Abstract
Purpose
Toxoplasmosis, caused by the parasite Toxoplasma gondii, can have serious impacts on fetal development in the setting of acute maternal primary infection. The American College of Obstetricians and Gynecologists (ACOG) sought to determine current knowledge, practices, opinions, and educational preferences regarding T. gondii infection in pregnancy among ACOG members practicing prenatal care.
Methods
ACOG sent a survey to 1,056 members chosen by stratified random sampling from membership lists, including 370 participants and 686 non-participants in the Collaborative Ambulatory Research Network (CARN). Mailings were sent up to four times to nonresponders.
Results
Survey minimum response rates were 40.3 % (CARN) and 19.7 % (non-CARN); response rates adjusted for imputed non-eligibility were 59.7 % (CARN) and 22.6 % (non-CARN). Among providers, 80.2 % had diagnosed no acute maternal T. gondii infections in the past 5 years, 12.7 % correctly identified the screening role of the Toxoplasma avidity test, 42.6 % performed serologic T. gondii screening for at least some asymptomatic pregnant women, and 62.1 % of those who so did used appropriate approaches. Providers in the northeastern United States were 2.02 times more likely to routinely screen than those in the west (p = 0.025) and female providers were 1.48 times more likely than male providers (p = 0.047). The potential educational interventions considered useful by the most practitioners were updated ACOG guidelines on screening (81.4 %) and management (71.7 %) for acute T. gondii infection in pregnancy.
Conclusions
ACOG members would benefit from educational efforts targeted at risk factor counseling and screening approaches.
Similar content being viewed by others
Notes
“Acceptable” screening methods included checking both IgG and IgM; checking IgG alone repeatedly (allowing ascertainment of seroconversion); or checking IgM if then confirmed with IgM and IgG.
References
Jones JL, Dietz VJ, Power M, Lopez A, Wilson M, Navin TR, Gibbs R, Schulkin J (2001) Survey of obstetrician-gynecologists in the United States about toxoplasmosis. Infect Dis Obstet Gynecol 9:23–31
Jones JL, Krueger A, Schulkin J, Schantz PM (2009) Toxoplasmosis prevention and testing in pregnancy, survey of obstetrician-gynaecologists. Zoonoses Public Health 57:27–33
ACOG Practice Bulletin: perinatal viral and parasitic infections no. 20 (2000). Int J Gynecol Obstet 76: 95–107
US Census Bureau. Census regions and divisions of the United States. https://www.census.gov/geo/www/us_regdiv.pdf. Accessed 10 June 2013
Jones JL, Kruszon-Moran D, Sanders-Lewis K, Wilson M (2007) Toxoplasma gondii infection in the United States, 1999–2004, decline from the prior decade. Am J Trop Med Hyg 77:405–410
Alford CA Jr, Stagno S, Reynolds DW (1974) Congenital toxoplasmosis: clinical, laboratory, and therapeutic considerations, with special reference to subclinical disease. Bull N Y Acad Med 50:160–181
Kimball AC, Kean BH, Fuchs S (1971) Congenital toxoplasmosis: a prospective study of 4,048 obstetric patients. Am J Obstet Gynecol 111:211–218
Guerina NG, Hsu HW, Meissner HC, Maguire JH, Lynfield R, Stechenberg B, Abroms I, Pasternack, Hoff R, Eaton RB, Grady GF, New England Regional Toxoplasma Working Group (1994) Neonatal serologic screening and early treatment for congenital Toxoplasma gondii infection. N Engl J Med 330:1858–1863
Lopez A, Dietz V, Wilson M, Navin TR, Jones JL (2000) Preventing congenital toxoplasmosis. MMWR Recomm Rep 49:37–75
