Toxoplasmosis in Pregnancy: Practical Everyday Precautions

The blood test result arrives: “toxoplasmosis: not immune”. And with it, a list of forbidden foods that makes you feel you will have to watch every mouthful for nine months. Toxoplasmosis in pregnancy deserves attention, not fear: the habits that protect you are simple, and they soon become second nature.

Here is what your blood test really says, what is known about the risk to your baby, and how to adapt the precautions to everyday life in Morocco, from the market to the kitchen, and the family cat too.

What is toxoplasmosis?

It is an infection caused by a microscopic parasite, Toxoplasma gondii. Its main host is the cat, which sheds the parasite’s eggs in its droppings for up to two weeks after being infected. These eggs can then survive for more than a year in soil.

You can catch it in three ways:

• by eating raw or undercooked meat, especially lamb or pork;
• by swallowing contaminated soil, from poorly washed fruit, vegetables or herbs, or dirty hands after gardening;
• through contact with cat droppings, in a litter tray or in sand.

In a healthy adult, the infection usually goes unnoticed. Sometimes it looks like a mild flu: tiredness, headache, aches, slight fever, swollen glands. It clears up on its own, and you are then protected for life.

Toxoplasmosis blood test: immune or not?

The blood test (serology) looks for antibodies against the parasite. Depending on the country and the doctor, it is part of the early pregnancy check-up, and it determines what happens next.

The laboratory distinguishes two families of antibodies: IgM, which appear first and may signal a recent infection, and IgG, which appear a few weeks after infection and stay for life. IgG alone, without IgM, generally indicates a past infection. A doubtful result is always checked.

Countries do not all make the same choice about screening. France tests early in pregnancy and then, if the mother-to-be is not immune, repeats the test regularly to catch any infection as early as possible. The UK and the US do not offer it routinely: the disease is less common there, and British authorities consider the evidence insufficient. In Morocco, ask your doctor whether your check-up includes the test and how often they want to repeat it.

What are the risks for the baby?

The danger comes from a first infection during pregnancy. A woman who is already immune almost never passes the parasite on to her baby.

Even with an infection during pregnancy, transmission is not automatic: according to a British medical reference, it occurs in about a quarter of cases (26%). The risk changes with the stage of pregnancy, in the opposite direction to severity:

• early in pregnancy, the parasite crosses the placenta less often, but the consequences can be severe, particularly in the first ten weeks (see how to count your weeks of pregnancy);
• late in pregnancy, it crosses more often, but the effects are generally milder.

The possible consequences mainly affect the eyes and the brain. Some infected babies seem healthy at birth, and damage to the retina may appear later: hence long-term follow-up of the child, who is often treated during the first year.

When an infection is found, care becomes specialised: antiparasitic treatment to limit transmission to the baby, more frequent ultrasound scans, and often an amniocentesis to find out whether the baby is affected. The medicines and how long to take them are decided by the specialist team.

Meat: the habits that protect you

The rule fits in three words: cooked right through. For minced meat, Quebec guidelines set 71 °C at the centre; by eye, that means meat that is brown all the way through, with no pink juices.

In practice, in Morocco:

• Kefta (minced meat) and kebabs: order them well done, even if they lose a little tenderness. At your local grill, just say so.
• Tagines and slow-cooked meat are no problem at all: long cooking is enough.
• Do not taste raw stuffing to check the seasoning of kefta or briouates (savoury pastries): cook a small meatball instead.
• On Eid day, raw meat is everywhere in the kitchen: wash your hands after touching it, as well as knives and boards, before moving on to raw vegetables.
• Dry-cured meats and raw marinated meats should be avoided unless they are well cooked.

Fruit, vegetables, herbs: how to wash them properly?

At the market, bunches of parsley, coriander and mint often come with a little soil, and soil is exactly how the parasite travels. Washing therefore matters as much as cooking.

1. Wash your hands before preparing food.
2. Rinse under running drinking water all fruit and vegetables, even those you will peel or cook.
3. Separate salad leaves and herbs and rinse them leaf by leaf.
4. Scrub firm-skinned vegetables: carrots, potatoes, melons, squash.
5. Peel when you can: it adds an extra layer of safety.

Ready-to-eat salads need washing too. When eating out, avoid raw vegetables and fresh herbs when you do not know how they were prepared. For drinking water, choose mains or bottled water over water from an unchecked well or spring. The rest of the food precautions in pregnancy, including listeria, are covered in our guide to what to eat when pregnant.

The cat, the garden and soil

There is no need to give up your cat. The risk comes from its droppings, especially if it goes outside, hunts or eats raw meat, far more than from cuddles.

• The litter tray: hand it over to someone else. If that is impossible, wear disposable gloves and wash your hands afterwards. A tray changed every day reduces the risk.
• Its food: dry or wet cat food, never raw meat.
• The kitchen: no cat on the worktop or the table, and no kisses on the nose for nine months.
• The garden and flowerpots: gloves are a must, and wash your hands afterwards.
• Stray cats, so numerous in our streets and medinas: admire them, but avoid touching them.

If an older child plays in a sandpit or in the dirt, washing hands when you get back from the park protects the whole family.

Throughout pregnancy, or only at the start?

Throughout pregnancy, as long as you are not immune. Transmission to the baby actually becomes more frequent as the months go by, as we saw above. Relaxing the precautions in the third trimester would therefore be a mistake. They stop at the birth.

Note the dates of your blood tests in your pregnancy record book, and bring the results to every appointment: to follow your care month by month, see also our pregnancy week by week guide.