Federal University of Pará, Belém, Brazil.
University of Pernambuco, Recife, Brazil.
PLoS Negl Trop Dis. 2024 Sep 5;18(9):e0012407. doi: 10.1371/journal.pntd.0012407. eCollection 2024 Sep.
Maternal-foetal transmission of Chagas disease (CD) affects newborns worldwide. Although Benznidazole and Nifurtimox therapies are the standard treatments, their use during pregnancy is contra-indicated. The effectiveness of trypanocidal medications in preventing congenital Chagas Disease (cCD) in the offsprings of women diagnosed with CD was highly suggested by other studies.
We performed a systematic review and meta-analysis of studies evaluating the effectiveness of treatment for CD in women of childbearing age and reporting frequencies of cCD in their children. PubMed, Scopus, Web of Science, Cochrane Library, and LILACS databases were systematically searched. Statistical analysis was performed using Rstudio 4.2 using DerSimonian and Laird random-effects models. Heterogeneity was examined with the Cochran Q test and I2 statistics. A p-value of <0.05 was considered statistically significant.
Six studies were included, comprising 744 children, of whom 286 (38.4%) were born from women previously treated with Benznidazole or Nifurtimox, trypanocidal agents. The primary outcome of the proportion of children who were seropositive for cCD, confirmed by serology, was signigicantly lower among women who were previously treated with no congenital transmission registered (OR 0.05; 95% Cl 0.01-0.27; p = 0.000432; I2 = 0%). In women previously treated with trypanocidal drugs, the pooled prevalence of cCD was 0.0% (95% Cl 0-0.91%; I2 = 0%), our meta-analysis confirms the excellent effectiveness of this treatment. The prevalence of adverse events in women previously treated with antitrypanocidal therapies was 14.01% (95% CI 1.87-26.14%; I2 = 80%), Benznidazole had a higher incidence of side effects than Nifurtimox (76% vs 24%).
The use of trypanocidal therapy in women at reproductive age with CD is an effective strategy for the prevention of cCD, with a complete elimination of congenital transmission of Trypanosoma cruzi in treated vs untreated infected women.
恰加斯病（CD）的母婴传播影响着全世界的新生儿。尽管贝那唑和硝呋莫司疗法是标准治疗方法，但在怀孕期间使用是禁忌的。其他研究强烈表明，在诊断出 CD 的女性中使用杀锥虫药物可有效预防先天性恰加斯病（cCD）。
我们对评估育龄期女性 CD 治疗效果并报告其子女 cCD 发生率的研究进行了系统评价和荟萃分析。我们系统地检索了 PubMed、Scopus、Web of Science、Cochrane 图书馆和 LILACS 数据库。使用 Rstudio 4.2 中的 DerSimonian 和 Laird 随机效应模型进行统计分析。使用 Cochran Q 检验和 I2 统计量检查异质性。p 值<0.05 被认为具有统计学意义。
纳入了 6 项研究，共纳入了 744 名儿童，其中 286 名（38.4%）是接受贝那唑或硝呋莫司治疗的女性所生，这两种药物都是杀锥虫药。通过血清学确认的 cCD 阳性儿童比例是主要结局，在未登记先天传播的女性中显著较低（OR 0.05；95%Cl 0.01-0.27；p = 0.000432；I2 = 0%）。在接受杀锥虫药物治疗的女性中，cCD 的总患病率为 0.0%（95%Cl 0-0.91%；I2 = 0%），我们的荟萃分析证实了这种治疗方法的极好效果。接受抗锥虫治疗的女性不良事件发生率为 14.01%（95%CI 1.87-26.14%；I2 = 80%），贝那唑的副作用发生率高于硝呋莫司（76%比 24%）。
在 CD 育龄女性中使用杀锥虫治疗是预防 cCD 的有效策略，可完全消除治疗与未治疗的感染女性之间的先天性克氏锥虫传播。
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