If a woman contracts toxoplasmosis during pregnancy, there is a possibility that her unborn child will be infected. Unborn children of women who have contracted toxoplasmosis prior to pregnancy are usually not at risk. According to OTIS (OTIS, 2002 ), "Congenital toxoplasmosis only occurs when the mother has an active infection during pregnancy. In general, there is no increased risk to the fetus when toxoplasmosis occurs more than 6 months prior to conception. If you had toxoplasmosis in the past, you are usually immune, and the fetus is not at risk."
The Organization of Teratology Information Services (OTIS, 2002 ) has stated, "In about 40% of the cases in which a pregnant woman has toxoplasmosis, the baby is also infected. Infants who become infected during pregnancy are said to have 'congenital toxoplasmosis' infection. In the United Sates, 1 to 2 per 1000 babies that are born each year have toxoplasmosis." According to the March of Dimes (MOD 2001), About one in 10 infected babies has a severe Toxoplasma infection evident at birth. These newborns often have eye infections, an enlarged liver and spleen, jaundice (yellowing of the skin and eyes), and pneumonia. Some die within a few days of birth. Those who survive can have mental retardation, severely impaired eyesight, cerebral palsy, seizures and other problems. Although up to 90 percent of infected babies appear normal at birth, between 55 and 85 percent of them develop problems months to years later, including eye infections that may affect sight, hearing loss and learning disabilities. Toxoplasmosis during pregnancy also can result in miscarriage or stillbirth.
Toxoplasmosis prevention
To prevent toxoplasmosis, the March of Dimes suggests that pregnant woman take the following precautions:
Don't empty the cat's litter box. Have someone else do this.
Don't feed the cat raw or undercooked meats.
Keep the cat indoors to prevent it from hunting birds or rodents.
Don't eat raw or undercooked meat, especially lamb or pork. Meat should be cooked to an internal temperature of 160F throughout.
If you handle raw meat, wash your hands immediately with soap. Never touch your eyes, nose or mouth with potentially contaminated hands.
Wash all raw fruits and vegetables before you eat them.
Wear gloves when gardening, since outdoor soil may contain the parasite from cats. Keep your hands away from your mouth and eyes, and wash your hands thoroughly when finished. Keep gloves away from food products.
Avoid children's sandboxes. Cats may use them as a litter box.
Diagnosis and Treatment
According to the March of Dimes,"If a health care provider suspects that a pregnant woman has an active Toxoplamsa infection, he or she may recommend one or more of several available blood tests. These tests require expert interpretation and, therefore, the Centers for Disease Control and Prevention recommends that all positive test results be confirmed by a Toxoplasma reference laboratory (one with special expertise in diagnosing this disorder)".
If the reference laboratory confirms that a pregnant woman has an active infection, the next step is to determine whether the fetus is infected. Prenatal tests including amniocentesis and ultrasound may help to determine whether the fetus is infected. Fetuses suspected of being infected are treated by giving the mother pyrimethamine and sulfadiazine. This approach appears to reduce the frequency and severity of the newborn's symptoms. Time is of the essence and the earlier the treatment of the mother, the less likely her baby is to have symptoms.
If tests show that the fetus is not yet infected, the mother may be given an antibiotic called spiramycin. Some studies suggest that spiramycin can reduce by about 50 percent the likelihood of the fetus becoming infected. Although spiramycin has not yet been approved for use in this country by the Food and Drug Administration (FDA), and is therefore considered an experimental drug, it can be obtained from the FDA. Physicians who are interested in obtaining the drug can contact the FDA at 301/827-2335.
