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You may not know if you've picked up toxoplasmosis while you're pregnant. That's because it often doesn't cause any symptoms.

Most healthy children and adults, including pregnant women, don't have any symptoms if they've got toxoplasmosis. In fact, they don't even know they've got it.¹

About 1 in 10 infected people get a mild flu-like illness that can last for a few weeks. They may get symptoms such as:

• Fever
• Swollen glands
• Headache
• Sore throat
• Muscle pain.

If you're pregnant and feel there's a chance you may be infected, you can have blood tests to find out for sure. For instance, if you are concerned about flu-like symptoms that you've had, or if you've eaten some meat that wasn't cooked properly.

If you're planning to get pregnant, you might also wish to have a blood test to see if you've already had toxoplasmosis. This would mean you're now immune to the disease.

Talk with your doctor or nurse if you feel you would like a blood test for toxoplasmosis.

Only a little blood is needed for the blood test, so there's no risk to your baby. The blood tests will look for antibodies to the parasite that causes toxoplasmosis.^{2 3} Antibodies are cells created by your immune system to fight infection. So if you have antibodies to the parasite in your blood, it means you have, or have had, the infection.

You may need to have more than one blood test. The tests will show not just whether you have been infected, but how recent that infection was. It is important to know this because antibodies can remain in your blood for as long as 18 months after you were first infected. But if you were infected more than three weeks before you became pregnant then it's unlikely to affect your baby.

The tests for toxoplasmosis are not completely reliable because they often give "false-positive" results. This means they show positive for toxoplasmosis when it is not present, or mistake an old infection for a current one.² This is one reason why pregnant women are not routinely screened for toxoplasmosis in the United States.

If you're pregnant and you have the HIV (human immunodeficiency virus) infection, your doctor will probably advise you to have the blood tests. That's because HIV, and some other conditions, weaken your immune system, and toxoplasmosis can cause serious health problems for you. Also, even if you've had toxoplasmosis in the past, HIV could weaken your body's defences and allow the infection to start up again.⁴

If your doctor does diagnose toxoplasmosis, the next step is to find out whether the infection has passed to your baby.

Your doctor can find out if your baby is infected by doing a test called amniocentesis. For this, they will take a sample of the amniotic fluid (the fluid that surrounds your baby in the womb) by inserting a needle into your abdomen. Or they can take a sample of the baby's blood from the umbilical cord. This is called cordocentesis.

The fluid is then checked for signs of infection using a special test called a polymerase chain reaction (PCR) test.

Like your blood tests, these tests are not completely reliable either. And amniocentesis is not entirely safe for your baby.⁵ It carries a small risk of miscarriage (losing your baby), which varies depending on the hospital where you have the test. But the risk of miscarriage is generally about 1 in 100.

You'll need to discuss the pros and cons of amniocentesis with your doctor. If you don't have the test, your baby can be checked for toxoplasmosis after birth. Your baby will have a blood test that looks for antibodies to the infection.⁵

If you have an amniocentesis test that suggests your baby has toxoplasmosis, your doctor will use ultrasound to look for signs of damage in your baby. The amniocentesis test won't tell you how badly your baby is affected.

Usually unborn babies who have toxoplasmosis look normal on ultrasound scans. But sometimes they show signs of the infection, such as:

• Hardening of tissue inside their brain
• Abnormalities of the lower parts of their heart (the ventricles)
• An enlarged liver
• Fluid in their abdomen (belly)
• A thickened placenta (the placenta is the organ in the womb that passes food and oxygen to your unborn baby).

If your doctor thinks your baby is severely affected by the infection, you may wish to discuss the question of an abortion (termination of your pregnancy). For example, If your baby seems to have been infected before the sixteenth week of pregnancy, when serious damage is most likely.² Or the ultrasound scan shows too much fluid in the brain, suggesting the baby has brain damage.

Understandably, if either you or your baby is found to have toxoplasmosis, you will feel very distressed. You may find it difficult to make decisions. But you can ask for counseling to help you make sure you have all the information you need and help you reach a decision about what to do.

Most newborn babies with congenital toxoplasmosis don't have any obvious signs of infection.² But some things can indicate that a baby has been born with the infection:¹

• Brain abnormalities, such as too much fluid in the brain (called hydrocephalus), or hardening of brain tissue
• Eye problems, such as inflamed or crossed eyes, or blindness
• Epilepsy
• Tiny red spots in the skin (called petechiae)
• Anemia (not enough oxygen in the blood).

A baby with toxoplasmosis may be also be born early (prematurely) and may have a low birth weight.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.