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Pregnancy outcomes, clinical manifestations, and long-term consequences of congenital Chagas disease

Trypanosoma cruzi infection and pregnancy outcomes

The proportions of abortions and stillbirths in women chronically infected with T. cruzi were reported to be either similar167168 or slightly higher than in uninfected women.5160169—171 Whether they are due to congenital infection and/or placental dysfunction remains unknown in most cases. However, such records are difficult, and recent and reliable data on abortions or stillbirths in Chagas disease are lacking, which perhaps underestimates rates of maternal—fetal transmission.

Neonatal mortality can occur in untreated severe congenital Chagas disease. We reported mortality rates up to 13% in a Bolivian cohort of congenitally infected newborns studied between 1992 and 1994, while the rate dropped to 2% in another study in 1999—2001, when Bolivia benefited from improved socioeconomic conditions, better maternal care, and extended its vector control programs.55,93 This latter factor is in line with the role of re-infections in the morbidity and mortality of congenital Chagas disease mentioned in Section, Other fetal/neonatal factors susceptible to interfere with the development of congenital Chagas disease. Neonatal pejorative outcomes are also much higher when acute or reactivated infection (coinfection with HIV) occurs during pregnancy (see sections: Parasitic load during pregnancy and transmission of congenital infection; Other maternal factors involved in transmission of congenital infection).61,85,86

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