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

BMJ 1999;318:1511-1514 ( 5 June )

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

Martine Wallon, associate professor, ^a Christiane Liou, librarian, ^b Paul Garner, senior lecturer, ^c François Peyron, professor. ^a

^a Service de Parasitologie, Hôpital de la Croix-Rousse, 69004 Lyons, France, ^b Service de Parasitologie, Faculté de Médecine, Université Claude Bernard, Lyons, France, ^c Cochrane Infectious Diseases Group, International Health Division, Liverpool School of Tropical Medicine, Liverpool

Correspondence to: Dr Wallon wallon{at}rockefeller.univ-lyon1.fr

Objective: To summarise the evidence that treating toxoplasmosisin pregnancy reduces the risk of congenital toxoplasma infectionand improves infantoutcomes.
Design: Systematic review of studies comparing atleast two concurrent groups of pregnant women with proved or likelyacute toxoplasma infection in which treatments were compared withno treatment and outcomes in the children werereported.
Subjects: Studies were identified from Medline (1966-97),Pascal (1990-7), Embase (1993-7), and Biological abstracts (1993-5)plus contact with experts in the field, including the EuropeanResearch Network on CongenitalToxoplasmosis.
Main outcome measure: Proportion of infected children at 1 yearborn to infected pregnant women who were or were nottreated.
Results: Out of 2591 papers identified, nine met theinclusion criteria. There were no randomised comparisons, andcontrol groups were generally not directly comparable with thetreatment groups. Congenital infection was common in treated groups.five studies showed that treatment was effective and four thatit wasnot.
Conclusion: It is unclear whether antenatal treatmentin women with presumed toxoplasmosis reduces congenital transmissionof Toxoplasma gondii. Screening is expensive, so the effects oftreatment and impact of screening programmes need to be evaluated.In countries where screening or treatment is not routine, thesetechnologies should not be introduced outside carefully controlledtrials.

Key messages

Pregnant women in France and Austria are routinely screened for toxoplasmosis, and women negative for antibodies are followed up at regular intervals
The value of antenatal toxoplasmosis screening programmes depends on safe treatments that reduce the risk of congenital disease
This systematic review found no good comparative data measuring the potential harms and benefits of antiparasitic drugs used for presumed antenatal toxoplasma infection
Most control groups were not comparable, and incidence of congenital infection was high in the intervention groups
Countries considering introducing screening should do so only in the context of a controlled trial

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