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Objective  To determine the association between congenital toxoplasmosis and preterm birth, low birthweight and small for gestational age birth.

Design  Multicentre prospective cohort study.

Setting  Ten European centres offering prenatal screening for toxoplasmosis.

Population  Deliveries after 23 weeks of gestation in 386 women with singleton pregnancies who seroconverted to toxoplasma infection before 20 weeks of gestation. Deliveries after 36 weeks in 234 women who seroconverted at 20 weeks or later, and tested positive before 37 weeks.

Methods  Comparison of infected and uninfected births, adjusted for parity and country of birth.

Main outcome measures  Differences in gestational age at birth, birthweight and birthweight centile.

Results  Infected babies were born or delivered earlier than uninfected babies: the mean difference for seroconverters before 20 weeks was −5.4 days (95% CI: −1.4, −9.4), and at 20 weeks or more, −2.6 days (95% CI: −0.5, −4.7). Congenital infection was associated with an increased risk of preterm delivery when seroconversion occurred before 20 weeks (OR 4.71; 95% CI: 2.03, 10.9). No significant differences were detected for birthweight or birthweight centile.

Conclusion  Babies with congenital toxoplasmosis were born earlier than uninfected babies but the mechanism leading to shorter length of gestation is unknown. Congenital infection could precipitate early delivery or prompt caesarean section or induction of delivery. We found no evidence for a significant association between congenital toxoplasmosis and reduced birthweight or small for gestational age birth.