What is toxoplasmosis?
Toxoplasmosis is an infection caused by the parasite Toxoplasma gondii. In non-pregnant women it doesn’t have many symptoms. In fact, many people will never know they have had it. Some people may have mild flu-like symptoms. A few may experience a more long-term illness similar to glandular fever and swollen lymph nodes.
Although toxoplasmosis normally causes a mild illness in people with healthy immune systems, it's risky during pregnancy because it may harm your baby.
The parasite can be found in meat, cat faeces, the soil where cats defecate and unpasteurised goats’ milk. The toxoplasma parasite can infect most birds and warm-blooded animals, including humans. Cats are the only animals that can have infected faeces. After it catches the infection through eating birds, mice or other raw meat, a cat can shed infectious faeces for about 14 days.
Toxoplasmosis cannot be caught by stroking a cat or having a cat as a pet. The infection comes from coming into contact with the infected faeces of a cat.
How common is toxoplasmosis?
It is estimated that between a third and half of the UK population will have the infection at some point in their lives. Once you have had the infection, you are then immune for life – you cannot catch it again. Around 2,000 UK women per year contract toxoplasmosis during pregnancy.
Most pregnant women may never know they have been infected unless they experience problems during their pregnancy that mean they have tests. However the infection often has no symptoms at all.
The effects of toxoplasmosis in pregnancy
Toxoplasmosis does not usually cause any symptoms and in most cases a person does not realise they have caught the infection. It can cause symptoms similar to flu or glandular fever, sometimes including swollen lymph nodes. Once a person has had the disease they are generally thought to be protected for life, unless they suffer an impairment of their immune system.
Risks of toxoplasmosis
Toxoplasmosis is only a risk to an unborn baby if caught for the first time during pregnancy or within a few weeks before you get pregnant.
If an unborn baby catches the disease they are said to have ‘congenital toxoplasmosis’. The damage the infection may cause will depend on when in pregnancy you got the infection.
If you catch toxoplasmosis for the first time during pregnancy, it does not mean that your baby will be infected.
On average, only 4 in 10 of such infections will pass to the baby. Caught during pregnancy, toxoplasmosis can cause miscarriage, stillbirth or damage to the baby’s brain and other organs, particularly the eyes.
However, most babies born with toxoplasmosis have no obvious damage at birth but develop symptoms, usually eye damage, during childhood or even adulthood. A few will have more serious symptoms such as blindness or brain damage.
How is toxoplasmosis caught?
Toxoplasmosis is caught by swallowing anything infected with, or contaminated by, the parasite.
This could be:
- raw or undercooked meat (meat showing any traces of pink or blood), and raw cured meat such as Parma ham or salami
- unwashed vegetables and fruit
- cat faeces or soil contaminated with cat faeces
- unpasteurised goats’ milk and dairy products made from it.
The infection can also be passed:
- through the placenta if the mother becomes infected infection (mother to unborn baby).
- through infected matter entering human body fluids; if, for example, during the process of lambing, material splashes into eyes or open cuts.
- through transplanted organs or blood products from other humans that are infected toxoplasmosis
- through inhaling the parasite eggs (possible but very unusual).
Person-to-person infection is not possible, except from mother to unborn child.
Who is at risk of toxoplasmosis?
Anyone who eats anything infected with the parasite. Pregnant women who work on the land, in catering or farming may be at higher risk as they may be more likely to come into contact with the parasite. Lambing is a particular risk for pregnant women.
Tips to avoid toxoplasmosis during pregnancy
Only eat meat that has been thoroughly cooked (ie, with no trace of blood or pinkness).
- Avoid raw meat and cured meat, such as Parma ham.
- Wash hands, chopping boards and utensils thoroughly after preparing raw meat.
- Wash all fruit and vegetables thoroughly before cooking/eating to remove all traces of soil.
- Avoid unpasteurised goats’ milk and dairy products made from it.
- Wear gloves when gardening and wash hands and gloves afterwards – if you eat while gardening wash your hands first, and try to avoid gardening in areas that may have been soiled with cat faeces.
- Cover children’s sandpits to prevent cats using them as litter boxes.
- Remove faeces from cat litter tray every day wearing rubber gloves (or ask someone else do this), scald trays regularly with boiling water.
- If you are handling litter trays, wash gloves and hands thoroughly afterwards.
