Cats are all fine and good...until you're pregnant. If you've been a preggo who also harbors felines, then no doubt you've heard the constant warnings about how bad cats are for pregnant women. A lot of the fuss centers around a little parasite called toxoplasma gondii, which causes toxoplasmosis. Women are told many different things about handling cats during pregnancy - most of which are incorrect. The top "advice" is usually this:
- Don't ever touch your cat or breathe the same air as your cat when pregnant.
- Don't ever, ever change a litter box when you're pregnant.
- Get rid of all cats now that you're pregnant.
Before I get into some parasite particulars, I want to give you some background so you don't think I'm just someone with a bug up her butt about, well, butt bugs. In my real life, I am a Certified Veterinary Technician. No, I don't hold and cuddle puppies and kittens all day. I went through a 2.5 year college program, completed 15 weeks of externships, earned my Associates in Veterinary Technology, sat for a national board exam and passed and earned my license as a veterinary technician. I complete 16 hours of continuing education every two years in order to keep my license legal and up to date. I have twelve years of experience in veterinary medicine - 10 of those years licensed. I do get to pet puppies and kitties now and then, but I also take radiographs, draw blood, place IV catheters, administer medications and treatments, educate clients and the community, run laboratory tests such as routine and non-routine chemistries, urinalysis and other bloodwork such as CBCs. I administer and monitor anesthesia as well as assist doctors in surgery. Oh, there is so much more that we do. Veterinary technicians are unsung heroes of the veterinary world. Anyway, one of my specialties is laboratory medicine. That is, I'm a wiz with things involving blood, pee, poop and other goodies from the body. I'm great friends with the microscope. Parasitology is one of my favorite things and, ahem, I'm dang good at it. What is it? It's the study of parasites. In my day to day life in the vet tech world, I obtain fecal samples, prepare them and look at them under the microscope where I identify all sorts of little buggers that shouldn't be there. Toxoplasma gondii is just one of those little bastards.
T.gondii can infect any warm-blooded animal - including us humanfolk - and birds. The big fuss about cats comes from the fact that they are the only primary hosts. That is, they are the only animal that sheds the oocysts (zygotes wrapped in a comfy and protective shell) in their feces. Any mammal or bird can carry the oocysts, but those oocysts will only bump uglies with one another in the intestines of cats. It's a fun cycle. Little oocysts are hanging out in the soil or nature. An animal comes in contact with the oocyst and ingests it. Kitty eats the animal that ingested the oocyst. Or, baby kitty gets it from mama's milk. From there, the oocysts "hatch" in the kitty's intestine. They proceed to make love sweet parasite love and give birth to, you guessed it, more oocysts that are then passed into the cats poop. These little bastards are resilient. Cats will only pass them in their feces for a few weeks after their initial infection. In most cases, their bodies eventually get rid of the T. gondii invaders after those first few weeks. However, the oocysts can survive in soil for an average of 18 months, with many making it for several years. This brings us to the methods of infection for people...
It is understandable to assume that cats are your biggest risk since they are the primary host. This is incorrect. More than half of toxoplasmosis infection occur after handling raw meat. As I said, any mammal or bird can acquire toxoplasmosis. This includes the wide variety of animals that end up on our plates at the dinner table, especially lamb, venison and pork. Handling or consuming raw or undercooked meat is the biggest culprit in toxoplasmosis infections. To be safe, all meat should be cooked to 160 degrees (180 in poultry). I like jerky and I'm an advocate for raw milk, but both should be avoided during pregnancy due to the risk of transmission. Jerky is a risk because of the low heat typically used to create it. Raw milk, especially goat, is a risk as T. gondii is passed through mama milk. Most people won't even notice if they've become infected. Symptoms resemble a mild flu or even mononucleosis. Those most at risk are people with immuno-compromising conditions, including pregnancy. In those folks, the oocysts eventually settle in the tissues, especially the eyes and the brain in humans and the muscles in animals. In pregnant women, the oocysts can be transmitted to the baby via the placenta.
Another method of transmission is contaminated soil. This is where the oocysts hang out after being passed through the cat's feces. Adults and children who dig around, garden or play in the dirt are susceptible. T. gondii can survive the harshest weather conditions, so the risk is still present even during a snowy winter. Their presence in the soil can also lead to contaminated water (more of an issue in developing countries) or fruits and vegetables. Thoroughly washing any fruits and vegetables is key to preventing transmission this way. It can also be present in children's sandboxes - your friendly neighborhood stray may enjoy using the sandbox as a litter box. Sandboxes - oh, having a parasitology background can just skeeve you - are a prime habitat for parasites like T. gondii and it's friends - roundworm and hookworm.
Now it's time to talk about kitties. I've heard it all - I've heard people telling pregnant women that you can get it from petting cats, getting bit or being scratched. This is false. The primary source of infection is the cat's feces. You can't get it from bites, scratches or handling their urine or blood. This is the part where people tell you that if you're pregnant and you scoop litter you will just die right there on the spot. Seriously, I heard that once. Again, this is incorrect. When an infected cat poops, the oocysts are present in the poop. However, it takes anywhere from 24 hours to 5 days for those oocysts to sporulate - that is, they become infective to humans. If you're practicing proper kitty hygiene and scooping the litter box at least once a day then your chances of acquiring toxoplasmosis are about nil. If you let the poop sit in their for a few days until it gets to the point of being a bit dry then you up your chances of infection. Even then, you practically have to lick the poop to get it. There's no definitive research stating that you can get it through litter dust as you're scooping, so wearing a mask would be fine if it makes you comfortable.
