Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy; Referral Center for Infectious Diseases in Pregnancy of Tuscany, Florence, Italy.
School of Human Health Sciences, Degree Course in Medicine and Surgery, University of Florence, Florence, Italy.
Eur J Obstet Gynecol Reprod Biol. 2021 Dec;267:285-289. doi: 10.1016/j.ejogrb.2021.11.019. Epub 2021 Nov 16.
Toxoplasmosis acquired in early pregnancy is a potentially severe complication for the fetus. Evaluating the risk of transplacental infection in pregnant women accessing the Tuscany Reference Center for Infectious Diseases in Pregnancy during the last 20 years with suspected or confirmed toxoplasmosis acquired in early pregnancy was the aim of the study.
We retrospectively enrolled all pregnant women undergoing amniocentesis for toxoplasmosis acquired in the first 16 gestational weeks in the period 1999-2019, comparing patients with certain acute infection (seroconversion occurred in pregnancy, CAIP) with those with suspected acute infection (IgG positive with low/intermediate IgG avidity index, SAIP).
237 patients were enrolled, 187 (78.9%) with SAIP and 50 (21.1%) with CAIP. Specific IgM was detected in 47.5% and 76.7% (p-value 0.001), and the mean IgG avidity index was 22.7% and 7.1% (p-value < 0.001) in the SAIP and in the CAIP group, respectively. The mean delay from diagnosis to antibiotic initiation was 14.6 in SAIP and 11 days in CAIP group. Toxoplasma DNA was detected in the amniotic fluid in one case in a patient with CAIP. Excluding 24 newborns with not available data, prevalence of congenital infection was 0.47% [1/213 (95% CI 0.08%-2.61%)], 0% [0/178 (95% CI 0%-2.11%)] in SAIP and 2.8% [1/35 (95% CI 0.51%-14.53%)] in CAIP group.
Toxoplasmosis acquired in early pregnancy has a low risk of fetal infection. Actively discussing case-by-case amniocentesis indication with patients, especially when a recent toxoplasmosis is not properly confirmed, is desirable.
妊娠早期获得的弓形体病是胎儿潜在的严重并发症。评估过去 20 年来在托斯卡纳传染病妊娠参考中心就诊的疑似或确诊妊娠早期获得的弓形体病孕妇的胎盘感染风险是本研究的目的。
我们回顾性地纳入了 1999 年至 2019 年期间因妊娠早期获得的弓形体病进行羊膜穿刺术的所有孕妇，将有明确急性感染（妊娠期间发生血清转换，CAIP）的患者与疑似急性感染（IgG 阳性且 IgG 亲和力指数低/中等，SAIP）的患者进行比较。
共纳入 237 例患者，187 例（78.9%）为 SAIP，50 例（21.1%）为 CAIP。47.5%和 76.7%（p 值<0.001）的患者检测到特异性 IgM，SAIP 和 CAIP 组的 IgG 亲和力指数平均值分别为 22.7%和 7.1%（p 值<0.001）。SAIP 组和 CAIP 组抗生素开始时间的平均延迟分别为 14.6 天和 11 天。在一名 CAIP 患者的羊水样本中检测到弓形虫 DNA。排除 24 例未提供数据的新生儿，先天性感染的患病率为 0.47%[1/213（95%CI 0.08%-2.61%）]，SAIP 组为 0%[0/178（95%CI 0%-2.11%）]，CAIP 组为 2.8%[1/35（95%CI 0.51%-14.53%）]。
妊娠早期获得的弓形体病胎儿感染的风险较低。与患者逐例讨论羊膜穿刺术的适应证，特别是当近期的弓形体病未得到适当证实时，是可取的。
