Toxoplasmosis in pregnancy; analysis of maternal seropositivity in a large cohort in Turkey and clinical consequences of neonates

Abstract

Toxoplasmosis infestation during pregnancy is typically asymptomatic however, the risk of vertical transmission increases with advancing gestational age. Due to the absence of overt clinical symptoms in most pregnant women, diagnosis relies on serological testing. Seroprevalence rates vary widely depending on geographical location and cultural practices. In the fetus, toxoplasmosis can result in a spectrum of outcomes, ranging from asymptomatic infection to severe neurological impairment. This study aimed to determine the seroprevalence of Toxoplasma gondii during pregnancy and to evaluate fetal transmission in seropositive pregnant women. For those diagnosed with acute toxoplasmosis, neonatal examination, serological tests, and transfontanel ultrasonography were conducted. This retrospective cohort study evaluated Anti-Toxoplasma IgM, IgG, and IgG avidity results of patients who presented to a tertiary medical center between 2015 and 2020. All maternal serological results, ultrasonographic evaluations, and neonatal data (e.g., serology, transfontanel ultrasonography) from births in the institution were obtained from hospital records. During the study period, 69 out of 2137 women (3.2%) had positive or borderline Toxoplasma IgM results. Seventeen patients were considered to have preconceptional infection, other 46 were suspected as acute toxoplasmosis during pregnancy. Three patients were lost to follow-up, and 5 pregnancies were terminated. Overall, 46 patients (2.1%) were started on spiramycin treatment by a mean gestational age of 14 weeks. Amniocentesis was performed in 14 cases, all of which had negative PCR results. Among neonates with available data, no findings suggestive of congenital toxoplasmosis were detected. The maternal seroprevalence of Toxoplasma gondii observed at our center aligns with findings from similar studies. 2 percent of 2137 women were suspected as acute toxoplasmosis and none of the 38 babies had neonatal intracranial abnormalities. However, the low acceptance rate (30%) for fetal diagnostic testing and the lack of complete neonatal serologic data may contribute to the observed low rate of congenital toxoplasmosis.