An Auckland woman who had a stillbirth at 31 weeks due to toxoplasmosis is pleading for more awareness about the infection.
Most people who get infected with toxoplasmosis do not have any symptoms.
Sarah* started to feel pain near her liver when she was between 24 and 25 weeks pregnant. But her midwife told her that some pain is normal during pregnancy.
Two weeks later, the pain had got a lot worse. Her GP referred her to get an ultrasound, but nothing abnormal was found.
She then went to the emergency department where the results of her blood tests showed she had elevated liver enzymes.
The routine tests undertaken for screening for abnormal liver function, including testing for hepatitis, were all negative.
Her pregnancy was not assessed at that time.
Three weeks later, when Sarah was 30 weeks pregnant, her water broke, and she went back to the emergency department.
For the first time, she saw a maternal-fetal medicine subspecialist, who told Sarah - based on the information Sarah had told her, blood tests, and ultrasound scans - there were two possibilities. The first was toxoplasmosis hepatitis, which is when the liver is affected by the infection, and the second was cytomegalovirus (CMV), which has similar symptoms.
By then, it was too late.
Two days later, Sarah gave birth to a dead baby.
The post-mortem findings confirmed the presence of toxoplasma gondii - the parasite which causes toxoplasmosis - in the baby's brain, lungs and the placenta. The baby also had an enlarged liver and spleen - a feature of congenital toxoplasmosis.
The maternal-fetal medicine subspecialist told Sarah when toxoplasmosis is detected during pregnancy, it can be treated with an antibiotic and antiparasitic to try and reduce the risk of transmission to the baby. Subsequently, if the baby is also diagnosed with toxoplasmosis, then another antibiotic and another antiparasitic would be added to the treatment to try and reduce any of the effects.
"In your situation, considering the severity of the effects on baby, this may not have made any difference, but we will never be able to determine this unfortunately," she told Sarah.
Now, Sarah wants to raise awareness about the risk of contracting toxoplasmosis during pregnancy.
"I went through something I hope no one on earth ever goes through again," she said.
"Even if it isn't the top cause of baby fatality, no one should suffer what could've been prevented.
"Please don't let another New Zealand baby die to toxoplasmosis."
In Austria, Belgium, France, Greece, Slovakia and Slovenia, pregnant women have to have a toxoplasma blood test every month. In New Zealand, toxoplasmosis is not routinely tested for during pregnancy.
Dr Michelle Wise, an obstetrician and gynaecologist, and a senior lecturer in the Faculty of Medical and Health Sciences at the University of Auckland, said this was because the incidence of getting infected during pregnancy was rare in New Zealand.
"There are some countries in the world that might do screening more regularly, and that would be because it is more common in some other countries," she said.
All obstetricians and gynaecologists learned about all infectious diseases in pregnancy, whether rare or common, she said.
"There are some symptoms, so we would offer screening, for example, if a mum had symptoms consistent with toxoplasmosis."
Health New Zealand said they did not hold national data around the rates of infection, because toxoplasmosis is not a reportable disease.
The symptoms of acute toxoplasmosis are a fever, fatigue, muscle aches, swollen lymph nodes and a sore throat. But Sarah did not have any of these symptoms - instead she experienced pain.
"Pain isn't typically a symptom of toxoplasmosis," Wise said.
The Ministry of Health said midwives also discussed toxoplasmosis with their clients, most commonly at the booking visit, when discussing food safety such as avoiding food-borne illnesses.
Maternity chief clinical officer Heather Muriwai said the ministry produce pamphlets about food safety as part of the standard information shared during antenatal care, which was available to be ordered by midwives and other providers of maternity care, as well as members of the public, from HealthEd.
"You can get toxoplasmosis by eating raw or undercooked meat, or through contact with infected cat faeces," she said.
"If you are pregnant and think you may be infected with toxoplasmosis, talk to your healthcare provider."
What is toxoplasmosis?
Toxoplasmosis is an infection caused by a parasite called toxoplasma gondii.
Worldwide, it is estimated that up to one in three people are infected with Toxoplasma gondii, but have no symptoms.
A person can get toxoplasmosis by direct or indirect contact with cat faeces, which can contaminate soil, water, plant material and food.
An active infection typically occurs only once in a lifetime, followed by lifelong immunity. Although the parasite remains in the body indefinitely, it is usually harmless and inactive unless the immune system is compromised.
While no immunisation is available, there are other precautions a person can take to reduce their chances of becoming infected. These include not eating raw or undercooked meat, not consuming unpasteurised milk, thoroughly washing fruits and vegetables, having someone else clean cat litter trays - or wearing gloves if that is not possible - and wearing gloves when handling soil or sand.
*Real name withheld for privacy
