trial, transmission was lower with P-S than S (18.5% vs 30%, P = .147); this association was strengthened when the treatment was started within 3 weeks of seroconversion, and the incidence of fetal cerebral ultrasound signs was significantly reduced in the P-S group. Rapid initiation of prophylactic therapy following maternal infection, which is usually asymptomatic, requires systematic screening for maternal seroconversion during pregnancy.

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Association between lymphadenopathy after toxoplasmosis seroconversion in pregnancy and risk of congenital infection

Donadono

Saccone

Sarno

et al. 2021

Eur J Clin Microbiol Infect Dis

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Incidence of toxoplasmosis in pregnancy in Campania: A population-based study on screening, treatment, and outcome

Cited by 19 publications

References 26 publications

Acute Perinatal Infection and the Evidenced-Based Risk of Intrauterine Diagnostic Testing: A Structured Review

Acute Perinatal Infection and the Evidenced-Based Risk of Intrauterine Diagnostic Testing: A Structured Review

Congenital toxoplasmosis: What is the evidence for chemoprophylaxis to prevent fetal infection?

Association between lymphadenopathy after toxoplasmosis seroconversion in pregnancy and risk of congenital infection

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