- Do not handle lambing ewes and do not bring lambs into the house.
Can I change the cat litter tray while pregnant?
Cats are the only animals that can shed this parasite in their faeces. Provided precautions are taken, cats are not a particular risk to a pregnant woman. If you are handling litter trays, wash gloves and hands thoroughly afterwards.
What should I do if I think I may have toxoplasmosis?
Toxoplasmosis is not routinely tested for during pregnancy in the UK. You may however request a blood test from your GP if you feel you may have put yourself at risk, you are concerned about symptoms.
The blood test looks for antibodies – the body’s natural defences – to the infection. It may take three weeks for these antibodies to be present following an infection, so the blood test will only pick up an infection that you’ve had for at least three weeks. Depending on the type of antibodies found and whether levels are stable, rising or falling, it’s possible to determine when the infection took place.
The results may come back in a week, or longer if they have been passed on to a Toxoplasma Reference Laboratory .
Tests for toxoplasmosis in pregnancy
Blood tests for toxoplasmosis can be done at any stage before or during pregnancy. The blood test can usually only show possible infection two to three weeks after any risk incident, as it can take this long for antibodies to be detectable.
The blood test involves taking a small amount of blood from the mother. There is no risk to the unborn baby. The blood test aims to show whether certain antibodies indicating toxoplasmosis are present or not, and, if they are present, to find out when the infection happened.
If the tests show that there is a recent or current infection, there is a risk that the baby will be infected. The obstetrician or GP will make a recommendation about any further action that might be required. It may take several weeks for the infection to pass from you to your baby. The degree of risk and severity of damage depends on when you were infected.
A positive result due to a current/recent infection
If the test shows a current or recent infection the blood must be sent on from the local laboratory to the Toxoplasma Reference Laboratory, for confirmation and further testing.
A small percentage of tests will appear positive when in reality a woman has never had the disease.
If further tests show that you have a current or recent infection, it means you are suffering from an acute toxoplasma infection. Further action needs to be taken to assess the risk of passing the infection on to your baby.
If you were infected shortly before conception
Infection caught shortly before conception (within a few weeks before) carries a one percent risk or below of transmission to the baby, but there is a risk of miscarriage if the baby does become infected.
If you were infected in the first trimester (week one to 12)
Infection caught at this stage of pregnancy carries about 10-15% risk of transmission to the baby. A baby infected at this stage has a risk of being miscarried or born with severe symptoms such as hydrocephalus (water on the brain), calcifications of the brain, or retinochoroiditis (inflammation of the retina).
If you were infected in the second trimester (week 13 to 28)
Infection caught at this stage of pregnancy brings about 25% risk of transmission. A baby infected at this stage is less likely to be miscarried, but is still at risk of developing severe symptoms as above.
If you were infected in the third trimester (week 29 to 40)
Infection caught later in pregnancy is more likely to spread to your baby, the risk of transmission may be as high as 70–80%, but if problems develop, they are less likely to be as serious. Most babies infected will be apparently healthy at birth, but a large proportion will develop symptoms later in life, usually eye damage.
Finding out if the baby has been infected
Further tests can be carried out to find out whether or not the baby is infected, although the tests will not show how severe the damage is. An obstetrician or GP can explain the risks and benefits of conducting these tests.
Amniocentesis is a technique where amniotic fluid is removed by a fine needle from the amniotic sac – the fluid-filled sac around the baby.
Cordocentesis is a technique where a sample of the baby’s blood is removed from the umbilical cord.
These procedures carry a .5-1% percent risk of causing miscarriage. They are normally carried out after 15 weeks of pregnancy. The amniotic fluid or blood from the umbilical cord is then tested at the Toxoplasma Reference Laboratory using a range of specialised tests.
If this is positive, the baby will be considered to be infected. Results typically take two to five days. A detailed ultrasound scan will show if there is major damage, such as hydrocephalus (water on the brain), but a scan that shows no damage, while reassuring, does not rule out the possibility that the baby is both infected and affected.
Treatment of toxoplasmosis in pregnancy
If you have a positive blood test result, you may be prescribed an antibiotic called spiramycin, which reduces the risk of the infection being passed from you to the baby. Spiramycin only reduces the risk of transmission from mother to baby and is not active against the parasite. It therefore cannot limit any damage if a baby has already become infected.
