Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
Eur J Obstet Gynecol Reprod Biol. 2019 Sep;240:316-321. doi: 10.1016/j.ejogrb.2019.07.033. Epub 2019 Jul 25.
The aim of this study was to evaluate the incidence of toxoplasmosis infection during pregnancy and to describe the characteristics of the serological status, management, follow-up and treatment.
This is a population-based cohort study of women referred for suspected toxoplasmosis during pregnancy from January, 2001 to December, 2012. Suspected toxoplasmosis was defined as positive IgM antibody during pregnancy. Women with suspected toxoplasmosis during pregnancy were classified into three groups: seroconversion, suspected infection, or no infection in pregnancy. Women in the first and second group were treated according to local protocol, and amniocentesis with toxoplasmosis PCR detection and serial detailed ultrasound scans were offered. Neonates were investigated for congenital toxoplasmosis at birth and were monitored for at least one year after birth.
During the study period, there were 738,588 deliveries in Campania. Of them 1159 (0.2%) were referred to our Institution for suspected toxoplasmosis during pregnancy: 183 (15.8%) women were classified as seroconversion, 381 (32.9%) were suspected infection, and 595 (51.3%) were not infected in pregnancy. Neonatal outcome was available for 476 pregnancies, including 479 neonates (3 twins, 473 singletons), out of the 564 pregnancies with seroconversion or suspected infection. 384 (80.2%) babies were not infected at birth and at follow-up, 67 (14.0%) had congenital toxoplasmosis, 10 (2.1%) were voluntary induced termination of pregnancy, 15 (3.1%) were spontaneous miscarriage, and 4 (0.8%) were stillbirth (of which one counted already in the infected cohort). Considering cases of congenital toxoplasmosis, the transmission rate in women with seroconversion was 32.9% (52/158), and in women with suspected infection was 4.7% (15/321).
Toxoplasmosis is uncommon in pregnancy with overall incidence of seroconversion and suspected infection in pregnancy of 0.8 per 1000 live births and incidence of congenital toxoplasmosis 0.1 per 1000 live births when applying a strict protocol of screening, follow-up, and treatment. 51.3% (595/1159) of women referred to our center for suspected infection were actually considered not infected.
本研究旨在评估妊娠期弓形虫感染的发生率，并描述血清学状态、管理、随访和治疗的特征。
这是一项基于人群的队列研究，纳入了 2001 年 1 月至 2012 年 12 月期间因疑似弓形虫病而转诊的孕妇。妊娠期疑似弓形虫病定义为 IgM 抗体阳性。将疑似弓形虫病孕妇分为三组：血清转换、疑似感染或妊娠期无感染。根据当地方案对妊娠期血清转换和疑似感染的孕妇进行治疗，并进行羊水穿刺和弓形虫 PCR 检测以及连续详细的超声检查。对新生儿进行先天性弓形虫病的出生检查，并在出生后至少随访 1 年。
在研究期间，坎帕尼亚地区有 738588 例分娩。其中 1159 例（0.2%）因疑似弓形虫病而被转诊至我院：183 例（15.8%）孕妇为血清转换，381 例（32.9%）为疑似感染，595 例（51.3%）妊娠期无感染。476 例妊娠的新生儿结局可查，其中 479 例新生儿（3 例双胞胎，473 例单胎）来自 564 例血清转换或疑似感染的妊娠。384 例（80.2%）新生儿出生时和随访时未感染，67 例（14.0%）患有先天性弓形虫病，10 例（2.1%）自愿终止妊娠，15 例（3.1%）自然流产，4 例（0.8%）死胎（其中 1 例已计入感染组）。考虑到先天性弓形虫病病例，血清转换孕妇的传播率为 32.9%（52/158），疑似感染孕妇的传播率为 4.7%（15/321）。
妊娠期弓形虫病并不常见，血清转换和疑似感染的总发生率为每 1000 例活产儿 0.8 例，应用严格的筛查、随访和治疗方案时，先天性弓形虫病的发生率为每 1000 例活产儿 0.1 例。在因疑似感染而转诊至我们中心的 595 例妇女中，实际上有 51.3%（595/1159）被认为未感染。
