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Dr. Coates is a veterinarian based in the other “Sunshine State” – that's Colorado to the rest of you – where she lives and plays with a varied range of animals. She shares her professional and personal experiences, Monday through Friday, here on petMD's blog, the Fully Vetted. Log in for your daily dose of her insight and wisdom.

 

How to manage your pregnancy AND live well with pets (Part 2)

January 30, 2009 / (24) comments


No, you don’t have to get rid of your pets during your pregnancy. You don’t have to fear interacting with them as you did before you conceived. I don’t care what your OB/Gyn says. I respond to a higher authority...the CDC (Centers for Disease Control and Prevention). 

 

The CDC has issued statements that reflect the most well-reasoned recommendations for the prevention of infectious diseases. I would have a hard time trusting any physician who issues proclamations in contravention of its sage, science-based advice.

 

The following discussion of points 7 through 10 on my ten-point checklist for living well with pets during pregnancy is based on the CDC’s official statements...with some references, in case you’d like to print them out and ask your doc about them.

 

7. Cat diseases

 

Here’s where some docs spin their wheels. It’s the issue of Toxoplasma, a protozoan parasite whose fetus-harming potential is legendary. Because cats are a host and a vector, it’s important to stay away from their stool once it’s 24 hours old. Because it’s the most contentious issue, I’ll included the CDC’s recommendations, verbatim:

 

"Do I have to give up my cat if I'm pregnant or planning on becoming pregnant?"

No. You should follow these helpful tips to reduce your risk of environmental exposure to Toxoplasma.

  • Avoid changing cat litter if possible. If no one else can perform the task, wear disposable gloves and wash your hands thoroughly with soap and water afterwards.
  • Change the litter box daily. The Toxoplasma parasite does not become infectious until 1 to 5 days after it is shed in a cat's feces.
  • Feed your cat commercial dry or canned food, not raw or undercooked meats.
  • Keep cats indoors.
  • Avoid stray cats, especially kittens. Do not get a new cat while you are pregnant.
  • Keep outdoor sandboxes covered.
  • Wear gloves when gardening and during contact with soil or sand because it might be contaminated with cat feces that contain Toxoplasma. Wash hands thoroughly after gardening or contact with soil or sand.”

 

Notice that the CDC recommends we keep cats indoors, in direct contravention to what some physicians urge. Indoors is safer for us and for them, too. That way they won’t be running about picking up new infections.

 

In this section I’ll also quote Megan (a Dolittler reader who will imminently enter the supply of veterinarians once she graduates in May):

 

“Here's the deal with toxo. Only a cat who has recently acquired toxoplasma sheds the oocysts (infectious eggs). The cat sheds the eggs for 2 to 3 weeks following an infection, and then the parasite encysts in the tissues of the cat's body, where it remains inactive (although there are rare reports of immunosuppressed cats that have resumed shedding oocysts).

 

The way that a fetus is affected by toxoplasma DUE TO CAT EXPOSURE is if a) the mother is exposed to a cat that is actively shedding oocysts AND b) the mother has never before been exposed to toxoplasma. 

If you are a woman who is concerned about toxo, you can go to your doctor and have a toxo titer drawn (because there is no risk to your fetus if you have already been exposed prior to pregnancy). 

You could also have your cat tested at the vet for a toxo titer, which could give you an idea of if and when your cat was exposed. Detection of one kind of antibody against toxo indicates that the cat has an active infection, while detection of another indicates that the cat had an infection in the past and is unlikely to be actively shedding oocysts.

The primary means of Toxoplasma infection in humans [is by] eating undercooked (or uncooked) meats containing toxoplasma cysts or [by] contact with soil contaminated with oocysts.”

Thank you, Megan. Couldn’t have said it better. I’ve said it before: I hope whoever hires you when you graduate pays you A LOT. 

 

8. Dog (and other pet) diseases

 

In this section I’ll simply reiterate some of the raw meat points made above: Don’t handle raw meats if this is what you feed your dogs. Or, if you, do, wear gloves or wash your hands thoroughly. Alternatively, you can take Megan’s advice to see if you’ve already been exposed to Toxoplasma. If you have you can practically handle raw meats with impunity. 

 

Stool, however, may still present an issue in dogs and cats infected with roundworms, Salmonella, Campylobacter, Giardia or Cryptosporidium. Because a fetus’s immune system is not fully developed and because a pregnant woman may be immunosuppressed, these more common, fecal-oral route infections may present a problem. 

 

Again...just don’t play with stool and wear gloves or wash your hands after gardening. And take any pets with diarrhea to the vet to have them checked out. OK?