If the baby is found to be infected, a combination of pyrimethamine and sulphadiazine can be taken. These are both stronger antibiotics and help limit any damage to the baby, although again, they cannot undo any damage.
At 20 weeks an ultrasound scan may also highlight any obvious physical problems in the baby. Termination of pregnancy is also an option for some women, when an infected baby with severe developmental problems has been confirmed.
All babies born to women with confirmed toxoplasmosis in pregnancy will be monitored closely by paediatricians and receive blood tests during their first year.
Side effects of treatments
Spiramycin is used routinely in France for treatment of toxoplasmosis in pregnancy, with little evidence of adverse effects. Experts consider that it is safe to use in pregnancy when a baby is at risk. Women taking spiramycin sometimes experience side effects such as nausea or rashes. Pyrimethamine and sulphadiazine can have side effects for both the mother and baby related to red-blood cell production. Although not normally prescribed in pregnancy, they can be used in extreme circumstances. They are taken with folinic acid, which helps to reduce the worst side effects.
All babies born to women who have had a recent or current infection in pregnancy should be given a thorough physical examination after birth, followed by blood tests during the first year of the baby’s life.
Treatment after the baby is born
A blood sample should be taken from at-risk babies shortly after birth. A blood sample should also then be taken from you to compare the levels of specific antibodies between you and your baby.
Tests will be carried out to look for different types of antibodies to toxoplasmosis in the baby’s blood. Your baby carries some of your antibodies, so a positive result is expected and not necessarily alarming. If additional antibodies are present, this may indicate that your baby is infected.
Babies who are known to be at risk of having congenital toxoplasmosis should be checked for signs of neurological damage. The eyes will be examined for signs of any problem, preferably by an ophthalmologist (eye specialist). Long-term follow-up by an ophthalmologist might be necessary if eye damage is confirmed.
Your baby’s general health will also be checked. If there is any possibility that the baby has brain damage, special head X-rays might be carried out to check for calcifications, enlarged ventricles or any other abnormalities.
Treatment for babies who have been infected with toxoplasmosis
If blood tests showed that your baby has been infected, antibiotics might be prescribed, even if your baby shows no symptoms. Treatment can sometimes be continued for as long as one year, to help prevent or limit the eye damage that can possibly occur later.
A blood sample taken every few months, up to the age of one year, can show whether your baby’s antibody level is falling. By that age, the level should be completely negative. This means that your baby will have lost the antibodies acquired from you and is not infected. When your baby’s blood sample is completely antibody-negative, it means they are definitely not congenitally infected. A falling antibody level is a good sign, but is not conclusive and tests should continue until the antibody level is completely negative.
Breastfeeding is safe if you have toxoplasmosis, the disease cannot be transmitted this way. You are also passing on extra antibodies to your baby, making their immune system stronger. Breastfeeding is therefore recommended, unless you are being treated with pyrimethamine. This medication should be changed before breastfeeding.
UK government policy on toxoplasmosis screening
The UK National Screening Committee recently reported that screening for toxoplasmosis in pregnancy should not be offered routinely as there is not enough evidence that it would help .
The Committee suggests that getting pregnant women to avoid undercooked or cured meat and communicating the best ways of avoiding infection is a better way of controlling toxoplasmosis than antenatal screening.
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- Joynson DHM, Wreghitt TG. Toxoplasmosis: A Comprehensive Clinical Guide. Cambridge Cambridge University Press, 2001
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- Hall S, Ryan M, Buxton D. The epidemiology of toxoplasma infection in Joynson DHM, Wreghitt TG, (eds.) Toxoplasmosis: A Comprehensive Clinical Guide. Cambridge, Cambridge University Press, 2001: 58-124.5
- Elsheikha HM. Congenital toxoplasmosis: priorities for further health promotion action. Public Health, 2008; 122(4): 335-53
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- Toxoplasma Reference Unit, Public Health Wales, Edward Guy. Personal communication, 2012
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- Daveluy et al, for the Eurotoxo Group (panel 2). Review of data related to side effects of drugs used in congenital toxoplasmosis [unpublished report]. Bordeaux, France The Eurotoxo Group, 2005
- Alex W, Joss L. Treatment. In Ho-Yen DO, Joss AWL (eds.) Human Toxoplasmosis. Oxford Oxford Medical Publications, 1992: 119-143
- Eaton RB et al. Newborn screening for congenital toxoplasma infection. In Joynson DHM, Wreghitt TG (eds) Toxoplasmosis: A Comprehensive Clinical Guide. Cambridge Cambridge University Press, 2001: 241-253
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- Bonametti AM, Passos JN. Research Letters (to the editor): Re: Probable transmission of acute toxoplasmosis through breastfeeding. Journal of Tropical Paediatrics 1997; 43: 116
- Goldfarb J. Breastfeeding. AIDS and other infectious diseases. Clin Perinatol 1993; 20: 225-243
- NSC (2015) Antenatal screening for Toxoplasmosis. External review against criterIA set by the UK Mational Screening Committee, UK National Screening Committee file:///C:/Users/user/Downloads/Review_Toxoplasmosis_2016.pdf
ℹLast reviewed on October 3rd, 2016. Next review date October 3rd, 2019.
