Editing Toxoplasmosis (section)

=== Pregnancy precautions ===
[[Congenital]] toxoplasmosis is a specific form of toxoplasmosis in which an unborn fetus is infected via the [[placenta]].<ref name="Sterkers_2011">{{cite journal |vauthors=Sterkers Y, Ribot J, Albaba S, Issert E, Bastien P, Pratlong F | title = Diagnosis of congenital toxoplasmosis by polymerase chain reaction on neonatal peripheral blood | journal = Diagnostic Microbiology and Infectious Disease | volume = 71 | issue = 2 | pages = 174–6 | year = 2011 | pmid = 21856107 | doi = 10.1016/j.diagmicrobio.2011.06.006 }}</ref> Congenital toxoplasmosis is associated with fetal death and miscarriage, and in infants, it is associated with hydrocephalus, cerebral calcifications and [[chorioretinitis]], leading to encephalopathy and possibly blindness.<ref name="TorgersonMastroiacovo2013"/> If a woman receives her first exposure to ''T.&nbsp;gondii'' while pregnant, the fetus is at particular risk.<ref name="TorgersonMastroiacovo2013" /> A simple blood draw at the first prenatal doctor visit can determine whether or not a woman has had previous exposure and therefore whether or not she is at risk. A positive antibody [[titer]] indicates previous exposure and immunity, and largely ensures the unborn fetus' safety.

Not much evidence exists around the effect of education before pregnancy to prevent congenital toxoplasmosis.<ref name=Di2015>{{cite journal |last1=Di Mario |first1=Simona |last2=Basevi |first2=Vittorio |last3=Gagliotti |first3=Carlo |last4=Spettoli |first4=Daniela |last5=Gori |first5=Gianfranco |last6=D'Amico |first6=Roberto |last7=Magrini |first7=Nicola |title=Prenatal education for congenital toxoplasmosis |journal=Cochrane Database of Systematic Reviews |date=23 October 2015 |volume=2015 |issue=10 |pages=CD006171 |doi=10.1002/14651858.CD006171.pub4 |pmid=26493047 |pmc=9272404 }}</ref> However educating parents before the baby is born has been suggested to be effective because it may improve food, personal and pet hygiene.<ref name=Di2015/> More research is needed to find whether antenatal education can reduce congenital toxoplasmosis.<ref name=Di2015/>

For pregnant women with negative antibody titers, indicating no previous exposure to ''T.&nbsp;gondii'', serology testing as frequent as monthly is advisable as treatment during pregnancy for those women exposed to ''T.&nbsp;gondii'' for the first time dramatically decreases the risk of passing the parasite to the fetus. Since a baby's immune system does not develop fully for the first year of life, and the resilient cysts that form throughout the body are very difficult to eradicate with antiprotozoans, an infection can be very serious in the young.{{citation needed|date=January 2021}}

Despite these risks, pregnant women are not routinely screened for toxoplasmosis in most countries, for reasons of cost-effectiveness and the high number of [[false positives]] generated; [[Portugal]],<ref name=Circular_DGS>{{cite web|url=http://www.srsdocs.com/parcerias/normas/circulares/dgs/2006/cuidados_pre_concepcionais.pdf |title=Circular Normativa sobre Cuidados Pré-Concepcionais – Direcção-Geral de Saúde |url-status=dead |archive-url=https://web.archive.org/web/20110716124341/http://www.srsdocs.com/parcerias/normas/circulares/dgs/2006/cuidados_pre_concepcionais.pdf |archive-date=2011-07-16 }}</ref> [[France]],<ref name=Sukthana_2006>{{cite journal | author = Sukthana Y | title = Toxoplasmosis: beyond animals to humans | journal = Trends in Parasitology | volume = 22 | issue = 3 | pages = 137–42 | date = March 2006 | pmid = 16446116 | doi = 10.1016/j.pt.2006.01.007 }}</ref> [[Austria]],<ref name=Sukthana_2006 /> [[Uruguay]],<ref name="elpais">[http://participacion.elpais.com.uy/lasalud/2008/05/20/los-gatos-domesticos-transmiten-toxoplasmosis/] {{webarchive|url=https://web.archive.org/web/20110824023934/http://participacion.elpais.com.uy/lasalud/2008/05/20/los-gatos-domesticos-transmiten-toxoplasmosis/|date=August 24, 2011}}</ref> and [[Italy]]<ref name="Paschale_2008">{{cite journal |vauthors=De Paschale M, Agrappi C, Clerici P, Mirri P, Manco MT, Cavallari S, Viganò EF | title = Seroprevalence and incidence of ''Toxoplasma gondii'' infection in the Legnano area of Italy | journal = Clinical Microbiology and Infection | volume = 14 | issue = 2 | pages = 186–9 | year = 2008 | pmid = 18034857 | doi = 10.1111/j.1469-0691.2007.01883.x | doi-access = free }}</ref> are notable exceptions, and some regional screening programmes operate in [[Germany]], [[Switzerland]] and [[Belgium]].<ref name=Paschale_2008/> As invasive [[prenatal]] testing incurs some risk to the [[fetus]] (18.5 pregnancy losses per toxoplasmosis case prevented),<ref name=Sukthana_2006/> [[postnatal]] or [[neonatal]] screening is preferred. The exceptions are cases where [[fetal]] abnormalities are noted, and thus screening can be targeted.<ref name=Sukthana_2006/>

