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Toxoplasmosis in Pregnancy – Risks and Treatment

Toxoplasmosis in pregnancy is an infection caused by the parasite Toxoplasma gondii that can pose serious risks to the unborn child. Early diagnosis and treatment are essential.

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Things worth knowing about "Toxoplasmosis in Pregnancy"

Toxoplasmosis in pregnancy is an infection caused by the parasite Toxoplasma gondii that can pose serious risks to the unborn child. Early diagnosis and treatment are essential.

What is Toxoplasmosis in Pregnancy?

Toxoplasmosis is an infectious disease caused by the parasite Toxoplasma gondii. While the infection is usually harmless in healthy adults, it can have serious consequences for the unborn child when contracted during pregnancy. A primary infection during pregnancy carries the risk that the pathogen is transmitted through the placenta to the baby – this is known as congenital toxoplasmosis.

Causes and Routes of Transmission

The pathogen Toxoplasma gondii is found worldwide. The main routes of transmission for pregnant women include:

Raw or undercooked meat (especially lamb, pork, and game) containing tissue cysts
Contact with cat feces, as cats are the only definitive hosts in which the parasite fully develops and sheds oocysts
Unwashed fruits and vegetables that have come into contact with contaminated soil
Contaminated water or soil when gardening without protective gloves

Symptoms in the Mother

In immunocompetent pregnant women, toxoplasmosis is asymptomatic or presents with very mild, flu-like symptoms in approximately 80–90% of cases:

Mild fatigue and general malaise
Swollen lymph nodes, often in the neck area
Low-grade fever
Muscle and joint pain

Because the symptoms are non-specific, the infection in the mother often goes unnoticed.

Risks to the Unborn Child

The risk of transmission to the child and the severity of harm depend strongly on the timing of the infection during pregnancy:

First trimester: The transmission risk is low (approx. 10–15%), but the consequences for the child are most severe – potentially including miscarriage or serious organ damage.
Second trimester: Moderate transmission risk (approx. 25–30%), with moderate to severe damage possible.
Third trimester: High transmission risk (approx. 60–70%), but the disease in the child is often milder or initially asymptomatic.

Possible consequences for the child include hydrocephalus (fluid on the brain), intracranial calcifications, eye damage (chorioretinitis), developmental delays, and neurological impairments.

Diagnosis

Diagnosis of toxoplasmosis in pregnancy is made through blood tests measuring specific antibodies (IgG and IgM) against Toxoplasma gondii:

IgM antibodies indicate a recent or current infection.
IgG antibodies indicate a past infection and generally reflect immunity.
In unclear cases, an avidity test can help determine the approximate timing of the infection.

If fetal involvement is suspected, an amniocentesis (analysis of amniotic fluid using PCR) can be performed to directly detect the pathogen. Ultrasound examinations are also used to identify potential fetal abnormalities.

Treatment

If an acute toxoplasmosis infection is detected during pregnancy, treatment with antibiotics is initiated to reduce the risk of transmission to the child and minimize potential damage:

Spiramycin: This antibiotic is used in early pregnancy before fetal involvement has been confirmed. It accumulates in the placenta and aims to prevent transmission to the child.
Pyrimethamine + Sulfadiazine + Folinic acid: This combination is used from the second trimester onward when fetal infection is confirmed or likely. Folinic acid is given alongside to reduce side effects.

Treatment should always be managed in close consultation with a specialized physician.

Prevention

Since there is no approved vaccine against toxoplasmosis, prevention through hygiene measures is particularly important:

Cook meat thoroughly (core temperature above 66 °C / 150 °F)
Wash fruits and vegetables thoroughly
Avoid contact with cat feces – have someone else change the cat litter
Wear gloves when gardening
Wash hands thoroughly after handling raw meat, soil, or animals

References

Robert Koch-Institut (RKI): Toxoplasmose – RKI-Ratgeber. Available at: https://www.rki.de (2023)
World Health Organization (WHO): Toxoplasmosis fact sheet. Available at: https://www.who.int
Montoya J.G., Liesenfeld O.: Toxoplasmosis. The Lancet, 2004; 363(9425): 1965–1976.

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