[Use of antiparasitic drugs in the prevention of congenital toxoplasmosis: systematic review and meta-analysis].

INTRODUCTION

In the context of preventing congenital Toxoplasma gondii infection, optimizing the use of antiparasitic molecules, such as spiramycin, pyrimethamine-sulfadiazine combinations, cotrimoxazole, and pyrimethamine-sulfadoxine, during the prenatal period is a significant challenge in limiting maternal-fetal transmission and reducing associated effects.

MATERIALS AND

METHODS

A systematic review of cohort studies published between 2000 and 2023 was conducted to determine the overall risk of mother-to-fetus transmission in pregnant women with primary Toxoplasma gondii infection, whether they are treated or not. The risk of maternal-fetal transmission in women undergoing treatment corresponds to the treatment failure rate.

RESULTS

The average overall risk of maternal-fetal transmission was estimated at 49% (95% CI, 36%-63%) among pregnant women infected during pregnancy who did not receive anti-toxoplasma treatment. This risk was assessed by categorizing the women according to their region of residence or whether their healthcare system had a prenatal care strategy. Among groups of pregnant women treated with spiramycin or pyrimethamine-sulfadiazine, the average overall treatment failure rates were 16% (95% CI, 7%-26%) and 11% (95% CI, 3%-22%), respectively, when the women were stratified according to region of residence or whether the healthcare system had a routine prénatal screening strategy. Congenital infection can cause several disorders, and the frequency of these disorders can be reduced by treating the maternal infection. There is insufficient data for a meta-analysis of treatment regimens such as pyrimethamine-sulfadoxine or sulfamethoxazole-trimethoprim combinations.

CONCLUSION

The failure rate of standard anti-toxoplasma treatments can be reduced by addressing several recognized risk factors early on. Each healthcare system must strengthen the monitoring and evaluation of treatment policies for primary infection per pregnancy in order to implement a more appropriate secondary prevention strategy.