Toxoplasmosis in Pregnancy: Causes, Symptoms & Risks
Toxoplasmosis is a rare parasitic infection. It can occur during pregnancy and can get transmitted to the unborn baby, causing serious health side effects. However, learning how to recognise the symptoms of an infection and getting timely tests can prevent this disease during pregnancy.
What Is Toxoplasmosis?
Toxoplasmosis is a parasitic infection caused by an organism called Toxoplasma gondii. The infection causes no obvious symptoms in adults with a healthy immune system, and it is estimated that up to half of the world’s population is infected with it at any given time (but show no symptoms.)
In cases that do become apparent, the patient experiences mild flu-like symptoms, tender or inflamed lymph nodes, muscle pains, and eye problems. Those with weakened immune systems, and pregnant women, are most prone to catching the infection. In the former, severe symptoms such as poor coordination, confusion, trouble breathing, and seizures may occur. In pregnant women, it could lead to a condition called congenital toxoplasmosis that may affect the baby.
You can come in contact with the parasite in various ways, including cat poop, undercooked infected meat, improperly washed utensils used to handle infected meat, and drinking contaminated water. The parasite spreads through its cysts that can exist dormant in the surroundings for many months until ingested. Toxoplasmosis can get transmitted from a pregnant mother to her baby, but doesn’t get transmitted from a person to person unless there is a case of blood transfusion or organ transplant involved.
How Common Is Toxoplasmosis in Pregnant Women?
Although toxoplasmosis spreads through contaminated meat and water, pet owners who own cats are at the greatest risk of an infection. If you have had cats for a long time, there’s a good chance your body is already immune to the parasite, but getting a new cat during pregnancy increases the risk.
Studies show that chances of toxoplasmosis in pregnancy are very low, and about one in 200 women get infected during that period generally, in developed countries. In India, however, there is no consensus regarding the rate of toxoplasmosis infections that occur during pregnancy.
What Are the Symptoms of Toxoplasmosis in Pregnancy?
In a large number of cases involving healthy adults with strong immunity, there may be no immediate visible symptoms of toxoplasmosis. But, if you have gotten infected, the signs would appear after two to three weeks and involve the following symptoms:
- A fever that’s over 100.4F
- Aching muscles
- General flu-like symptoms
- Swollen lymph nodes in the neck
What Causes Toxoplasmosis in Pregnant Women?
Toxoplasmosis infections occur when you unknowingly ingest the cysts of the infection causing parasite through food, water or even by practicing poor hygiene. It is estimated that half of these infections occur from eating raw or undercooked meat that is infected. Lamb, pork, and game meat can contain the parasite in their body in the form of tissue cysts that can be infectious if the meat is undercooked. The cysts can also make it into your body when you drink unpasteurized goat milk or cheese, eat unwashed fruits and vegetables, or when you touch your nose, mouth, or eyes after handling contaminated mediums such as soil, water, or cat litter.
Even though all warm-blooded animals can contain this parasite, cats are the major host of these disease causing agents. A pet cat owned by a pregnant woman can get infected with the parasite by eating an infected rodent or contaminated meat. The parasites reproduce in their intestines and form ‘oocysts’, which are excreted along with the feces. Kittens are most susceptible to this and can excrete millions of these oocysts over a period of three weeks, and in most cases, they show no sign of infection. The oocysts turn infectious after 24 hours and can remain infectious up to 18 months. They can contaminate water systems, fruit, vegetables, and meat in this period. Therefore, handling cat litter or gardening during pregnancy puts you at a high risk of an infection.
Treatment for Toxoplasmosis During pregnancy
Since toxoplasmosis doesn’t cause major problems to most people, there’s no treatment needed if the immune system of the person infected is healthy and strong. For pregnant women however, the chances of transferring the parasite to her baby are fairly high, therefore it is treated with antibiotics. In cases where the unborn baby shows no sign of the infection, the doctor might prescribe an antibiotic called Spiramycin. In cases where the baby is infected, the doctor may recommend sulfadiazine and pyrimethamine after the 16th week of pregnancy. Also, in cases where the amniotic fluid is infected and an ultrasound gives a confirmation of a problem, the mother can consult a specialist and also refer to a genetic counselor for further advice. Depending on the gestational age of the baby, termination of the pregnancy is also an option.
