Abstract
BackgroundCongenital toxoplasmosis is associated with severe complications. German state health insurance covers rubella, but not toxoplasmosis, immunity screening. We analysed the effect of socioeconomic factors on the efficiency of private toxoplasmosis screening during pregnancy.MethodsToxoplasmosis and rubella screening data (n = 5402 mothers) were collected within the population-based Survey of Neonates in Pomerania (SNiP).ResultsAt the first-trimester screening, 34.4 % (88.1 %) of expecting mothers were immune to toxoplasmosis (rubella). Susceptibility for toxoplasmosis (rubella) was observed in 39.6 % (8.9 %) and 25.8 % (2.95 %) were not tested. Data on a 2nd screening were available in a subgroup of women with negative immunity showing less than 45 % participation rate. Active toxoplasmosis (no rubella) infection was observed in 0.3 % (n = 17) of pregnant women. A multiple logistic regression model (AIC = 719.67; AUC = 0.725) revealed that the likelihood of participating in a second toxoplasmosis screening increased among women with a good level of education and a steady partnership and decreased with paternal unemployment and the absence of breastfeeding. The highest probability of non-participation in toxoplasmosis screening was found among women with temporal burden and family responsibilities. A cost-benefit analysis showed that covering general screening for toxoplasmosis with health insurance saved costs.ConclusionToxoplasmosis carried a substantial risk of infection during pregnancy. Although increased socioeconomic status was positively associated with the participation in toxoplasmosis screening, this was not the case when pregnant women had strong temporal burden and family responsibilities. This data supports the need for toxoplasmosis screening among pregnant women as a general healthcare benefit covered by insurance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0966-0) contains supplementary material, which is available to authorized users.
Highlights
IntroductionGerman state health insurance covers rubella, but not toxoplasmosis, immunity screening
Congenital toxoplasmosis is associated with severe complications
When socioeconomic factors were viewed as cofounders, the likelihood of participating in a second toxoplasmosis screening increased among women with a good level of maternal education and a steady partnership
Summary
German state health insurance covers rubella, but not toxoplasmosis, immunity screening. The overall rate of toxoplasmosis infection during pregnancy varies from 1 to 120 per 10,000 births, depending on environmental conditions [1, 2] the German Ministry of Health reported eight cases of acute gestational toxoplasmosis infection in 2009, higher rates seem likely [3]. During the first two trimesters, acute toxoplasmosis infection is characterised by septic symptoms, hepatosplenomegaly, thrombocytopenia, hyperbilirubinemia, and central nervous system infections [1, 7, 8] The latter typically present with encephalitis in combination with retinochorioiditis, hydrocephalus, intracranial calcifications, microphthalmia, and microcephaly, as well as calcifying necroses developing from reactive inflammations, to the point of spontaneous abortion [9]. T. gondii infections are mostly asymptomatic in adults and immunocompetent individuals; acute infections during pregnancy usually go unnoticed [8, 14]
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