Lopes AP, Cardoso L, Rodrigues M (2008) Serological survey of Toxoplasma gondii infection in domestic cats from northeastern Portugal. Vet Parasitol 155(3–4):184–189. doi:10.1016/j.vetpar.2008.05.007
Cvetković D, Bobić B, Jankovska G, Klun I, Panovski N, Djurković-Djaković O (2010) Risk factors for Toxoplasma infection in pregnant women in FYR of Macedonia. Parasite 17(3):183–186
Anand R, Jones CW, Ricks JH, Sofarelli TA, Hale DC (2012) Acute primary toxoplasmosis in travelers returning from endemic countries. J Travel Med 19:57–60. doi:10.1111/j.1708-8305.2011.00564.x
Dubey JP (1994) Toxoplasmosis. J Am Vet Med Assoc 205:1593–1598
Dubey JP, Miller NM, Frenkel JK (1970) The Toxoplasma gondii oocyst from cat feces. J Exp Med 132:636–662
Lélu M, Villena I, Dardé ML, Aubert D, Geers R, Dupuis E, Marnef F, Poulle ML, Gotteland C, Dumètre A, Gilot-Fromont E (2012) Quantitative estimation of the viability of Toxoplasma gondii oocysts in soil. Appl Environ Microbiol 78:5127–5132
Montoya JG, Remington JS (2008) Management of Toxoplasma gondii Infection during pregnancy. Clin Infect Dis 47:554–566
Liesenfeld O, Press C, Montoya JG, Gill R, Isaac-Renton JL, Hedman K, Remington JS (1997) False-positive results in immunoglobulin M (IgM) Toxoplasma antibody tests and importance of confirmatory testing: the Platelia Toxo IgM Test. J Clin Microbiol 35:174–178
Wilson MJ, Remington S, Clavet C, Varney G, Press C, Ware D (1997) Evaluation of six commercial kits for detection of human immunoglobulin M antibodies to Toxoplasma gondii. J Clin Microbiol 35:3112–3115
Gras L, Gilbert RE, Wallon M, Peyron F, Cortina-Borja M (2004) Duration of the IgM response in women acquiring Toxoplasma gondii during pregnancy: implications for clinical practice and cross-sectional incidence studies. Epidemiol Infect 132:541–548
Gilbert R, Petersen E (2013) Toxoplasmosis and pregnancy. UptoDate Online. Accessed 16 October 2013
Paquet C, Yudin MH (2013) Toxoplasmosis in Pregnancy: prevention, screening, and treatment. J Obstet Gynaecol Can 35:78–79
Peckham C (2011) Screening for toxoplasmosis. Expert review for United Kingdom policy. http://www.screening.nhs.uk/policydb_download.php?doc=138. Accessed 5 August 2013
UK National Screening Committee policy on toxoplasmosis screening in pregnancy (updated December 2011), http://www.screening.nhs.uk/toxoplasmosis. Accessed 5 August 2013
Rudin C, Boubaker K, Raeber PA, Vaudaux B, Bucher HC, Garweg JG, Hoesli I, Kind C, Hohlfeld P (2008) Toxoplasmosis during pregnancy and infancy, a new approach for Switzerland. Swiss Med Wkly 138(Suppl 168):1–8
Röser D, Nielsen HV, Petersen E, Saugmann-Jensen P, Nørgaard-Pedersen PB (2010) Congenital toxoplasmosis—a report on the Danish neonatal screening programme 1999–2007. J Inherit Metab Dis 33(Suppl 2):S241–S247
Miron D, Raz R, Luder A (2002) Congenital toxoplasmosis in Israel: to screen or not to screen. Isr Med Assoc J 4:119–122
Khoshnood B, De Vigan C, Goffinet F, Leroy V (2007) Prenatal screening and diagnosis of congenital toxoplasmosis: a review of safety issues and psychological consequences for women who undergo screening. Prenat Diagn 27:395–403
Cornu C, Bissery A, Malbos C, Garwig R, Cocherel C, Ecochard R, Peyron F, Wallon M (2009) Factors affecting the adherence to an antenatal screening programme: an experience with toxoplasmosis screening in France. Euro Surveill 14:21–25
Sagel U, Kremer A, Mikolajczyk RT (2011) Incidence of maternal Toxoplasma infection in pregnancy in Upper Austria, 2000-2007. BMC Infect Dis 11:348