Risks and Health Complications Associated with Toxoplasmosis
Toxoplasmosis infection can be risky to the unborn child. The parasite can travel through the placenta and infect the baby causing a condition called congenital toxoplasmosis. Although it is a rare condition, the risk factor depends mainly on the stage/time at which the mother got infected during her pregnancy. The earlier the infection is contracted and caught , the more severe are its effects on the baby. Miscarriage and still birth are common after effects of congenital toxoplasmosis during early pregnancy as the critical developmental processes occur at this stage. An infection during the second trimester can lead to complications such as:
- Brain damage due to water in the brain (hydrocephalus)
- Damage to the eyes and other organs
Most babies that get infected later into the pregnancy are less affected because most of the critical organs have developed and show no obvious symptoms of the infection at birth. They may later develop the symptoms as they grow, and have problems such as:
- Learning difficulties due to brain damage
- Hearing problems
- Damage to the eyes
According to one study in India, about half of the untreated maternal infections are transmitted to the baby. Of those that are transmitted to the foetus, 60 percent do not show symptoms, 30 percent show severe damage, and 9 percent of them result in death.
Diagnosis of Toxoplasmosis
Since the risk of an infection is low, screening for toxoplasmosis is not routine in pregnancies, and there need to be enough symptoms for your doctor to suggest for a screening test. However, when needed, a blood test can detect the presence of an infection by the specific antibodies. The blood test needs to be done at least three weeks after an infection and the antibodies to appear.
If the test is negative:
- It could mean that there has never been a toxoplasmosis infection and you are not immune to it.
- A false negative; the infection has been so recent that it is yet to be detected as the body hasn’t produced antibodies to fight off the infection.
If the test is positive:
- A positive result shows that there has been an infection at sometime in the past and does not mean that there is an active infection. The time of the infection can be determined by the type of antibody present in the blood. There are two types of antibodies that the tests look for; IgG and IgM antibodies.
- IgG are long term antibodies and stay in the body for a lifetime to protect you from toxoplasmosis. Their presence indicates that there has been an infection in the past and you have immunity towards it. It also means that your baby will be safe from an infection during pregnancy.
- IgM antibodies are produced immediately after an infection and take a few months to disappear. Their presence indicates that there has been an infection recently or within the last year.
If there is a risk that you have been infected during pregnancy, further blood tests can determine how recent it through an IgM antibody count. Increasing levels of IgM antibodies show a recent infection that the body is currently fighting. Decreasing IgM antibodies show that the infection has just subsided. A stable IgM count suggests that you are immune to the infection.
Guidelines to Prevent Toxoplasmosis During Pregnancy
A few simple guidelines when followed can greatly reduce your chances of contracting a toxoplasmosis infection during your pregnancy. Some of them are as follows:
- Pay Attention to Personal Hygiene: Personal hygiene is the key to avoid all infections. Thoroughly wash your hands before preparing or handling food. The cooking utensils must be cleaned thoroughly as well.
- Check Meat Storage: Freezing meat for several days will lower the chances of infection.
- Ensure You Cook Your Meals Properly: Heat kills parasites and cysts, therefore it is important to cook meat well to eliminate the chances of an infection.
- Avoid Certain Types of Poultry: Avoid smoked or salt-cured meats such as salami and Parma ham unless they are steamed well.
- Check Milk Before Consumption: Do not drink unpasteurized goat milk or consume products made from it.
- Be Careful While Cooking Meat: While handling meat, avoid touching your eyes, nose, or mouth. Wear gloves if possible, to protect any cuts on sores on the hands.
- Wash Your Utensils: Keep the cooking counter, utensils, and other food handling equipment clean by washing them with hot soapy water.
- Avoid Cleaning Cat Feces: If you have a cat, avoid cleaning its litter box, and let another family members do it.
- Avoid Getting a New Kitty Home: Do not adopt a new kitten during pregnancy, as kittens pass the oocysts in the first 6 months of their life
- Wear Proper Protective Gear: If you do need to clean up cat litter, wear tough gloves, and wash your hands thoroughly afterwards.
1. Will toxoplasmosis harm your baby in womb?
Yes. The parasite can cause congenital toxoplasmosis and impair the foetus’s development early on during the pregnancy, which can result in miscarriages or stillbirth. Signs such as fluid buildup in the brain indicate damage due to the infection, and cause mental and motor developmental delays in the baby once it grows up. It can also affect other organs and lead to cerebral palsy and epilepsy.
2. Can women breastfeed when having toxoplasmosis?
Yes. Women can breastfeed while having an infection, as the possibility of the transmission of the infection is unlikely through breast milk.