By Anonymous (not verified) on 12 Feb 2018 - 20:38
Hi sorry becues I ask to match question becues I warry about my baby I waited to long tel I get pregnant I just want to know it is possible the baby die if I get tox in this stage of the pregnancy I'm 26 and it is possible to pass to the baby and it is possible to to damage my baby brain
By Midwife @Tommys on 14 Feb 2018 - 11:05
It might be best for you to call me on 0800 0147800 to talk this through as it unclear if you are 26 weeks pregnant having been diagnosed with Toxoplasmosis, or if you are just worried about it.
Please do call when you can
By Anna (not verified) on 4 Feb 2018 - 21:54
Had a medium rare beef steak yesterday, without realising it could be harmful to me. There was no blood in the steak but it was pink. I am 10 weeks pregnant. Would I need to have a blood test in 3 weeks to find out if I caught toxoplasmosis?
By Midwife @Tommys on 7 Feb 2018 - 10:27
For your own peace of mind, it might be sensible to go to your GP and tell them that you may have been exposed to Toxoplasmosis and that you would like a blood test. Some GP's offer this for free, others incur a charge of approx £50 for the test. As you have probably read on the information page above, the test will tell you if you have a current or a historical toxoplasmosis infection. Please try not to worry for now. The likelihood is that you do not have the infection. If you wish to call us on the pregnancyline, please do.
All the best
Sophie, Tommy's Midwife
By Anonymous (not verified) on 29 Jan 2018 - 11:27
Is cured meat (such as chorizo) ok if it is cooked?
By Midwife @Tommys on 31 Jan 2018 - 09:50
Yes, when cooked, cured meats are safe to consume in pregnancy.
By Anonymous (not verified) on 25 Jan 2018 - 16:26
And i can every month call gp for blood test and the gp they doesn't make blood test any time i ask it for thank you
By Kashwer (not verified) on 25 Jan 2018 - 15:22
Thank you for your advice I make appointment for blood test but I just worry about what they my family bring in their shoes I just want to make sure if it possible to get tox from dog poop or it is possible to cat make poo in street or in mud becues some time i forget to wash my hands after touch my shoes or my dughter shoes this make my alway worry
By Midwife @Tommys on 25 Jan 2018 - 16:49
Hi, if you are still concerned about anything or feel like you need more reassurance then please feel free to call the Tommy's Midwives on 0800 0147 800 Monday to Friday 9am-5pm and we will be delighted to hear from you. Take care, Tommy's Midwives x
By Anonymous (not verified) on 24 Jan 2018 - 23:00
We have been planning on getting a cat for some time but timing has not quite been right. We were looking at getting a cat imminently but am 7w pregnant and wondering whether we need to put plans on hold now :( . I understand toxoplasmosis can only be caught by humans once then you are immune. I had a family cat from the age of 5 for 18years and lived at home until 18.5 full time. Therefore i understand there's a good chance I've caught it before and immune. I understand the advice re litter trays etc. I'd really value your thoughts and advice.
By Midwife @Tommys on 25 Jan 2018 - 11:28
Hi Thank you for your comment.
