Toxoplasma gondii Infection in Relation to Pregnancy Characteristics and Bad Obstetric History among Pregnant Women Seeking Healthcare in Sana’a City, Yemen
Authors: Abdul-Ghani Rashad , Al-Nahari Afnan , Yousef Ahlam , Al-Haj Al-Anood , Aqlan Amnh , Jaadan Enas , Barood Hajar , Al-Dubai Nada , Sharaf Nawal 
Published: June 2022

Objective: To determine the seroprevalence and risk factors associated with Toxoplasma gondii among pregnant women seeking healthcare in Sana’a city in relation to pregnancy characteristics and bad obstetric history (BOH).
Methods: This hospital-based, cross-sectional study was conducted among 379 pregnant women seeking healthcare in Sana’a city. Data on socioeconomic and pregnancy characteristics, BOH and possible risk factors associated with T. gondii infection were collected using a structured, pre-designed questionnaire. Anti-Toxoplasma IgG and IgM antibodies were detected using OnSiteTM Combo tests. Data were analyzed using the IBM SPSS Statistics using appropriate statistical tests, and a bivariate logistic regression model was used to determine the risk factors possibly associated with T. gondii infection among pregnant women. Differences or associations between categorical variables were considered statistically significant at P values <0.05.
Results: T. gondii infection was seroprevalent among 18.7% of pregnant women seeking healthcare in Sana’a. Educational status and household size were the sociodemographic factors significantly associated with anti-Toxoplasma IgG seropositivity. Illiterate women were at fourfold higher risk of infection compared to those with higher education (OR = 4.0, 95% CI: 1.69–9.25; P = 0.002). Although those with school education were twice more likely to be infected with T. gondii compared to those with higher education, the association was on the borderline (OR = 2.0, 95% CI: 0.98–4.06; P = 0.055). On the other hand, pregnant women living in households of ≥5 members were 1.7 times more likely to be infected (OR = 1.7, 95% CI: 1.03–2.95; P = 0.026). Regarding the BOH among pregnant women, past exposure to infection was significantly associated with premature delivery (P = 0.004) and history of fetal deaths (P = 0.004). Drinking unboiled water (OR = 2.1, 95% CI = 0.55–8.07; P = 0.192) and frequent blood transfusion (OR = 1.8, 95% CI = 0.50–6.1; P  =  0.288) increased the odds of exposure of pregnant women to infection, but the associations were not statistically significant. On the other hand, other studied factors were not significantly associated with past exposure to infection.
Conclusions: The majority (>80.0%) of pregnant women seeking healthcare in Sana’a city are non-immune to primary infection with T. gondii during pregnancy as evidenced by their seronegative status, where only 18.7% of them were seropositive for anti-Toxoplasma IgG. Higher infection rates were significantly associated with being illiterate and living within households of ≥5 members. With respect to self-reported BOH, T. gondii infection was significantly associated with premature delivery and history of fetal deaths. Drinking unboiled water and frequent blood transfusions increased the odds of exposure of pregnant women to infection, though not reaching statistical significance. Further large-scale community-based studies are recommended to determine the risk factors associated with pregnancy characteristics and BOH among pregnant women in the country.