Acute or Reactivated Toxoplasmosis During Pregnancy, Its Impact on Birth Outcomes and the Associated Costs of Inpatient Care in the United States, 2001-2009

Objective: To describe prevalence of acute or reactivated toxoplasmosis during pregnancy (ARTP) in the United States (US) and its association with maternal-fetal outcomes. Methods: The authors conducted a cross-sectional analysis of a national sample of pregnancy-related hospital discharges using 2001-2009 annual data from the largest publicly-available National Inpatient Sample database in the US (N=42,468,049). Maternal toxoplasmosis and clinical outcomes were identified using International Classification of Diseases, 9th Edition, Clinical Modification diagnosis codes. We described the annual prevalence of ARTP and used survey logistic regression to evaluate the associations between ARTP and adverse pregnancy outcomes. The cost of inpatient care for pregnant women with ARTP was compared with inpatient care cost for those without ARTP. Results: The national prevalence of ARTP was 2 per 100,000 pregnancyrelated discharges. Odds of a prolonged hospital stay quadrupled among ARTP cases (AOR=4.59, 95% CI: [2.81- 7.48]). Women with ARTP also had three times higher odds of having and infant with poor fetal growth (AOR= 3.41, 95% CI: [1.71-6.77]) and stillbirth (AOR= 3.41, 95% CI: [1.23-9.49]). The mean medical care cost for women with ARTP was $6,686, compared to $4,347 for women without ARTP. The excess cost associated with ARTP over the study period was $1,939,031. Conclusion: Toxoplasmosis during pregnancy is associated with adverse maternal-fetal outcomes and increased cost of maternal inpatient care.