There is no reason that you shouldn't get a cat as like you said, you may have been exposed to Toxoplasmosis in the past when you had cats growing up. As long as you avoid changing the litter trays and maintain good hand hygiene then the risk of contracting Toxoplasmosis is the lowest it can be. If you are still concerned, your GP or midwife can always do a test for Toxoplasmosis to see is you have already had an exposure to a previous infection. Toxoplasmosis can have significant health implications for the baby if it is contracted in pregnancy so please follow all the advice to reduce the risk of exposure. Hope this helps, Take Care, Tommy's Midwives x
By Anonymous (not verified) on 24 Jan 2018 - 16:35
Thank you for your advice I alway thought that the cat doesn't make poo in street or in the park becoues I read in google that the cat doesn't make poo in street or in park becoues I hear that the cat alwaye caver the poo by soil I didnt know he do it in the street oh in the park
By Midwife @Tommys on 24 Jan 2018 - 16:43
Hi, your are welcome, if you have further questions then please don't hesitate to contact us again. Take Care, Tommy's Midwives x
By Curious mom (not verified) on 24 Jan 2018 - 12:27
Is there treatment to clear scars that are caused from undetected tocxo? My child was born by C-section at 32 weeks with suspected birth defect.
Nothing was detected. However, we we're told at age 5 with hours of eye testing that she had scaring from Toxoplasmosis.
It's left scars in back of her eyes that cause her partial vision. Is there a treatment to remove scaring?
By Midwife @Tommys on 24 Jan 2018 - 15:37
Hi Thank you for your comment.
We are sorry to hear about your little girls scaring in the backs of her eyes, this is can be common with Toxoplasmosis exposure. Scaring of the retina can be permanent but it would have to be an ophthalmologist that would really be the specialist that could advise you more accurately on this. Does your daughter have an eye specialist that she sees or is she being followed up with regards to her partial vision? If she is then you can ask the doctors more about treatment options. You can always speak to your GP who will be able to refer her to an eye specialist if needed. Sorry that we cannot give you any further information but it is a specialist area. Hope this helps, Take Care, Tommy's Midwives x
By Toxoplasmosis (not verified) on 18 Jan 2018 - 11:25
What about if the mother has been infected in childhood and her infection is not active as an adult. If she is aware of carrying the parasite and wants to have a baby, what are the options and the risks?
By Midwife @Tommys on 19 Jan 2018 - 13:11
Usually if someone has had a toxoplasmosis infection previously then they develop immunity and therefore will not be affected by toxoplasmosis again and the unborn baby is not at risk. If you have any doubts then the GP can do a blood test and this will indicate any past and current infections and antibody status. The concern is if there is a current infection which would need to be treated before pregnancy. I hope this helps, if you would like to talk further then please do email us [email protected] x
By Midwife @Tommys on 24 Oct 2017 - 09:10
Thanks for posting the paragraph below is taken directly from our site titled Toxoplasmosis in Pregnancy.
'Cats are the only animals that can have infected faeces. After it catches the infection through eating birds, mice or other raw meat, a cat can shed infectious faeces for about 14 days.'
Toxoplasmosis only presents a problem if you are exposed to it and infected for the first time in pregnancy and since oocysts (toxoplasmosis spores) are transmitted by ingestion, in order to contract toxoplasmosis, a pregnant woman would have to make contact with contaminated faeces and then, without washing her hands, touch her mouth or otherwise transmit the contaminated faecal matter to her digestive system. If you take necessary precautions – such as regular hand washing the risk is minimal.
Cats do not cause risk - because the toxoplasma parasite completes its lifecycle in the gut of a cat – it is the faeces of an infected cat that presents the risk. However, these faeces only become infective from at least 24 hours after being passed – when spores are released. This is why we advise cat litter to be changed daily (and if possible not by a pregnant woman).
It is thought that very few cats are actually infected at any one time – some estimations say only 1% of cats in the UK have active toxoplasmosis. Typically a cat only excretes toxoplasmosis spores when he is first exposed to Toxoplasma and this goes on for only two weeks, you would not know when this occurred by looking at him.
So you can see that the likelihood of coming into contact with infected cat faeces in pregnancy when such a small number of cats have the active infection (<1% of UK cat population) and ingesting it is rare.
I hope this answers your question adequately. Please give us a call on 0800 0147 800 weekdays 9-5 pm if you need to talk to a midwife.
By Anonymous (not verified) on 23 Oct 2017 - 10:32
Hi when it says infection is only active in feceas 24 hours onwards does that mean if you have come into contact and unintentional ingested spores before the 24 hours will it pass through the mother and likely not cause infection?