But wait, is your cat even at risk? Cats at highest risk of carrying T. gondii are outdoor cats (that is, any cat who goes outside for any period of time - even if it's just to sit outside on the porch for 10 minutes) as they hunt and eat little rodents and birds and they come in contact with infested soil. New kittens are also high risk as they could have gotten it from mama. Most of the time, new kittens come to us from shelters or rescues, so we don't know if mom was a street cat. Cats who spend all of their time indoors are at the lowest risk. Very low. Now, if you have little mice sharing your home and your cat eats them, his risk increases slightly. There is also a slight risk that you could track T. gondii into your home on your shoes and kitty could become infected if he licks your shoes or the carpet where you walked. This is so rare, but I'm putting it out there as many people assume their indoor only cats aren't at risk for anything (you can also track in coccidia, giardia, roundworm, whipworm and hookworm - in case you already weren't feeling icky. Tell that to Flylady next time she insists you wear your shoes in the house from sun up to sun down).
How do you know if your cat has toxoplasmosis? In general, you don't. If your cat is healthy, he or she likely won't show any signs and will eventually rid their body of the toxoplasma. Young kittens and those with weaker immune systems are more susceptible. The most common signs would be a lack of appetite, lethargy and a fever. In severe cases, cats will show neurologic signs (changes in personality, dizziness, blindness, seizures...). You can test for toxoplasmosis. It takes from 3 days up to 2 weeks for it to show up in fecal and blood tests. Fecal tests are okay, but not preferred. While the cat sheds millions of the oocysts in their feces, they are often missed during fecal examinations. The oocysts look a lot like little air bubbles and even coccidia or giardia. Staff that isn't adequately trained or those using poor equipment may miss these little guys on the microscope. In addition, cats only shed the oocysts for a brief time during the infection, so they may not be present in the feces. The best test is a blood test that looks for antibodies - IgG and IgM. This test will indicate if your kitty has acquired toxoplasmosis and if he or she has an active infection or was exposed in the past and is now immune. If your kitty has it, the vet may tell you that he doesn't need treatment as most cats get through it just fine. However, as a preggo, you may opt for treatment. Treatment can include a few different drugs, the most common being the antibiotic Clindamycin, which acts as an anti-protozoan in this case.
So, to recap, you are most likely - here in America and in other developed nations - to acquire toxoplasmosis via the handling or consumption of raw and undercooked meats. Gardening or handling soil also puts you at risk. The hype about cats being a giant risk is just one big overinflated myth that has led to the unnecessary deaths of many cats (being put in shelters and then euthanized after owners become pregnant). Good hygiene is key to keeping yourself safe.
- Always wash anything that comes into contact with raw and undercooked meats - your hands, all utensils and cookware, cutting surfaces and counters.
- Freezing your meats for 2 to 3 days before use can reduce, but not eliminate, your risk of toxoplasmosis.
- Cook meats thoroughly to 160 F (180 F if it's poultry). Experts recommend letting the meat sit for three minutes after cooking to insure proper temperature distribution.
- Wash your hands. Wash your hands. Wash your hands.
- Wear gloves when working in the garden. Wash hands afterwards.
- Wash hands after handling soil.
- Thoroughly wash all fruits and vegetables, including those that you grown on your own.
- Use caution when handling kiddie sandboxes. If you own it, keep it covered when not in use in order to prevent neighborhood kitties from using it as a litter box.
- Scoop cat litter daily. <------will also help eliminate kitty bathroom behavior problems.
- Be careful not to touch your face while scooping the litter. Wash your hands after scooping the litter.
- Wash your hands. Wash your hands. Wash your hands.
- Do not lick the cat poop.
- It's fine to wear gloves and/or a mask while scooping cat litter if that makes you feel more comfortable.
- Keep your kitties indoors to lower their risk of infection. Be mindful of tracking soil through the house on your shoes.
- Don't feed kitty an raw or undercooked meat.
- Make sure kitty has a check up once a year at the veterinarian and ask for a fecal test. If you are extra concerned about toxoplasmosis, request an antibody test.
- Your midwife, family doctor, or OB can perform an antibody blood test for toxoplasmosis when you go in for your first check up. This will let you know if you've been exposed and if it's an older exposure or if it's an active infection. And older exposure would mean, in most cases, that you are immune.
- Wash your hands. Wash your hands. Wash your hands. (with NON antibacterial soap)
Finally, take my experience. I have worked in veterinary medicine for 12 years and have had 6 kitties in that time - 5 of whom are living today. I have changed and cleaned thousands of litter boxes. I have handled thousands of kitty poop samples. I have only seen toxoplasmosis (and I do know how to distinguish it from other parasites) three times in 12 years. Twice in cats and once in a monkey (yeah, monkey shit it the most vile substance on the planet, fyi). I get myself tested for toxoplasmosis during pregnancy and in between. I've never tested positive for it. That's been the experience of many of my fellow veterinary colleagues.
I hope this takes away some of the fear regarding cats in pregnancy. I mean it when I say that a lot of cats have been given up and/or just plain euthanized when an owner becomes pregnant because there is so much misinformation out there. Now go hug your kitty.