What are the other Names for this Condition? (Also known as/Synonyms)

• Infection by Toxoplasma Gondii during Pregnancy
• Pregnancy and Toxoplasma Gondii Infection
• Toxoplasmosis and Pregnancy

What is Toxoplasmosis during Pregnancy? (Definition/Background Information)

• Infection by Toxoplasma gondii, which is a common microorganism (classified as protozoa), causes toxoplasmosis. This condition is generally caused by consuming meat that is contaminated by the parasitic microorganism. The contamination can occur even during the cooking or preparation stage
• Cats are host to the microorganism; cat feces are a possible source of the protozoa. An accidental ingestion of the same, can also cause toxoplasmosis
• Women, who are exposed to the protozoa, during or just before pregnancy, may pass on the infection to the baby in the womb. This causes congenital toxoplasmosis, a condition that can lead to serious complications, congenital defects, and spontaneous abortion (in some cases)
• This infection normally does not affect an individual with healthy immune system. However, pregnant women and those suffering from various immunodeficiencies may be severely affected. In such individuals, complications can arise, which can lead to life-threatening situations
• Treatment measures of toxoplasmosis include prescription oral medications, controlling related symptoms (such as fever, body pain), and taking plenty of rest
• The prognosis of toxoplasmosis is dependent upon the health status of an individual; in women with poor immune system, the prognosis is guarded
• Adequate preventive steps for toxoplasmosis may include consuming well-cooked meat and drinking clean water, and toxoplasmosis screening for women in the period immediately following a pregnancy. This may reduce incidence of the condition and stop its transmission

Who gets Toxoplasmosis during Pregnancy? (Age and Sex Distribution)

• According to CDC (US, Centers for Disease Control and Prevention) statistics, only around 15% of women in their reproductive phase, are immune to toxoplasmosis infection
• A (recently infected) pregnant woman can infect the baby in the womb through the placenta. This transplacental vertical infection from mother to the developing fetus can cause damaging affects in the unborn child
• Toxoplasmosis is very common in parts of Europe, South America, Asia, and Africa - regions with hot-humid climate. A majority of the human population carry this parasite in a latent state, within their body

What are the Risk Factors for Toxoplasmosis during Pregnancy? (Predisposing Factors)

The risk factors of Toxoplasmosis during Pregnancy include:

• Consuming meat (beef, lamb, pork, and venison) that is partially-cooked, or cooked improperly (without maintaining proper hygienic standards, like using contaminated vessels, knives)
• Inadvertently touching one’s face, mouth, while handling contaminated raw meat; not following safe meat preparation procedures
• Eating raw vegetables and fruits, without washing or cleaning them
• Drinking untreated water from a stream or a well, or from any such source that is contaminated
• Direct exposure to cat feces, or to soil contaminated by the feces
• Living in crowded neighborhoods and/or travelling to areas with poor sanitation facilities
• Eating food that is mass-prepared (using contaminated meat) without proper quality control
• Women with weak immunity constitution (caused by factors like AIDS/HIV, cancer, organ transplant, diabetes, and so on) have a significantly increased risk of Toxoplasmosis
• Women working at high-risk zones, such as meat processing/packing plants, pet stores, zoos, and veterinary hospitals, are prone to toxoplasmosis infection to a higher degree

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Toxoplasmosis during Pregnancy? (Etiology)

During pregnancy, toxoplasmosis infection may be caused by:

• Consuming undercooked or improperly cooked meat, including handling raw meat, using kitchen items contaminated by raw meat, or taking unclean water, is the primary cause of Toxoplasmosis. The protozoa Toxoplasma gondii (an unicellular organism) is responsible for the infection
• Cats (even pets) act as a primary host to the microorganism. Individuals handling cat feces (including feces-infected soil), cleaning their resting area/shelter box, etc. have to be extremely careful, since an accidental ingestion of the contaminant will cause an infection
• Infected garden soils (with cat feces), where plants/vegetables/fruits are home-grown, may also serve as transmission agents. Eating raw fruits and vegetables, without cleaning or washing them, can also cause toxoplasmosis
• Congenital transmission of the infection can take place from a mother to the infant child, in the womb (known as vertical transplacental transmission of infection)
• There are also some rare instances, when the parasitic infection is passed on, via a blood transfusion or from an infected organ donor, during an organ transplant

What are the Signs and Symptoms of Toxoplasmosis during Pregnancy?