 

Then there’s the issue of ringworm and mange. I’ve had cause to find that both of these common skin infections (in dogs or cats) are more likely to manifest in pregnant women and immunosuppressed clients than in other humans. No, they won’t maim your unborn but they may give you a horrible case of the itchies and unsightlies. Take your pet to the vet at the first sign of a skin lesion and seek out a dermatologist if any appear on you. 

 

Ideally, your pets should be seen by a veterinarian if you’re working on getting pregnant.  At minimum, consider taking in a stool sample for examination. 

 

Finally, I should mention the issue of rodents (mice, hamsters, rats and guinea pigs) and the Lymphocytic Choriomeningitis Virus (LCMV). Infection with this lesser-known virus can cause birth defects and miscarriage. That’s why the CDC recommends you leave these pets in the care of someone else or in an isolated room while you’re pregnant. Someone else should clean out the bedding, as it can be aerosolized in the bedding material. Here’s more info from the CDC on this.

 

9. Pet products and medications

 

Though we’re not sure what many veterinary medications and products can do to harm an unborn baby, the key is to play it safe. Don’t handle any parasitacides and/or insecticides directly (heartworm drugs, flea and tick meds, etc.). Wear gloves. Don’t touch any area where it’s been applied for at least 24 hours. And ask your veterinarian whether you need to be especially careful with eye drops, ear meds or any other drug. 

 

Recognize that some drugs (like cyclosporine eye drops) can be harmful (under any condition, not just when you’re pregnant) and you should know! Ask!!

 

 

10. Safe baby prep

 

The problem of pregnancy and pets, from a veterinarian’s point of view, is not only that many recommendations strike fear, unnecessarily, into the heart of a pet’s family. It’s that this fear sets up conditions whereby our pets are more readily marginalized when “the real baby” arrives. That means more pets surrendered to shelters or left to fend for themselves out of doors.

 

Many families assume that their pets will be a hazard to their children and they take steps to isolate them from the center of the household. But our pets are unlikely to become a serious liability to the baby as long as we’re careful about bringing baby into the fold. 

 

There’s a lot of information out there on how to prepare your pets for the arrival of a baby in the household. One of the most complete online resources for these issues may be found at Dogs & Storks, a blog that details baby and pet interaction issues with regularity. 

 

That’s my top ten...any more you want to add?

 

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COMMENTS (24)
1
by on 08/07/2009 06:18pm

Hi-


 


We recently added to our family with our son, Riley. We have two cats that we had previously adopted from a shelter. We generally keep our home clean and change the litter box regularly. When we found our we were pregnant, we actually were using an automatic litter box. My husband changed the trays regularly, and I wasn't extremely worried about Toxoplasma when I did deal with the box. A scoopfree (scoopfree.com) might be something for a pregnant woman to look into, especially if she is the sole litter box cleaner. If you use as directed, your contact with litter is very minimal... you would really just have to lift the box and take the tray to the trash before preparing a new tray. (and if you put the lid on the tray, you really should have no reason to be in contact with used litter). Just my two cents! :)

2
by on 01/31/2009 06:54pm

Regarding the risk of fetal infection in women who had  documented Toxo prior to pregnancy: There have been cases of reactivation during pregnancy, with consequences for the fetus. The risk is probably much <1% but not zero. Unfortunately there is at present no good way of monitoring for reactivation. Antibody titers are said not to be useful.

3
by on 01/31/2009 04:48pm

Thanks, Dr. K., for response on the cyclosporine. I have no worries, I'm long past child-bearing years!


Barbara Albright/NH

4
by on 01/31/2009 11:56am

Sorry for not getting back to the cyclosporine issue sooner. Cyclosporine is a chemotherapeutic drug with strong immunosuppressive side effects. In the oral form (as in Atopica) the pill is completely covered in a gelcap and cannot harm you when you touch it. When it's in eye drops, however, it can be absorbed by the skin of the person instilling the drops. NOT good for a rapidly dividing early embryo.  

5
by on 01/31/2009 01:06am

khatti,  When my son was born last winter, our dearly beloved Psycho Kitty instantly decided she was his mother.  If she didn't think I was doing a good job, she would nip my ankles.  She too did the attempt to pick up baby and, when he was learning to roll over, would bat at his head like she was trying to help him.  But the funniest thing of all was the evening I was helping my husband get ready for work and our son was lying on his blanket fussing.  Psycho Kitty went over, stretched herself out close by, and started making that mewing noise momma cats make when the milk bar is open.  (This is a spayed cat who has never had kittens, fyi).  A year later, we still laugh about that night.