Toxoplasma gondii Antibodies, IgM, Quantitation; Toxoplasma gondii Antibodies, IgG. The healthcare blue book. www.healthcarebluebook.com. Accessed 2 Feb 2014
Hedman K, Lappalainen M, Seppala I, Makela O (1989) Recent primary Toxoplasma infection indicated by a low avidity of specific IgG. J Infect Dis 159:736–740
Roberts A, Hedman K, Luyasu V, Zufferey J, Bessieres JH, Blatz RM, Candolfi E, Decoster A, Enders G, Gross U, Guy E, Hayde M, Ho-Yen D, Johnson J, Lecolier B, Naessens A, Pelloux H, Thulliez P, Petersen E (2001) Multicenter evaluation of strategies for serodiagnosis of primary infection with Toxoplasma gondii. Eur J Clin Microbiol Infect Dis 20:467–474
Cortina-Borja M, Tan HK, Wallon M, Paul M, Prusa A, Buffolano W, Malm G, Salt A, Freeman K, Petersen E, Gilbert RE, European Multicentre Study on Congenital Toxoplasmosis (EMSCOT) (2010) Prenatal treatment for serious neurological sequelae of congenital toxoplasmosis: an observational prospective cohort study. PLoS Med 7:e1000351
Gratzl R, Sodeck G, Platzer P, Jäger W, Graf J, Pollak A, Thalhammer T (2002) Treatment of toxoplasmosis in pregnancy: concentrations of spiramycin and neospiramycin in maternal serum and amniotic fluid. Eur J Clin Microbiol Infect Dis 21:12–16
Desmonts G, Couvreur J (1979) Congenital toxoplasmosis: a prospective study of the offspring of 542 women who acquired toxoplasmosis during pregnancy. In: Thalhammer O, Pollak A, Baumgarten K (eds) Perinatal medicine: proceedings of the 6th European Congress, Vienna. Georg Thieme Publishers, Stuttgart, pp 51–60
Forestier F (1991) Les foetopathies infectieuses: prevention, diagnostic prenatal, attitude pratique. Presse Med 20:1448–1454
Couvreur J, Desmonts G, Thulliez P (1988) Prophylaxis of congenital toxoplasmosis: effects of spiramycin on placental infection. J Antimicrob Chemother 22:193–200
Thiébaut R, Leroy V, Alioum A, Binquet C, Poizat G, Salmi LR, Gras L, Salamon R, Gilbert R, Chêne G (2006) Biases in observational studies of the effect of prenatal treatment for congenital toxoplasmosis. Eur J Obstet Gynecol Reprod Biol 124:3
Foulon W, Villena I, Stray-Pedersen B, Decoster A, Lappalainen M, Pinon JM, Jenum PA, Hedman K, Naessens A (1999) Treatment of toxoplasmosis during pregnancy: a multicenter study of impact on fetal transmission and children’s sequelae at age 1 year. Am J Obstet Gynecol 180:410
Gilbert RE, Gras L, Wallon M, Peyron F, Ades AE, Dunn DT (2001) Effect of prenatal treatment on mother to child transmission of Toxoplasma gondii: retrospective cohort study of 554 mother-child pairs in Lyon, France. Int J Epidemiol 30:1303
Jones JL, Kruszon-Moran D, Wilson M, McQuillan G, Navin T, McAuley JB (2001) Toxoplasma gondii Infection in the United States: seroprevalence and Risk Factors. Am J Epidemiology 54:357–365
Acknowledgments
This study is funded in part by grant UA6MC19010, through the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program.
Conflict of interest
Authors have no conflicts of interest.
Ethical standards
This manuscript does not contain clinical studies or patient data.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Davis, S.M., Anderson, B.L., Schulkin, J. et al. Survey of obstetrician-gynecologists in the United States about toxoplasmosis: 2012 update. Arch Gynecol Obstet 291, 545–555 (2015). https://doi.org/10.1007/s00404-014-3450-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-014-3450-y