The onset of signs and symptoms of toxoplasmosis, which occur within 10-14 days after being infected with the parasitic organism, depend on the health condition of the individual affected and the severity of the infection. These are categorized as:

• Normal, healthy women usually do not exhibit any signs of the infection, but act as a carrier of the protozoa. This condition is referred to as latent toxoplasmosis. If any signs and symptoms are exhibited, they are mild and these may include:
  • Fever
  • Headaches, body aches
  • Enlarged lymph nodes
  • Sore throat (sometimes)
• In case of acute toxoplasmosis, some individuals may have flu-like symptoms, with muscle aches and body aches, swollen lymph nodes, which subside after 1-2 months
• Infrequently, itchy eruptions on the skin with formation of nodules or lesions are observed. This condition is referred to as cutaneous toxoplasmosis
• Growth abnormalities in the fetal stage and congenital defects (after birth) may be noted, if there is an Infection by Toxoplasma gondii during Pregnancy

Pregnant women with weak immune systems may be severely affected and suffer damage to the eyes, brain, lungs, and other vital organs. In such cases, either the parasite (which the individual carried) gets reactivated due to favorable conditions, or a recent infection might have occurred. The signs and symptoms in such cases may include:

• Reduced vision or blurred vision, vision impairment, sensitivity to light, eye pain, redness of the eyes
• Anxiety, confusion, lack of coherent (focused) behavior, even seizures
• Fever and headaches

How is Toxoplasmosis during Pregnancy Diagnosed?

Some healthcare providers conduct toxoplasmosis screening for women in the period immediately following a pregnancy (during the first few visits). However, if any associated signs and symptoms are observed, and/or if the individual has a weak immune system, then screening becomes essential. A prompt diagnosis of toxoplasmosis is vital to protect the unborn child and the mother.

The exams and tests that could be conducted to diagnose toxoplasmosis include:

• Physical exam and evaluation of medical history
• Blood samples are examined, to detect the presence of the IgG and IgM antibodies against the microorganism. This blood test may be repeated after an interval of time, to determine the status of infection. Some other blood tests include:
  • Polymerase chain reaction (PCR)
  • ELISA test for toxoplasma
  • Sabin-Feldman dye test
• Cordocentesis: A test to check, if toxoplasmosis infection occurred during pregnancy
• Testing of amniotic fluid and blood of the fetus
• Abdominal ultrasound scan

In case an infection is suspected, then the following tests may be performed on the individual:

• Biopsy of the brain: The biopsy is examined under a microscope by the pathologist, to arrive at a definitive diagnosis. Usually, brain biopsies are avoided, as far as possible during pregnancy
• CT scan of head
• MRI scan of the brain
• Eye examination using a slit-lamp

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Toxoplasmosis during Pregnancy?

A few complications associated with Toxoplasmosis during Pregnancy are:

• The fetus could be infected via the placenta and it may develop growth abnormalities and mental disorders. Owing to this, miscarriage, stillbirth, or death of the infant following its birth, are other severe complications of toxoplasmosis
• Individuals with weak immune systems can be ‘severely-to-fatally’ affected, with the infection spreading all over the body
• Toxoplasmosis during Pregnancy could affect the brain and cause behavioral changes

How is Toxoplasmosis during Pregnancy Treated?

