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Experimental, parasitological, and clinical data suggest a \u201cwindow of opportunity\u201d following maternal infection. Among medications active against <jats:italic>Toxoplasma gondii<\/jats:italic>, mainly spiramycin (Spy) and pyrimethamine\u2009+ sulfonamide combinations (P\u2010S) have been evaluated. Results from observational studies suffered treatment bias, since prescriptions differed according to the gestational age at seroconversion, which is the major risk factor for transmission, and many lacked precise timing. Some large retrospective studies found no difference in transmission according to prophylactic treatment, but transmission was lower when treatment started promptly after maternal seroconversion. A few recent studies adjusting for timing of infection observed lower transmission in case of P\u2010S than other or no prophylaxis. In the only randomized controlled trial, transmission was lower with P\u2010S than S (18.5% vs 30%, <jats:italic>P<\/jats:italic> =\u2009.147); this association was strengthened when the treatment was started within 3\u2009weeks of seroconversion, and the incidence of fetal cerebral ultrasound signs was significantly reduced in the P\u2010S group. Rapid initiation of prophylactic therapy following maternal infection, which is usually asymptomatic, requires systematic screening for maternal seroconversion during pregnancy.<\/jats:p>","DOI":"10.1002\/pd.5758","type":"journal-article","created":{"date-parts":[[2020,5,26]],"date-time":"2020-05-26T14:03:12Z","timestamp":1590501792000},"page":"1693-1702","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Congenital toxoplasmosis: What is the evidence for chemoprophylaxis to prevent fetal infection?"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5883-7597","authenticated-orcid":false,"given":"Laurent","family":"Mandelbrot","sequence":"first","affiliation":[{"name":"Service de Gyn\u00e9cologie\u2010Obst\u00e9trique Assistance Publique\u2010H\u00f4pitaux de Paris Nord Universit\u00e9 de Paris, H\u00f4pital Louis Mourier  Colombes France"},{"name":"Inserm IAME 1137, Universit\u00e9 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