A systematic review 1 including individual patient data (IPD) from observational cohorts from 14 studies (including IPD for 20 cohorts of 1 721 women and 26 cohorts of 550 infants) was abstracted in DARE.
Mother-to-child transmission: The risk of mother-to-child transmission increased with gestational age at seroconversion (OR 1.15 per week, 95% CI: 1.12 to 1.17). Prenatal treatment was associated with a lower risk of transmission (OR 0.94 per week, 95% CI: 0.90 to 0.98), especially when treatment was started early after the mother's seroconversion. The odds of transmission also decreased significantly with higher (5 degrees) latitude (OR 0.71, 95% CI: 0.53 to 0.96). Rates of mother-to-child transmission were not significantly different when patients were treated with spiramycin compared with pyrimethamine-sulphonamide (OR 0.79, 95% CI: 0.55 to 1.13).
Clinical manifestations: Higher gestational age at seroconversion was associated with a lower risk of overall clinical manifestations (OR 0.96 per week, 95% CI: 0.93 to 0.99, p=0.01), intracranial lesions (OR 0.91 per week, 95% CI: 0.87 to 0.95) and ocular lesions (OR 0.97 per week, 95% CI: 0.93 to 1.00, p=0.04) in infancy. The risk of any clinical manifestations was comparable between infants of treated and untreated mothers (OR 1.11, 95% CI: 0.61 to 2.02). Correcting for the type of treatment, period of the study, or the latitude of the centre did not modify these findings. The combination of spiramycin and pyrimethamine-sulphonamide carried a higher risk of any clinical manifestations than pyrimethamine-sulphonamide alone (OR 1.29, 95% CI: 1.42 to 9.34).
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