Wallon M, Liou C, Garner P, Peyron F
Service de Parasitologie, Hôpital de la Croix-Rousse, 69004 Lyons, France.
BMJ. 1999 Jun 5;318(7197):1511-4. doi: 10.1136/bmj.318.7197.1511.
To summarise the evidence that treating toxoplasmosis in pregnancy reduces the risk of congenital toxoplasma infection and improves infant outcomes.
Systematic review of studies comparing at least two concurrent groups of pregnant women with proved or likely acute toxoplasma infection in which treatments were compared with no treatment and outcomes in the children were reported.
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 European Research Network on Congenital Toxoplasmosis.
Proportion of infected children at 1 year born to infected pregnant women who were or were not treated.
Out of 2591 papers identified, nine met the inclusion criteria. There were no randomised comparisons, and control groups were generally not directly comparable with the treatment groups. Congenital infection was common in treated groups. five studies showed that treatment was effective and four that it was not.
It is unclear whether antenatal treatment in women with presumed toxoplasmosis reduces congenital transmission of Toxoplasma gondii. Screening is expensive, so the effects of treatment and impact of screening programmes need to be evaluated. In countries where screening or treatment is not routine, these technologies should not be introduced outside carefully controlled trials.
总结孕期治疗弓形虫病可降低先天性弓形虫感染风险并改善婴儿预后的证据。
对研究进行系统评价，比较至少两组确诊或疑似急性弓形虫感染的孕妇，一组接受治疗，另一组未接受治疗，并报告儿童的预后情况。
从医学索引数据库（1966 - 1997年）、帕斯卡数据库（1990 - 1997年）、荷兰医学文摘数据库（1993 - 1997年）和生物学文摘数据库（1993 - 1995年）中检索研究，并与该领域专家联系，包括欧洲先天性弓形虫病研究网络。
接受或未接受治疗的感染孕妇所生1岁儿童的感染比例。
在检索到的2591篇论文中，9篇符合纳入标准。没有随机对照比较，对照组一般与治疗组没有直接可比性。先天性感染在治疗组中很常见。5项研究表明治疗有效，4项研究表明治疗无效。
对于疑似弓形虫病的孕妇，产前治疗是否能降低弓形虫的先天性传播尚不清楚。筛查成本高昂，因此需要评估治疗效果和筛查项目的影响。在筛查或治疗不常规的国家，不应在严格控制的试验之外引入这些技术。