6
by on 01/30/2009 11:40pm

What a great post. I can't tell you how many times I look on in astonishment when a pregnant client breezily tells me that her OB told her she might consider getting rid of her cat, even now, with all we know. I think I should bookmark this and the CDC link to hand out. :)

7
by on 01/30/2009 09:46pm

On raw feeding of dogs and those with compromised immune systems (does that include pregnant women?), I've read that some additional care should be taken but not because of toxo.  My understanding is that the concern is over salmonella and other stuff that won't affect the dog but could subsequently affect the person with the compromised immune system because the pet is then carrying the hazard all over the house.  http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=339295  (Sorry, not well written, tired tonight.)


Doc, thanks for the reference link :)

8
by on 01/30/2009 09:08pm

I'd like to know about the cyclosporine eyedrops. I administered them to my old dog for quite sometime. I know they are immunesupressor, but what can it realistically do if tiny amounts are absorbed on hands?


A real "biggie" in New Hampshire would be the dreaded Leptospiros.....seems it is really emphasized, HOWEVER, no or zero positive reports of the disease have ever been reported by ANY media sources. And for such "high" risk, it is not even listed as a "reportable disease" to the Agriculture Dept. or State Veterinarian.


Apparently, this is a big "concern" in Massachusetts, according to one vet, no reports in that state either!


Would this be a rational fear for a pregnant woman?


Barbara A. Albright/NH

9
by on 01/30/2009 07:01pm

"Recognize that some drugs (like cyclosporine eye drops) can be harmful (under any condition, not just when you’re pregnant) and you should know! Ask!!"


Dr. K. - how (and when) is cyclosporine harmful - is it just the eye drops (a friend is using it orally for a cat with derm problems, and there were no warnings given to her about this drug.

10
by on 01/30/2009 05:51pm

Sorry about all that extraneous stuff!

11
by on 01/30/2009 05:49pm

<!-- /* Font Definitions */ @font-face {font-family:"Arabic Typesetting"; panose-1:3 2 4 2 4 4 6 3 2 3; mso-font-charset:0; mso-generic-font-family:script; mso-font-pitch:variable; mso-font-signature:-1610604433 -1073741824 8 0 211 0;} @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:-1610611985 1073750139 0 0 159 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> Just out of curiosity, regarding toxoplasma..


In the case of immunosuppressed cats who test positive for prior exposure, is it sufficient to keep visitors who are expecting away from the litter boxes, or should they steer clear of the cat as well? I've always opted to err on the side of caution on this one, which sometimes annoys friends and relatives.




12
by on 01/30/2009 04:28pm

khatti: My mother has similar stories of our cat Marsha in my crib. She couldn't get her out and eventually gave birth to her kittens there. Whenever my mother would try to relocate everyone she'd move 'em all back. Luckily my mom is not your typical Cuban mother. She eventually gave up trying to keep us all apart. Family lore subsequently dictates that I was destined to be a veterinarian from birth.

13
by on 01/30/2009 04:24pm

Yeah, the CDC recommends "officially" that women should not handle raw or undercooked meat without gloves. But given that hand washing is also recommended after gardening, it seems like the rule is a little flexible. "Use common sense" should be the party line. But that's not so easily understood, as we all well know. 

14
by on 01/30/2009 03:54pm

When I had both of my kids (15 months apart) I was actively showing and breeding cats. We normally had from 8 to 12 cats running around the house the entire time. My husband graciously took over the litter box chores. I was making a lot of my own cat food at the time from raw mixes made especially for cats that we could buy from meat packers---but don't remember if I was doing that during my pregnancy or not. Doubt it---I was tired!  My OB/GYN was not the alarmist type and seemed to have no problems with my cats at all.  And once the kids were born, my pediatrician was totally in to having kids raised with lots of animals. I brought up the subject of potential allergies once and he said no way should I ever consider getting rid of my pets (not that I would have anyway).  I was lucky to have awesome doctors!


What I noticed was that cats really didn't like to get too close to the babies. Babies move suddenly and with very little purpose at first. They twitch and flail around. Cats aren't real fond of stuff like that. If a cat ever got into the cradle with one, it would be sleeping safely at the foot---safely away from the jumpy baby. And if the baby was on the floor, sitting on a blanket, there would be cats curled up on all four corners. Cats do love the soft bedding that accompanies babies, but getting too close to babies, not so much.


One funny story. We had a cat named Butterball. She was born maternal---I think she was allowing other cats' kittens to nurse on her when she was 6 months old. She just loved baby things! She was the one that kept an eye on my son when he was first born---and who slept at the foot of his cradle. One day he started to cry...I was in the kitchen heating up his bottle and Butterball came running in---totally wild eyed. "Do something" she was saying. She would look at me and look at my son.  And when I didn't move fast enough she ran over to him and tried to pick him up! It looked like she was trying to bite his head---but I knew she would never do that---she just tried to put her jaws carefully around his head and carry him like a mom cat would. It was the strangest thing I had ever seen. Of course her efforts were doomed to failure, which she quickly figured out---so she continued to pester me until I got him fed.


