Each month we will bring you a feature on current issues and an update on the research that is going on. Drop us an email if you'd like us to cover a particular topic!

A.Many women, and more women than men, suffer from migraine so this is a question frequently asked. Migraine should be distinguished from more common tension headaches. Migraine causes a throbbing, one-sided headache. The name Migraine is derived from the Greek words hemi and kranion meaning half the skull, reflecting that the headache is on one side of the head only. The headache is often accompanied by sweating, nausea and vomiting and light tends to make it worse, so your natural instinct is to find a dark room. Many women get warning of impending migraine as they get a visual disturbance with flashing lights or wavy lines. Sometimes strange sensations or ringing in the ear or a feeling of dizziness herald an attack. The true mechanism of migraine is unknown, but Doctors have found that it is related to changes in the blood vessels supplying the brain. These seem to open up more during an attack. In some cases the tendency for migraine seems to run in families. Interestingly women who suffer from migraine have a higher chance of developing pre-eclampsia in pregnancy (a condition where there is disturbance of the blood vessels leading to high blood pressure, kidney upset and sometimes damage to the afterbirth), although Doctors do not fully understand this link. However, in over half of women who suffer from migraine it actually improves during pregnancy. You should be aware that some of the medication used to treat and to prevent migraine attacks is not advised when you are pregnant, so it is important to consult your Doctor or pharmacist before taking any of these medications. Paracetamol is not associated with any problems for the baby in pregnancy and so is safe to use for treatment although again you may wish to discuss this with your Doctor. Some anti-nausea medications are also safe. For prevention of attacks low doses of aspirin (60-75mg) can be effective and there is good evidence from large trials that this has no harmful effect on the pregnancy. Other medications that can be used in pregnancy are available to prevent attacks, but these need to be prescribed by a Doctor. If you are a migraine sufferer consult your Doctor about your medication before you get pregnant. This will allow your therapy to be adjusted if required and will also allow you to have a supply of suitable medication to treat an attack if you have one while pregnant. One final point is that women with migraine should not take the combined (estrogen) containing oral contraceptive pill.

Toxoplasma Infection in Pregnancy: The main source of infection is undercooked, raw and cured meat not cats

Recent research has shown that Toxoplasma infection in pregnancy is most commonly due to eating raw, undercooked or cured meat and from contact with soil. Contact with cats was not found to be an important risk factor. Avoiding undercooked meat, washing all fruit and vegetables before eating and avoiding contact with soil can help prevent Toxoplasma infection.

Toxoplasma is an organism called a protozoan that usually lives in cats. It is excreted in cat faeces so litter trays are potentially a source of infection. Contaminated meat and soiled vegetables are also sources of infection. Furthermore the organism can remain viable in soil for many months. Toxoplasma infection, passed from the mother to the developing baby in the womb, can be a cause of serious abnormalities in the baby. It is uncommon for babies to be infected. Only about 1-10 in every 10,000 newborn babies in Europe will be found to be infected. Overall about 70% of these infected babies will have no problem, the others will have eye problems and a small number will have similar problems to those seen with German measles infection. Infection in early pregnancy can sometimes cause miscarriage. Infection rates in adults vary from country to country. In the UK about 10% of pregnant women will have evidence of past infection, while in France and Greece over 50% will have been previously infected. In adults infection is usually symptomless or mild. Infection should be considered in pregnant women with a mild flu-like illness and a blood test checked for Toxoplasma if this is a possibility. Infection of the baby is more likely to occur in later pregnancy, but the risk of damage at this stage is less than in early pregnancy. The infection can be treated with an antibiotic called spiramycin. Some countries like France and Austria offer maternal screening for Toxoplasma to all pregnant women. If the baby is at risk it will require regular ultrasound examinations and sometimes samples of the baby’s blood or amniotic fluid are required to diagnose infection.



The best way to deal with Toxoplasma is clearly to avoid being exposed to the risk of infection in pregnancy. To do this Doctors need to identify the risk factors for infection. This will enable women to avoid these risks in pregnancy. Although traditionally linked with cats, recent research has shown that the main source of infection is actually from eating raw or undercooked meats. This research study was carried out in 6 large European cities, Naples, Lausanne, Copenhagen, Oslo, Brussels and Milan and was published in the British Medical Journal earlier this year*. Pregnant women in these centres were screened for Toxoplasma infection using a blood test. Those with evidence of infection, 252 in all, were compared with 858 women who showed no evidence of infection in pregnancy. The researchers were able to identify risk factors for infection from interviewing these women. The main risk factors were eating undercooked meat –lamb, beef or game, contact with soil, and travel outside Europe and North America. Up to 63% of infections were attributed to eating undercooked meats including cured pork products, and up to 17% with contact with soil. Farm animals are more likely to be infected if they are farmed outdoors and obviously this also depends on farm hygiene. Freezing meat is important as this kills the Toxoplasma organism so reducing the risk of infection. Contact with cats, kittens and cat’s litter was not a significant risk factor in this research study. This may be because cats only excrete Toxoplasma in their faeces for the first 2 weeks after they have been infected for the first time. As the organism can remain viable for long periods of time in soil, contact with contaminated soil appears to be more of a problem than infected cats. Many of the women in this study were not aware of important risk factors for Toxoplasma infection. This indicates a need for better health information being provided for pregnant women.



The researchers were able to recommend that measures to prevent Toxoplasma infection should include better labelling of meat products to reflect the farming and processing methods, better information provided to women about the risk factors for infection, and attempts to reduce the levels of infection in meat. The key practical messages for pregnant women are 1) to avoid eating any meat that has not been thoroughly cooked, 2) ensure that you wash your hands thoroughly after handling raw meat, 3) wash all fruit and vegetables before eating, 4) avoid unpasteurised milk or milk products made from unpasteurised milk, and 5) avoid direct contact with soil while pregnant.

*Reference: Cook AJC et al (2000) Sources of Toxoplasma infection in pregnant women: European multicentre case-control study. British Medical Journal, volume 321, pages 142-147.