Oxford Handbook of Midwifery by Janet Medforth, Sue Battersby, Maggie Evans, Beverley Marsh, Angela Walker Page A
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suppressed immune response in pregnancy, the bacteria can cross the placenta. Infection during pregnancy is serious and can lead to spontaneous abortion, stillbirth, preterm labour, congenital infection, or infection after birth. Affected babies often develop pneumonia, septicaemia, or meningitis, depending on when the infection occurred. Case studies of pregnancies complicated by listeriosis report a history of having had a flu-like illness up to 2 weeks before the onset of labour, and of eating soft French cheeses, pre-packaged salads, or pre-cooked chicken.
Advice from the Department of Health 1 for vulnerable groups includes the following:
Avoid mould-ripened cheeses, such as Brie and Camembert, and blue- veined cheeses, such as Danish Blue or Stilton.
Avoid meat, fish, or vegetable pâté, unless it is tinned or marked pasteurized.
Thoroughly re-heat cook-chill foods and ready-cooked poultry.
Toxoplasmosis
Toxoplasmosis is an infection caused by the parasite Toxoplasma gondii , a microscopic, single-celled organism that can be found in raw and inad- equately cooked/cured meat, cat faeces, the soil where cats defecate, and unpasteurized goats’ milk. Infection is often asymptomatic, although if symptoms do present, they are of a mild flu-like illness. Infection produces lifelong immunity. It is predicted that 30% of people will have had toxo- plasmosis by the age of 30 years.
Vulnerable groups are babies, the elderly, immunocompromised individuals, and pregnant women. The risk of vertical transmission ranges from 15% in the first trimester to 65% in the third trimester. 2 If the infection is contracted during the first trimester of pregnancy, then severe fetal damage is likely and may result in miscarriage or stillbirth. If it is contracted during the third trimester, then the risk of the fetus being infected is higher. Babies with congenital toxoplasmosis may develop encephalitis, cerebral calcification, convulsions, and chorioretinitis.
Immune status can be determined by serological screening, although routine testing in the UK is not offered, as it is predicted that 80% of women would be negative. 3 If infection during pregnancy is suspected, blood tests for antibodies will be able to detect whether the infection is recent, and amniocentesis or cordocentesis will determine whether the fetus is affected. Management may include antibiotic therapy. Termination of
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pregnancy may be offered when there is evidence of fetal damage or infection.
Avoiding the infection is the simplest and best way to prevent congenital toxoplasmosis; therefore the following advice should be given to pregnant women:
Only eat well-cooked meat which has been cooked thoroughly right through (i.e. no traces of blood or pinkness).
Avoid cured meats such as Parma ham.
Wash hands and all cooking utensils thoroughly after preparing raw meat.
Wash fruit and vegetables thoroughly to remove all traces of soil.
Take care with hygiene when handling dirty cat litter. Wear rubber gloves when clearing out cat litter and wash hands and gloves afterwards. If possible, get someone else to do the job.
Cover children’s outdoor sandboxes to prevent cats from using them as litter boxes.
Wear gloves when gardening and avoid hand-to-mouth contact. Wash hands afterwards.
Avoid unpasteurized goats’ milk or goats’ milk products (although this route of transmission is rare).
Avoid sheep that are lambing or have recently given birth.
There is no contraindication to breastfeeding by a woman who has, or is undergoing treatment for, toxoplasmosis.
Vitamin A
Vitamin A is a fat-soluble vitamin that is essential for embryogenesis, growth, and epithelial differentiation. The retinol form of vitamin A is found chiefly in dairy products such as milk, butter, cheese, and egg yolk, some fatty fish, and in the liver of farm animals and fish. Experiments in animals have shown that retinoids, but not carotenoids, can be teratogenic. 4
A high dietary intake of vitamin
Advice from the Department of Health 1 for vulnerable groups includes the following:
Avoid mould-ripened cheeses, such as Brie and Camembert, and blue- veined cheeses, such as Danish Blue or Stilton.
Avoid meat, fish, or vegetable pâté, unless it is tinned or marked pasteurized.
Thoroughly re-heat cook-chill foods and ready-cooked poultry.
Toxoplasmosis
Toxoplasmosis is an infection caused by the parasite Toxoplasma gondii , a microscopic, single-celled organism that can be found in raw and inad- equately cooked/cured meat, cat faeces, the soil where cats defecate, and unpasteurized goats’ milk. Infection is often asymptomatic, although if symptoms do present, they are of a mild flu-like illness. Infection produces lifelong immunity. It is predicted that 30% of people will have had toxo- plasmosis by the age of 30 years.
Vulnerable groups are babies, the elderly, immunocompromised individuals, and pregnant women. The risk of vertical transmission ranges from 15% in the first trimester to 65% in the third trimester. 2 If the infection is contracted during the first trimester of pregnancy, then severe fetal damage is likely and may result in miscarriage or stillbirth. If it is contracted during the third trimester, then the risk of the fetus being infected is higher. Babies with congenital toxoplasmosis may develop encephalitis, cerebral calcification, convulsions, and chorioretinitis.
Immune status can be determined by serological screening, although routine testing in the UK is not offered, as it is predicted that 80% of women would be negative. 3 If infection during pregnancy is suspected, blood tests for antibodies will be able to detect whether the infection is recent, and amniocentesis or cordocentesis will determine whether the fetus is affected. Management may include antibiotic therapy. Termination of
FOOD SAFETY
89
pregnancy may be offered when there is evidence of fetal damage or infection.
Avoiding the infection is the simplest and best way to prevent congenital toxoplasmosis; therefore the following advice should be given to pregnant women:
Only eat well-cooked meat which has been cooked thoroughly right through (i.e. no traces of blood or pinkness).
Avoid cured meats such as Parma ham.
Wash hands and all cooking utensils thoroughly after preparing raw meat.
Wash fruit and vegetables thoroughly to remove all traces of soil.
Take care with hygiene when handling dirty cat litter. Wear rubber gloves when clearing out cat litter and wash hands and gloves afterwards. If possible, get someone else to do the job.
Cover children’s outdoor sandboxes to prevent cats from using them as litter boxes.
Wear gloves when gardening and avoid hand-to-mouth contact. Wash hands afterwards.
Avoid unpasteurized goats’ milk or goats’ milk products (although this route of transmission is rare).
Avoid sheep that are lambing or have recently given birth.
There is no contraindication to breastfeeding by a woman who has, or is undergoing treatment for, toxoplasmosis.
Vitamin A
Vitamin A is a fat-soluble vitamin that is essential for embryogenesis, growth, and epithelial differentiation. The retinol form of vitamin A is found chiefly in dairy products such as milk, butter, cheese, and egg yolk, some fatty fish, and in the liver of farm animals and fish. Experiments in animals have shown that retinoids, but not carotenoids, can be teratogenic. 4
A high dietary intake of vitamin
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