• Toxoplasmosis during Pregnancy requires prompt and early treatment with antibiotic medication, to prevent spread of infection to the fetus. The fetus is also periodically checked using diagnostic imaging (ultrasound) tools, for any defects
• Most cases of toxoplasmosis are self-limiting, meaning that a healthy individual usually recovers from the condition in a few weeks. In such cases, no treatment is usually required, or the condition may be treated symptomatically by the physician, as required
• Prolonged treatment with antibiotics and even antimalarial drugs, may be required for immunocompromised individuals, who are infected by the toxoplasmosis parasite

How can Toxoplasmosis during Pregnancy be Prevented?

The likelihood of the fetus being affected is significant, if toxoplasmosis infection in mother is contracted prior to or during the period following pregnancy (in the 1st trimester). Infection of fetus during first trimester can lead to severe organ damage, because the main organs in fetus start forming during this period.

The transmission of infection from mother to child is the highest during the 3rd trimester. However, since vital organs have already formed and considerable fetal development taken place by then, the risk to major organs in the fetus is minimized.

The following measures to prevent Toxoplasmosis during Pregnancy are recommended for pregnant women and for those, who are planning and/or preparing for a pregnancy:

• To reduce the incidence of Toxoplasmosis, proper precautions have to be taken to prevent transmission of the harmful protozoa, via food and water. This has to be considered even while traveling to other countries and cities
• Avoid undercooked food (mainly meat) and contaminated water; always drink water that is clean and from a reliable source
• Follow basic rules while cooking and consuming food, such as:
  • Carefully washing food items (like meat and vegetables)
  • Washing food vessels, cutting boards, etc. before use
  • Cooking meat to the required temperatures to kill any microorganisms
  • Keeping food items covered and stored properly
  • Washing hands before eating, and/or immediately after handling raw meat
• Sample tasting of meat, while it is being cooked (or while still undercooked) is to be avoided
• Fruits and vegetables have to be washed and cleaned well, particularly if they are to be consumed raw
• Completely avoid handling cat feces and cleaning cat litter boxes. Nevertheless, do ensure that the litter boxes are cleaned regularly (by others)
• Garden soil may be contaminated with Toxoplasma found in cat feces - ensure that you wash your hands thoroughly with soap and water after being in contact with the soil (due to activities such as gardening or backyard cleaning)
• If you belong to any of the high-risk groups such as working at a vet clinic, a pet store, or having a weak immune system; then, do ensure that you take adequate safety precautions while handling cats (or other pets), also avoid touching or playing with stray cats

What is the Prognosis of Toxoplasmosis during Pregnancy? (Outcomes/Resolutions)

• Prompt treatment of Toxoplasmosis during Pregnancy is necessary, if pregnant women are infected, especially during the first trimester. An infection of toxoplasmosis during weeks 10-24, poses a maximum threat of the fetus being born with congenital defects
• A healthy pregnant woman usually recovers from toxoplasmosis within a few days, even if no treatment is given and only certain basic self-care steps are followed (like drinking enough fluids, getting adequate rest). Nevertheless, during pregnancy, the fetus has to be constantly monitored for any abnormalities or infection
• Infected pregnant women may suffer a miscarriage, or the child may be stillborn, or die after birth, if the condition is serious, left untreated, or if it remains undetected. Hence, Toxoplasmosis during Pregnancy is a serious situation and requires close medical attention and monitor

Additional and Relevant Useful Information for Toxoplasmosis during Pregnancy:

• It is best not to get pregnant if you have had a recent infection of toxoplasmosis. It is advisable to consult your gynecologist to plan your child, in such cases
• Individuals with weak immune systems should wait for a period of time and recover completely from their illness, before planning for a child
• The prevention and treatment of Toxoplasmosis during Pregnancy can be accomplished to a good extent through mass-education. This should include providing information on proper hygiene, maintaining good food preparation practices, and following outlined preventive measures (mentioned above)
• The microorganism Toxoplasma gondii is also said to be associated with an individual’s psychological wellness. It can also cause behavioral problems, like schizophrenia, depression, uneasiness, etc.