By Midwife @Tommys on 23 Oct 2017 - 14:06
Hi, I can't see where it is written that infection is active in faeces 24 hour onwards. Can you clarify where you have read this and I will check the information? Thanks
By Klouise77 (not verified) on 23 Oct 2017 - 14:53
Hi thanks for the reply. I’ve read that the faeces only because a infections after it’s been 2-5 days that’s why they say change everyday. Thought it was on this page but I’ve certainly read it somewhere
By Anonymous (not verified) on 28 Jul 2017 - 20:28
Can a woman contract toxo vaginally if she gave birth in unsanitary conditions. Say dirt, water, etc?
By Midwife @Tommys on 31 Jul 2017 - 10:12
I have never heard of toxoplasmosis being contracted vaginally at birth, but if you think that your baby has been put at risk during the birth you can request that he/she has a blood test to check for toxoplasmosis. If there is any sign that your baby is unwell please see your GP as soon as possible.
By Midwife @Tommys on 1 Sep 2016 - 13:02
Most people have an acquired immunity following contact prior to being pregnant , however if you think you are at risk having had the cured ham , it would be advisable to have the blood test anyhow and your GP can organise this. The blood test can usually only show possible infection two to three weeks after any risk incident, as it can take this long for antibodies to be detectable.
By Kashwer (not verified) on 19 Jan 2018 - 22:47
Hi I have a question is it possible to get tox from dog poop
By Midwife @Tommys on 22 Jan 2018 - 11:20
No, it is not thought that dog 'poo' can be infected.
By Kashwer (not verified) on 23 Jan 2018 - 22:00
Hi I have another question did cat make poo in street or in the park becoues when my husband or my dughter come back from out said I smell their shoes I near it to my mouth an nose and I scared some time to be cat bo maxit with mud I'm pregnant 24 week and I'm so scared to get it when I smell it their shoes
By Midwife @Tommys on 24 Jan 2018 - 14:42
Hi, Thank you for your comment.
It is possible for cats to 'poo' in the street or in parks as many cats do go outside. It is difficult to say if the poo came from a cat and it is highly unlikely that you have caught Toxoplasmosis because you need to get this in an open cut or ingest the organism. It may have only been mud on your daughters shoes, however, if you think your may have been exposed then you can always see your GP who will be able to do a blood test to check for Toxoplasmosis. Hope this helps, if you need any further advice please email the Tommy's Midwives on [email protected] Take Care x
By Kashwer (not verified) on 24 Jan 2018 - 16:50
Thanks for your advice I didn’t thought that the cat make poo out side in the street because I read in the google that the cat when he make poo they cover it by soil that what I read that the cat always covers they poo this ways I didn’t car about cat poo I always says maybe it is dogs poo in their shoes thank you
By Kashwer (not verified) on 24 Jan 2018 - 22:38
But some time i see the poo in their shoes I siad mayeb is dog poo becoues I read in google that the cat doesn't make poo in street or in and they cover the poo by soil after finish that what I see in you tube
By Midwife @Tommys on 25 Jan 2018 - 10:29
Hi, if you are unsure if this came from a cat or a dog and you are still concerned about your pregnancy then you can request a blood test from the GP who will be able to see if you have been exposed to Toxoplasmosis. Take Care, Tommy's Midwives x
By Anonymous (not verified) on 9 Feb 2018 - 15:13
Hi if I pregnat 26 week I do blood test for tox if it is positive it is possible to spare to the baby and damage his brain in this stage of pregnancy
By Midwife @Tommys on 9 Feb 2018 - 16:10
If you were to test positive for Toxoplasmosis at this stage of pregnancy then you would be referred to a consultant to start you on some medication to minimise the risk of transmission to the baby and you would also be referred to the fetal medicine unit for an in depth scan and on going monitor to look at the health and well being of the baby. Once they were born they would also be reviewed by a neonatal doctor.
By Anonymous (not verified) on 15 Feb 2018 - 15:05
Hi if I get tox in this stage of the pregnant I'm 26 week it possible to the baby die I read in NHS page they write it very rare to pass to the baby
By Midwife @Tommys on 16 Feb 2018 - 09:24
Toxoplasmosis is not known to be a cause of stillbirth and babies who are affected can have health and development problems however it is not a know cause of a baby dying. If you have on going concerns then do speak with your midwife or GP who can support you.