Real-world implementation and clinical outcomes of a regional prenatal screening programme for Trypanosoma cruzi infection in a non-endemic European setting: an 11-year retrospective cohort study.

BACKGROUND: In non-endemic countries, congenital transmission has become the main source of new Trypanosoma cruzi infections. Prenatal screening programmes targeting women from endemic areas are recommended, yet long-term real-world evaluations in Europe remain limited. We assessed the implementation of a regional prenatal screening programme and the association between maternal T. cruzi infection and maternal and neonatal outcomes. METHODS: We conducted an 11-year retrospective cohort study (2014-2024) at a tertiary hospital in Valencia, Spain. All pregnancies in women born in endemic countries were eligible. Two analyses were performed: (1) implementation of prenatal screening and factors associated with non-screening; and (2) maternal and neonatal outcomes according to maternal serological status. Multivariable logistic regression models with clustered robust standard errors were used to identify independent associations. RESULTS: Among 3,004 eligible pregnancies, 2,460 (81.9%) underwent prenatal screening and 70 (2.8%) were seropositive; most seropositive women were born in Bolivia (95%). Screening uptake increased over time (adjusted OR per calendar year 1.09, 95% CI 1.04-1.14). Increasing maternal age was associated with lower screening probability (aOR 0.97 per year, 95% CI 0.96-0.99), which also varied according to country of origin. Of the 70 seropositive pregnancies identified through prenatal screening, 62 had available delivery data and were included in the maternal and neonatal outcomes analysis, together with 2,080 seronegative pregnancies. An independent association was observed between maternal seropositivity and gestational complications (aOR 1.84, 95% CI 1.03-3.24), maternal age (aOR 1.11 per year, 95% CI 1.05-1.16), autoimmune disease (aOR 9.71, 95% CI 2.33-33.07), hepatitis B infection (aOR 11.31, 95% CI 3.02-37.63), previous ectopic pregnancy (aOR 5.73, 95% CI 1.09-21.73), and higher neonatal birthweight percentile (aOR 1.02 per unit, 95% CI 1.01-1.03). One case of congenital infection was identified (1.8%) CONCLUSIONS: Prenatal screening for T. cruzi infection achieved high and progressively increasing coverage in a non-endemic European setting. Maternal seropositivity was associated with gestational complications and specific maternal health factors, suggesting that the clinical impact of chronic infection during pregnancy may extend beyond congenital transmission.