Risk Of Maternal-fetal Transmission Research Articles

Toxoplasmose et grossesse

Toxoplasmosis is usually a mild infection, except in immunocompromised patients and fetus during in-utero contamination. The risk of maternal-fetal transmission is of the order of 29% but is very variable depending on the term of pregnancy (from 6% in the first trimester to about 80% at the end of pregnancy), while the severity of the disease evolves inversely (severe forms in case of transmission in early pregnancy, subclinical forms in late pregnancy). The number of congenital toxoplasmosis is relatively constant for several years around 250 cases per year, representing an incidence of 0.3 per 1 000 live births in France. The risk of maternal-fetal transmission is of the order of 29% but is very variable depending on the term of pregnancy (from 6% in the first trimester to about 80% at the end of pregnancy), while the severity of the disease evolves inversely (severe forms in case of transmission in early pregnancy, subclinical forms in late pregnancy). The number of congenital toxoplasmoses has been relatively constant for several years, around 250 cases per year, which represents an incidence of 0.3 per 1 000 live births in France. Since 1978, France has initiated a program for the prevention of congenital toxoplasmosis in pregnant women, with mandatory serological screening (IgG and IgM) before the end of the first trimester and surveillance until the end of pregnancy for non-pregnant women. -immunisées. If contamination occurs during pregnancy, it is fundamental to date contamination to propose a prenatal diagnosis. This is based on the detection of toxoplasmic DNA in the amniotic fluid coupled with monthly ultrasound monitoring until delivery. Postnatal biological diagnosis will also be implemented, based on both serology and toxoplasmic DNA research.

DEFB-1 genetic polymorphism screening in HIV-1 positive pregnant women and their children

Objective. In our study we evaluated the frequency of three SNPs (−52 G/A, −44 C/G; −20 G/A) in the 5′ UTR of DEFB-1 gene, in a cohort of 130 HIV-1 infected mothers and their children, collected by the Italian group SIGO in Obstetrics and Gynecology.Methods. The three SNPs (−52 G/A, −44 C/G; −20 G/A) in the 5′ UTR of DEFB-1 gene were genotyped by direct sequencing of PCR products.Results. The C allele at position −44 was shown to be significantly different in both HIV-1 positive mothers and their children when compared to the healthy controls. The odds ratio for −44 C allele in children born to HIV-1 infected mothers is 7.09 (confidence interval 3.38–15.3) while the odds ratio for this allele in HIV-1 infected mothers is 6.42 (confidence interval 3.14–13.4).Conclusions. Our results evidence a high frequency of the −44 CC allele in HIV-1 infected mothers and their children with augmented potential risk of maternal fetal transmission. This potential vertical transmission risk has been successfully prevented by antiretroviral drug treatment and cesarian section of the HIV-1 positive mothers.

Antiretroviral Treatments to Reduce Mother-to-Child Transmission of HIV

HIV Clinical Trials 2001;2(1):46–55 Agrowing number of studies demonstrate the efficacy of various perinatal antiretroviral regimens for preventing transmission of HIV from mothers to babies. This review summarizes the results available as of July 2000 (Table 1). Taken together, these studies show that the rate of transmission to the infant, which in untreated HIV-infected pregnant women exceeds 20%, can be dramatically reduced by antiretroviral therapy given in the perinatal period. Optimal regimens have been found to include treatment of the mother in the third trimester of pregnancy and during labor, with subsequent treatment of the infant for at least the first few days of life. Regimens begun at the time of labor are effective (although somewhat less so) only if followed by treatment of the infant, probably for several weeks. When prenatal care is lacking, treatment of the infant alone, especially if done within the first 48 hours of life, also provides a reduction in transmission risk. The benefit of perinatal treatment is diminished in breastfed infants compared with those who are not breastfed; perinatal treatment in the setting of breastfeeding may serve largely to shift part of the risk of infection from the peripartum period to several months later. This situation is complicated by the lack of viable alternatives to breastfeeding in many areas of the world most heavily affected by HIV. The risk of maternal-fetal transmission decreases with decreasing viral load and is very low in women receiving effective antiretroviral therapy as a matter of routine care.1,2 The risk of transmission may reach less than 1% in women with plasma Antiretroviral Treatments to Reduce Mother-toChild Transmission of HIV