Congenital Toxoplasmosis

Of 378 pregnant women with high initial toxoplasma antibody titers or seroconversion during pregnancy, 183 acquired the infection during pregnancy, a rate of 6.3 per 100 pregnancies. There were 11 abortions; seven infants were stillborn or died. Toxoplasmosis occurred in 59 of the nonaborted offspring. Among these, two died, and seven had severe disease with cerebral and ocular involvement. Of the remaining 50, 11 had mild, and 39 had subclinical illness. Severe disease was noted only when maternal infections were acquired during the first two trimesters. Later acquisition resulted in subclinical or no fetal infections. Parasites were isolated from the placentas of 25 per cent of those who acquired toxoplasma during pregnancy. Treatment with spiramycin during pregnancy reduced the overall frequency of the fetal infections but not of overt disease. Mothers with antibodies before they became pregnant had no infected infants. (N Engl J Med 290:1110–1116, 1974)