Toxoplasmosis in pregnancy

Abstract

Pregnant women who acquire infection from toxoplasma gondii usually remain asymptomatic, although infection acquired in pregnancy may cause severe damage to the fetus. The number of women susceptible to an acute infection falls with advancing age. Given the asymptomatic nature of most toxoplasma infections, primary prevention in pregnant women after appropriate counselling may lower the risk of congenital infection. Diagnosis of toxoplasmosis is established by serological techniques or by direct detection of the parasite in the amniotic fluid. However, interpretation of toxoplasma-specific IgM-positive results is complicated by the persistence of IgM anti-bodies for a prolonged time span after infection and by false-positive results in commercial tests. If the presence of acute toxoplasmosis is confirmed, maternal treatment is initiated in an effort to prevent transmission to the fetus. The most commonly used therapeutic regimen, and probably the mosteffective, is the combination of pyrimethamine with sulfadiazine and folinic acid. Maternal treatment is continued until delivery. Postnatally cord blood samples are collected for further serological testing. Also, placental tissue is sent for direct detection of toxoplasma gondii. The majority of neonates with congenitally acquired toxoplasmosis appear asymptomatic at birth but develop complications later in life.