BTW, I did get a toxo screen and it was positive---more than likely from the blood rare steaks I had been eating all my life.


 


khatti

15
by on 01/30/2009 03:18pm

I wouldn't be too quick to recommend taking Toxo titers.
First reason is that if you are negative and you are the worrying type, you *will* spend the rest of your pregnancy worrying about getting infected (just because irrational worrying is something you do when pregnant).
Second: how long does it take for titers to become positive post-infection? I have no idea, but I have the feeling it takes a while, like several weeks.
As for raw feeders, I'd be more afraid of other types of infection, such as Campylobacter from chicken and Salmonella from just about anything.
I wouldn't stop preparing or cooking, but I'd wash my hands an awful lot more often, and not because of Toxo.

16
by on 01/30/2009 02:31pm

I'm so honored to be quoted! I'd love it if someone paid me lots of money someday, but it won't be for a little while yet- I don't graduate until May of 2010. I still have to get through clinics!


H. Houlahan, I think the issue with feeding raw food is that, if you feed your cat something raw that contains toxo cysts, and the cat has never been exposed before, then the cat will shed oocysts, and if you've never been exposed, then you could get the infection and pass it on to your fetus. There are a lot of "if's" in there, of course, but it's a risk. Again, checking titers (of cat and mom) could help put fears to rest. If I remember correctly, freezing meat for 24 hours will kill tissue cysts, so that could be a good preventative measure for raw feeders.

17
by on 01/30/2009 01:49pm

"Recognize that some drugs (like cyclosporine eye drops) can be harmful (under any condition, not just when you’re pregnant) and you should know! Ask!!"

Dr. K. - how (and when) is cyclosporine harmful - is it just the eye drops (a friend is using it orally for a cat with derm problems, and there were no warnings given to her about this drug.

18
by on 01/30/2009 01:03pm

I'm not sure why raw feeders should have to stop feeding raw.


It's not like they are eating raw meat themselves.


I handle raw meat when I prepare it for my animals -- AND when I get ready to cook for humans.


Are doctors telling pregnant women to stop cooking?


Just normal food-safety handling should be adequate.

19
by on 01/30/2009 01:01pm

PJBoosinger: Here's an excellent resource (aimed at physicians) for antibody detection and Toxoplasma. Hope this helps.

20
by on 01/30/2009 12:28pm

How about birds and rabbits?


Any chance of talking you out of the IGG/IGM/IGA reference ranges for toxo and which one shows active v. past infection?  (I ask because I've seen docs lie to support their recommendation to get rid of pets.)

21
by on 01/30/2009 11:54am

Thanks brebis noire...good thing my goats can't harm the unborn that will no longer reside in my belly. 


And Stefani: You can still feed raw if you're careful. I'd wear gloves. 

22
by on 01/30/2009 11:45am

Although most people don't have goats (or sheep) as pets, it's worth it to mention that there are a variety of miscarriage-causing potential diseases with these animals, such as Q fever.

23
by on 01/30/2009 11:32am

Yes, Megan's post was terrifically informative and educational.

So, I gather that "raw feeders" are advised to stop raw feeding during pregnancy?

24
by on 01/30/2009 11:19am

I followed all of Megan's recommendations 12 years ago when I was a vet student and pregnant with my first kid.
I had a few cats at the time, some indoor, some outdoor - and they were never my biggest worry.
My biggest worry was all the other cats I DIDN'T know about who may have been infected, and who may have used my garden as a litter box. Or, for that matter, any garden where vegetables were grown for my consumption.
The upshot was that I did a lot of vegetable washing and scrubbing when I was pregnant.
Once I realised that the biggest Toxo danger was not from my cats, I laughed and continue to laugh at doctors who don't recommend that pregnant women use reasonable and recommended precautions when consuming produce. Or meat, for that matter.
The reason why the *worldwide* Toxoplasma infection rates are so high is most definitely NOT because of house cats.
(Though it's a great excuse to avoid litter box duty for several months.)

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About fully vetted

Patty Khuly, VMD, MBA

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Dr. Khuly is a former petMD blogger and small animal veterinarian in Miami, Florida, where she practices medicine at Sunset Animal Clinic and serves on the board of the South Florida Veterinary Medical Association. She is a graduate of Wellesley College, the University of Pennsylvania School of Veterinary Medicine, and The Wharton School of Business.

As a significant sideline, she writes...a lot. She authors pet health columns for USA Today, The Miami Herald and Vetstreet. She also writes a popular monthly column for Veterinary Practice News and serves as regular contributor to Veterinary Economics, The Bark, and the Veterinary News Network.

Dr. Khuly lives in South Miami with her brood of hens, goats, dogs, cats...and humans.

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