Open Access Research article

Association between congenital toxoplasmosis and parent-reported developmental outcomes, concerns, and impairments, in 3 year old children

Katherine Freeman1, Alison Salt2, Andrea Prusa3, Gunilla Malm4, Nicole Ferret5, Wilma Buffolano6, Dorthe Schmidt7, Hooi Kuan Tan8, Ruth E Gilbert8* and The European Multicentre Study on Congenital Toxoplasmosis (EMSCOT)

Author Affiliations

1 Albert Einstein College of Medicine, Department of Epidemiology and Population Health, New York, U.S.A

2 The Neurodisability Service, Great Ormond Street Hospital for Children and Institute of Child Health, London, UK

3 Department of Pediatrics, Division of Neonatology and Intensive Care, Medical University of Vienna, Austria

4 Karolinska University Hospital, Huddinge, Stockholm, Sweden

5 CHU de NICE, Service Parasitologie – Mycologie, Hopital L'Archet II, BP 3079, 06202 NICE Cedex 3, France

6 Perinatal Infection Unit, Dept of Pediatrics, University of Naples Federico II, Naples, Italy

7 Department of Parasitology, Staten Seruminstitut, Copenhagen, Denmark

8 Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK

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BMC Pediatrics 2005, 5:23  doi:10.1186/1471-2431-5-23

Published: 13 July 2005



Information is lacking on the effects of congenital toxoplasmosis on development, behavior, and impairment in later childhood, as well as on parental concerns and anxiety. This information is important for counselling parents about the prognosis for an infected child and for policy decisions on screening.


We prospectively studied a cohort of children identified by screening for toxoplasmosis in pregnant women or neonates between 1996 and 2000 in ten European centers. At 3 years of age, parents of children with and without congenital toxoplasmosis were surveyed about their child's development, behavior, and impairment, and about parental concerns and anxiety, using a postal questionnaire.


Parents of 178/223 (80%) infected, and 527/821 (64%) uninfected children responded. We found no evidence that impaired development or behavior were more common in infected children, or that any potential effect of congenital toxoplasmosis was masked by prenatal treatment. Parents of infected children were significantly more anxious and reported more visual problems in their children.


On average, children aged three to four years with congenital toxoplasmosis identified by screening and treated during infancy in this European setting had risks of abnormal development and behavior similar to uninfected children. Parental anxiety about infected children needs to be addressed by clinicians. Future studies with longer follow up and clinician-administered assessments may be better able to detect any subtle differences in child outcomes.