Pregnant women should avoid handling [[raw meat]], drinking [[raw milk]] (especially goat milk) and be advised to not eat raw or undercooked meat regardless of type.<ref name="Kapperud_1996">{{cite journal |first1 = Georg|last1 = Kapperud|first2 = Pal A.|last2 = Jenum|first3 = Babill|last3 = Stray-Pedersen|first4 = Kjetil K.|last4 = Melby|first5 = Anne|last5 = Eskild|first6 = Jan|last6 = Eng | title = Risk factors for ''Toxoplasma gondii'' infection in pregnancy. Results of a prospective case-control study in Norway | journal = American Journal of Epidemiology | volume = 144 | issue = 4 | pages = 405–412 | year = 1996 | pmid = 8712198 | doi = 10.1093/oxfordjournals.aje.a008942 |doi-access = free}}</ref> Because of the obvious relationship between ''Toxoplasma'' and cats it is also often advised to avoid exposure to cat feces, and refrain from gardening (cat feces are common in garden soil) or at least wear gloves when so engaged.<ref name="Kapperud_1996"/> Most cats are not actively shedding [[oocyst]]s, since they get infected in the first six months of their life, when they shed oocysts for a short period of time (1–2 weeks).<ref name="Hill_2002">{{cite journal |vauthors=Hill D, Dubey JP | title = ''Toxoplasma gondii'': transmission, diagnosis and prevention | journal = Clinical Microbiology and Infection | volume = 8 | issue = 10 | pages = 634–40 | year = 2002 | pmid = 12390281 | doi = 10.1046/j.1469-0691.2002.00485.x | doi-access = free }}</ref> However, these oocysts get buried in the soil, sporulate and remain infectious for periods ranging from several months to more than a year.<ref name="Kapperud_1996"/> Numerous studies have shown living in a household with a cat is not a significant risk factor for ''T.&nbsp;gondii'' infection,<ref name="Kapperud_1996"/><ref name=Cook_2000>{{cite journal |vauthors=Cook AJ, Gilbert RE, Buffolano W, Zufferey J, Petersen E, Jenum PA, Foulon W, Semprini AE, Dunn DT | title = Sources of toxoplasma infection in pregnant women: European multicentre case-control study. European Research Network on Congenital Toxoplasmosis | journal = BMJ | volume = 321 | issue = 7254 | pages = 142–7 | date = Jul 15, 2000 | pmid = 10894691 | pmc = 27431 | doi = 10.1136/bmj.321.7254.142 }}</ref><ref name=Bobic1998>{{cite journal |vauthors=Bobić B, Jevremović I, Marinković J, Sibalić D, Djurković-Djaković O | title = Risk factors for ''Toxoplasma'' infection in a reproductive age female population in the area of Belgrade, Yugoslavia | journal = European Journal of Epidemiology | volume = 14 | issue = 6 | pages = 605–10 | date = September 1998 | pmid = 9794128 | doi = 10.1023/A:1007461225944 | s2cid = 9423818 }}</ref> though living with several kittens has some significance.<ref>{{cite journal |vauthors=Jones JL, Dargelas V, Roberts J, Press C, Remington JS, Montoya JG | title = Risk Factors forToxoplasma gondiiInfection in the United States | journal = Clinical Infectious Diseases | volume = 49 | issue = 6 | pages = 878–884 | year = 2009 | pmid = 19663709 | doi = 10.1086/605433 | doi-access = free }}</ref>

In 2006, a Czech research team<ref name="pmid17028886">{{cite journal |vauthors=Kanková S, Sulc J, Nouzová K, Fajfrlík K, Frynta D, Flegr J | title = Women infected with parasite ''Toxoplasma'' have more sons | journal = Die Naturwissenschaften | volume = 94 | issue = 2 | pages = 122–7 | year = 2007 | pmid = 17028886 | doi = 10.1007/s00114-006-0166-2 | bibcode = 2007NW.....94..122K | s2cid = 9610443 }}</ref> discovered women with high levels of toxoplasmosis antibodies were significantly more likely to give birth to baby boys than baby girls. In most populations, the birth rate is around 51% boys, but people infected with ''T.&nbsp;gondii'' had up to a 72% chance of a boy.<ref>{{cite news |last1=Sample |first1=Ian |title=Pregnant women infected by cat parasite more likely to give birth to boys, say researchers |url=https://www.theguardian.com/science/2006/oct/12/uk.health |work=The Guardian |date=12 October 2006 }}</ref>