Infections in pregnancy, every year 300 newborns with Toxoplasmosis

Rome - Infections that are transmitted from mother to fetus during pregnancy pregnancyChildbirth and breastfeeding still pose an underestimated threat. Diseases such as toxoplasmosis, rubella, cytomegalovirus, and syphilis can cause serious harm to the unborn child, including deafness, developmental delays, and blindness.

These are the so-called Torch or Torches, an acronym which stands for Toxoplasmosis, Infectious Diseases (syphilis, HIV, hepatitis B, chickenpox, parvovirus B19, etc.), Rubella, Cytomegalovirus (CMV), Herpes simplex virus (HSV), Enterovirus and other pathogens (e.g. Zika virus, group B streptococcus).

The rising numbers and risks for newborns, according to experts, highlight the need to work together and strengthen screening and prevention campaigns. This is why a national network has been created, involving institutions, scientific societies, civil society, and businesses, to "join forces and ensure universal access to screening and preventive treatments."

The initiative was launched today in Rome during the conference entitled "The Complexity of Maternal-Fetal Infections and the Crucial Role of Diagnostics in the Management of Torch Infections," organized by Senator Guido Quintino Liris, member of the Parliamentary Intergroup for the Prevention and Control of Infectious Diseases, with the support of the Association of Italian Clinical Microbiologists (Amcli), Cittadinanzattiva, Diasorin, and Federchimica Assobiotec.

"In a National Health Service that can take advantage of technology, personalized and predictive medicine, and advanced research," Liris emphasized, "prevention and early diagnosis are the cornerstone of sustainability, as they increase the chances of recovery on the one hand and the stability of public finances on the other.

The prenatal setting is one of the most complex yet important aspects of prevention: intervention during pregnancy can make a difference in terms of quality of life, both for the woman and the unborn child. It is crucial to ensure the health of both women and their babies during one of the most exciting yet delicate phases of their lives. Furthermore, in a context where births are increasingly rare, it is crucial to avoid interference.

A silent emergency: the case of cytomegalovirus (CMV)

In Italy, however, approximately 13 primary Cytomegalovirus infections are observed each year in pregnant women. One newborn in 150 is born with this infection. Although only 10-15% show symptoms at birth, up to 1 in 4 may develop serious consequences in the first years of life, such as deafness or delays in neuropsychomotor development.

CMV is recognized as the most common virus causing intrauterine infections and is responsible for approximately 10% of all cases of cerebral palsy and 8-21% of cases of sensorineural hearing loss at birth, a percentage that increases to 25% within the first four years of life. Overall, 30-40% of pregnant women are susceptible to CMV and can acquire a primary infection during pregnancy, which remains the main cause of mother-to-fetus transmission of the virus.

Since December 2023, maternal serological screening for CMV during pregnancy is recommended by the Physiological Pregnancy Guidelines and in 2025 it will be included in the Essential Levels of Assistance (Lea). Antiviral therapy to prevent maternal-fetal transmission of the virus has already been free since 2020 thanks to Aifa; nevertheless, regional heterogeneity in neonatal screening remains.

"Cytomegalovirus is the leading cause of congenital infection in high-income countries," explained Professor Tiziana Lazzarotto, Full Professor of Microbiology and Clinical Microbiology at the Alma Mater Studiorum University of Bologna, Director of the Microbiology Unit at the IRCCS AOU of Bologna, and Scientific Director of Amcli, during the conference. "Thanks to the new ISS Guidelines and their implementation in the Essential Levels of Assistance (LEA), we can now identify at-risk pregnant women early and intervene promptly with drugs that have no side effects for mother and child."

Monitoring HIV status from conception until mid-pregnancy is essential to protect the unborn child: neurological risk is directly related to the timing of infection, especially in the first trimester.

Toxoplasmosis in pregnancy: still a high risk

Toxoplasmosis contracted during pregnancy as a primary infection, experts explained today in the Senate, can cause spontaneous abortion, hydrocephalus, brain lesions (particularly calcifications) and chorioretinitis, with permanent consequences.

The risks come from the consumption of raw or undercooked meat (30-63% of cases), sausages, contact with cat feces, which is the natural reservoir of Toxoplasma, contaminated soil or water. Screening is provided by the LEA at the first prenatal check and then every 4-6 weeks, if the result is negative.

"Since over 90% of expectant mothers with toxoplasmosis are asymptomatic, it is crucial to know their serological status from the beginning of pregnancy," emphasized Professor Marcello Lanari, Professor of General and Specialist Pediatrics at the Alma Mater Studiorum University of Bologna and Director of the Pediatrics Unit at the IRCCS AOU of Bologna. "Hand hygiene, a proper diet, and targeted medications as prescribed by a doctor are the key to success in the event of fetal infection."

It is essential for women to know their serological status for all TORCH infections, from the beginning of pregnancy or, even better, when planning it, in order to adopt hygiene and dietary measures and targeted therapies to protect the unborn child, considering that the greatest risk of fetal involvement is in the first and second trimesters, with a possible poor prognosis.

Sero-prevalence data in 2025: the Amcli study is coming

A study conducted by AMCLI, scheduled for publication in the coming months in the scientific journal Eurosurveillance, documents a seroprevalence (presence of antibodies in the blood) of CMV and Toxoplasma gondii, confirming trends already observed in other European countries. The following values ​​emerge from a representative sample of Italian women of childbearing age: Toxoplasma gondii: 10%; Parvovirus B19: 64%; Treponema pallidum (syphilis): 1%; Rubella virus: 86%; Cytomegalovirus (CMV): 59%.

Among foreign women of childbearing age in Italy, however: Toxoplasma gondii: 22%; Parvovirus B19: 57%; Treponema pallidum: 1%; Rubella virus: 86%; VMC: 93%. Thanks to mandatory pediatric vaccination and coverage rates above 95%, Italy was declared free of endemic rubella at the end of 2023. However, according to experts, screening of foreign women arriving from countries without vaccination recommendations remains crucial to "prevent imported cases." The main focus is therefore on cytomegalovirus and toxoplasmosis.