Maternal toxoplasmosis and adverse pregnancy outcomes

Background: Although toxoplasmosis is considered a mild health problem, women infected during pregnancy, especially during first trimester, may be at higher risk of adverse perinatal outcomes. Methods: We conducted a population-based, retrospective cohort study on infants born alive to Florida-resident women from 1998-2009 (N=2,328,630) using a linked dataset. Maternal toxoplasmosis was identified using International Classification of Diseases, 9th Edition (ICD-9) diagnosis codes of 130.0 through 130.9. Socio-demographic and perinatal outcomes were collected from birth certificates and ICD-9 codes, respectively. Descriptive statistics were used to compare characteristics of women with and without toxoplasmosis. Logistic regression was used to assess the association between toxoplasmosis and selected adverse birth outcomes. We also assessed maternal/infant hospitalization charges by toxoplasmosis status. Results: The rate of toxoplasmosis was 2.75 per 100,000 live births. Highest rates were observed in Hispanic women, born in Central/South America, of advanced age (>35), nulliparous, with lower education, and who used alcohol, tobacco, and/or drugs. Women diagnosed with toxoplasmosis were more likely to have inadequate antenatal care, pregnancy-related complications, undergo cesarean section, and give birth to an infant that was preterm (odds ratio [OR]: 1.74), low birth weight (OR: 1.57), small-for-gestational age (OR: 1.71) or born with a birth defect (OR: 1.93). The median, per-patient maternal and infant hospitalization charges at birth for a mother with toxoplasmosis were higher those without toxoplasmosis (maternal: $10,632 vs. $9,286, p=0.02; infant: $2,436 vs. $1,882, p<0.01). Conclusions: Toxoplasmosis during pregnancy is associated with adverse fetal birth outcomes and increased cost of maternal and infant inpatient care.