[Toxoplasmosis in pregnancy: Practical Management].

Area of Science:

• Medical Parasitology
• Infectious Disease Epidemiology
• Prenatal Care

Background:

• Congenital toxoplasmosis incidence has declined in France, attributed to effective screening and timely therapeutic interventions for pregnant women, fetuses, and newborns.
• The French national program for toxoplasmosis screening and prevention has been re-evaluated and validated, despite observed temporal decreases in incidence.

Framework:

• Serological diagnosis of maternal toxoplasmosis is generally straightforward, but IgM detection in the first trimester necessitates expert laboratory referral.
• Prompt referral of pregnant women with confirmed seroconversion to specialized centers is crucial for management decisions regarding treatment and antenatal diagnosis.

Implementation:

• Prophylactic prenatal treatment, initiated within three weeks of seroconversion, demonstrates moderate evidence for reducing maternal-fetal transmission and infant sequelae.
• Treatment protocols vary by gestational age: spiramycin for infections before 14 weeks, and pyrimethamine-sulfadiazine with folinic acid for infections at or after 14 weeks.
• Amniocentesis is recommended for prenatal diagnosis to guide management; PCR confirmation of fetal infection warrants early initiation or continuation of pyrimethamine-sulfadiazine therapy to mitigate neurological and ocular damage.

Implications:

• The established French program highlights the success of integrated screening and treatment strategies in managing congenital toxoplasmosis.
• Further research is needed to explore and validate novel approaches for the prevention of congenital toxoplasmosis.