Trypanosoma cruzi infection in pregnancy: New approaches to address the diagnosis and follow-up of women and newborns

The transplacental route is the main human-to-human transmission mode of Trypanosoma cruzi infection, causing congenital Chagas disease, a major health problem in most endemic and nonendemic areas. The prevention, diagnosis, and follow-up of pregnant women and congenitally infected newborns face limitations, such as regional variations of concordance among serological tests used to diagnose T. cruzi infection in the Americas, the low sensitivity of microscopic examination for detecting live trypomastigotes in blood, and losses of infected women and newborns in screening and follow-up programs. In addition, fetal growth retardation was recently documented in uninfected newborns of infected mothers. The potential practical impacts of some new approaches, based on fundamental concepts and results of clinical observations addressing T. cruzi infection in pregnancy, such as simplifying the serodiagnosis, detecting and identifying live T. cruzi clones and monitoring fetal growth retardation in all neonates of infected mothers, are discussed as open research questions.