Late Pregnancy Concerns: Toxoplasmosis Testing and Risks Explained

Late pregnancy

Hello, doctor.
I am currently 33 weeks pregnant.
I previously tested negative for Toxoplasma gondii.
I usually avoid eating raw food, but occasionally I handle raw meat and vegetables, and I eat out frequently.
I have two turtles at home, but I don't take care of them, and I don't have any cats or dogs! I also went out for hot pot once, and I would like to know if it is necessary to retest for Toxoplasma in the late stages of pregnancy.
If I were to get infected in the later stages, what impact would it have on the fetus? Is there medication available for treatment? If I were to contract Toxoplasmosis during breastfeeding, would it transmit to the baby? Is there a treatment for that as well?

adj, 20~29 year old female. Ask Date: 2017/10/16

Dr. Huang Jianzhong reply Obstetrics and Gynecology

At 33 weeks pregnant, I previously tested negative for Toxoplasma.
I usually avoid eating raw food, but occasionally handle raw meat and vegetables, and I eat out frequently.
I have two turtles at home, but I don't take care of them, and I don't have cats or dogs! Later, I went out for hot pot, and I want to know if it's necessary to test for Toxoplasma again in the late stages of pregnancy.
If infected in the later stages, what impact could it have on the fetus? Is there medication available for treatment? If I get infected with Toxoplasma during breastfeeding, can it be transmitted to the baby? Is there a treatment for that?
Answer: The most common routes of Toxoplasma infection in humans are threefold.
The most frequent source is undercooked meat, which may contain tissue cysts harboring Toxoplasma bradyzoites.
These tissue cysts can be found in approximately 8% of beef, 20% of pork, and 20% of lamb.
Direct ingestion of infectious oocysts is a less common mode of transmission, and direct contact with cats is unlikely to result in transmission.
If a pregnant woman is infected with Toxoplasma for the first time during pregnancy, it may be transmitted to the fetus via the placenta.
The primary risks of Toxoplasma infection during pregnancy include consuming undercooked meats, contact with soil, and eating raw or unwashed vegetables.
Screening for Toxoplasma antibodies at various stages of pregnancy can help diagnose new infections; however, the false positive rate for IgM antibody testing and the low prevalence of Toxoplasma have raised questions about the utility of such screening, which is not recommended in the United States.
Congenital Toxoplasmosis is extremely rare, with approximately 3,000 newborns affected each year in the U.S.
Since adult Toxoplasma infections are often asymptomatic, only pregnant women without Toxoplasma antibodies are at risk for primary infection.
Even with a first-time infection, not all pregnant women will transmit the infection to the fetus.
The infection rate increases as pregnancy progresses, with rates of 15% in the first trimester, 30% in the second trimester, and 60% in the third trimester.
However, the rate of congenital anomalies due to infection is higher in the earlier stages of pregnancy.

Reply Date: 2017/10/16

More Info

During pregnancy, particularly in the later stages, concerns about infections such as toxoplasmosis become increasingly relevant. Toxoplasmosis is caused by the parasite Toxoplasma gondii, which can be transmitted through various means, including undercooked meat, contaminated water, and exposure to cat feces. Given your situation, let's address your questions regarding testing, risks, and treatment options.

Testing for Toxoplasmosis
Since you mentioned that you have previously tested negative for toxoplasmosis, it is generally not necessary to retest unless you have had potential exposure to the parasite. However, if you have engaged in activities that could increase your risk—such as handling raw meat or if you have had any symptoms suggestive of infection—it may be prudent to discuss with your healthcare provider whether a repeat test is warranted.

Risks of Toxoplasmosis Infection During Pregnancy
If a pregnant woman contracts toxoplasmosis, especially during the first trimester, there is a risk of transmission to the fetus. The potential consequences can be severe, including:
- Congenital Toxoplasmosis: This can lead to serious health issues in the baby, such as vision problems, hearing loss, and developmental delays. The severity of the effects often depends on the timing of the infection during pregnancy; infections in the first trimester are typically more severe than those later on.

- Neurological Issues: In some cases, the infection can lead to neurological problems, including seizures and other developmental disorders.

Treatment Options
If you suspect that you may have been exposed to Toxoplasma gondii or if you develop symptoms (such as flu-like symptoms, swollen lymph nodes, or muscle aches), it is crucial to contact your healthcare provider. They may recommend serological testing to check for antibodies against the parasite. If you test positive for an active infection, treatment typically involves the use of medications such as pyrimethamine and sulfadiazine, which can help manage the infection and reduce the risk of transmission to the fetus.

Breastfeeding and Toxoplasmosis
Regarding breastfeeding, if a mother is infected with toxoplasmosis, the parasite is not transmitted through breast milk. However, it is still essential to maintain good hygiene practices while handling food and caring for pets to minimize any risk of infection. If you are concerned about potential infection during breastfeeding, consult your healthcare provider for personalized advice.

Conclusion
In summary, while your previous negative test results for toxoplasmosis are reassuring, it is essential to remain vigilant about potential exposures, especially as you approach the later stages of your pregnancy. If you have any concerns or experience any symptoms, do not hesitate to reach out to your healthcare provider for further evaluation and guidance. Maintaining good hygiene practices, particularly when handling food, will also help mitigate the risk of infection. Your health and the health of your baby are paramount, so staying informed and proactive is key.

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