Congenital toxoplasmosis is considered a rare but potentially severe infection. Prenatal education about congenital toxoplasmosis could be the most efficient and least harmful intervention, yet its effectiveness is uncertain.
To assess the effects of prenatal education for preventing congenital toxoplasmosis.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (15 January 2012), PubMed (1966 to 15 January 2012), EMBASE (1980 to 15 January 2012), CINAHL (1982 to 15 January 2012), LILACS (1982 to 15 January 2012), IMEMR (1984 to 15 January 2012), and reference lists of relevant papers, reviews and websites.
Randomized and quasi-randomized controlled trials (RCTs) of all types of prenatal education on toxoplasmosis infection during pregnancy. Cluster-randomized trials were included.
Two review authors independently assessed trials for inclusion and study quality. Two review authors extracted data. Data were checked for accuracy.
Two cluster-randomized controlled trials (involving a total of 5455 women) met the inclusion criteria. The two included trials measured the effectiveness of the intervention in different ways which meant that meta-analysis of the results was not possible One trial (432 women enrolled) conducted in Canada was judged of low methodological quality. The authors did not report measure of association but only provided P values (P less than 0.05) for all outcomes. Moreover, losses to follow-up were high (34%, 147 out of 432 women initially enrolled). The authors concluded that prenatal education can effectively change pregnant women's behavior as it increased pet, personal and food hygiene. The second trial conducted in France was also judged of low methodological quality. Losses to follow-up were high (44.5%, 2233 out of 5023 women initially enrolled) and differential (40% in the intervention group and 52% in the control group). The authors concluded that prenatal education for congenital toxoplasmoses has a significant effect on improving women's knowledge whereas it has no effect on changing women's behavior. In this trial 17/3949 pregnant women seroconverted for toxoplasmosis: 13/2591 (0.5%) in the intervention group and 4/1358 (0.3%) in the control group. The number of events was too small to reach conclusions about the effect of prenatal education on seroconversion rate during pregnancy.No other randomized trials on the effect of prenatal education on congenital toxoplasmosis rate, or toxoplasmosis seroconversion rate during pregnancy were detected.
Even though primary prevention of congenital toxoplasmosis is considered a desirable intervention, given the lack of related risks compared to secondary and tertiary prevention, its effectiveness has not been adequately evaluated. There is very little evidence from RCTs that prenatal education is effective in reducing congenital toxoplasmosis even though evidence from observational studies suggests it is. Given the lack of good evidence supporting prenatal education for congenital toxoplasmosis prevention, further RCTs are needed to confirm any potential benefits and to further quantify the impact of different sets of educational intervention.
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"Although numerous studies have provided some evidence that education of pregnant women may be beneficial,68–72 one review of toxoplasmosis-related health education called for more rigorously designed research on prevention of toxoplasmosis through education, and questioned the validity of results from published studies.73 In addition, a recent Cochrane systematic review found very little rigorous scientific evidence that prenatal education is effective in reducing congenital toxoplasmosis and called for randomized controlled trials to confirm the potential benefits and quantify the impact of educational interventions.74 "
[Show abstract][Hide abstract]ABSTRACT: Toxoplasma gondii is a leading cause of severe foodborne illness in the United States. Population-based studies have found T. gondii infection to be more prevalent in racial/ethnic minority and socioeconomically disadvantaged groups. Soil contaminated with cat feces, undercooked meat, and congenital transmission are the principal sources of infection. Toxoplasmosis-associated illnesses include congenital neurologic and ocular disease; acquired illness in immunocompetent persons, most notably ocular disease; and encephalitis or disseminated disease in immunosuppressed persons. The association of T. gondii infection with risk for mental illness is intriguing and requires further research. Reduction of T. gondii in meat, improvements in hygiene and food preparation practices, and reduction of environmental contamination can prevent toxoplasmosis, but more research is needed on how to implement these measures. In addition, screening and treatment may help prevent toxoplasmosis or reduce the severity of disease in some settings.
Preview · Article · May 2014 · The American journal of tropical medicine and hygiene
[Show abstract][Hide abstract]ABSTRACT: Control programs have been executed in an attempt to reduce vertical transmission and the severity of congenital infection in regions with a high incidence of toxoplasmosis in pregnant women. We aimed to evaluate whether treatment of pregnant women with spiramycin associated with a lack of monitoring for toxoplasmosis seroconversion affects the prognosis of patients.
We performed a prospective cohort study with 246 newborns (NB) at risk for congenital toxoplasmosis in Goiania (Brazil) between October 2003 and October 2011. We analyzed the efficacy of maternal treatment with spiramycin.
A total of 40.7% (66/162) of the neonates were born seriously infected. Vertical transmission associated with reactivation during pregnancy occurred in 5.5% (9/162) of the NB, with one showing severe infection (systemic). The presence of specific immunoglobulins (fetal IgM and NB IgA) suggested the worst prognosis. Treatment of pregnant women by spiramycin resulted in reduced vertical transmission. When infected pregnant women did not undergo proper treatment, the risk of severe infection (neural-optical) in NB was significantly increased. Fetal IgM was associated with ocular impairment in 48.0% (12/25) of the fetuses and neonatal IgA-specific was related to the neuro-ophthalmologic and systemic forms of the disease. When acute toxoplasmosis was identified in the postpartum period, a lack of monitoring of seronegative pregnant women resulted in a higher risk of severe congenital infection.
Treatment of pregnant women with spiramycin reduces the possibility of transmission of infection to the fetus. However, a lack of proper treatment is associated with the onset of the neural-optical form of congenital infection. Primary preventive measures should be increased for all pregnant women during the prenatal period and secondary prophylaxis through surveillance of seroconversion in seronegative pregnant woman should be introduced to reduce the severity of congenital infection in the environment.
Full-text · Article · Jan 2014 · BMC Infectious Diseases
[Show abstract][Hide abstract]ABSTRACT: To assess information provided by midwives about methods to prevent toxoplasmosis, listeriosis and cytomegalovirus, and whether the amount of provided information varied according to clients' and midwives' characteristics.
Intake consultations with 229 clients in four midwifery practices were videotaped between August 2010 and April 2011. Videotaped intake consultations, where infectious disease prevention were discussed, were evaluated, using a specifically designed nine-item scoring tool. Midwives and clients filled in a questionnaire about their background characteristics. Multilevel linear regression analysis was performed to establish associations between the amount of information provided and clients' and midwives' characteristics.
In total 172 consultations with fifteen midwives were suitable for analyses. Information about not eating raw or undercooked meat and not consuming unpasteurized dairy products was provided most often. Information about not sharing eating utensils with small children and thoroughly reheating all ready-to-eat foods were rarely provided. More information was provided when the client was a primigravidae or the consultation lasted longer than 50min.
Information on infectious disease prevention given to pregnant women by primary care midwives was insufficient; especially for cytomegalovirus prevention.
A guideline for professionals on preventable infectious diseases may be useful to inform pregnant women properly.