What we don’t see won’t hurt us? Perspectives on the psychological issues arising from infections acquired during pregnancy

Infections in pregnancy which may impact on maternal health and wellbeing and outcomes for the pregnancy or for the baby are important from the point of view of women and their families at a time in their lives when they would normally be looking forward to the future. Toxoplasmosis is one such infection. It is caused by the parasite Toxoplasma Gondii and the infective route (Jones et al., 2001) is via a spectrum of media, including undercooked meat, soil contamination and contact with cat faeces. The perceived unpleasantness which may be associated with awareness of the routes of transmission alone may not present this area as an attractive topic of relevance and interest for psychologists working within the sphere of reproductive health. The impact on adults of toxoplasmosis is potentially broad, although often benign and associated with good outcomes; however, those with comorbidities may encounter severe and, indeed, life-threatening consequences of infection (Bossi et al., 2002).

Approximately 2,000 UK women each year contract toxoplasmosis during pregnancy and in about 800 of these cases the infection will pass from mother to baby, with about 80 babies per year being severely affected. It is also associated with miscarriage and possible stillbirth. While not common, congenital toxoplasmosis nevertheless has important implications for women, their families and the developing infant. The chances of infection increase with the duration of pregnancy; however, although infection early in pregnancy may be relatively rare, the developmental consequences can be catastrophic, including neurological and sensory impairment such as blindness and severe disability (Dutton, 1989; Jones et al., 2001). Public Health policies vary considerably, with an absence of comprehensive screening programmes during pregnancy in many developed countries, though testing appears to be straightforward, cost-effective, results accurate and interventions effective. This situation contrasts markedly with some other countries, for example France, which has utilised routine screening for toxoplasma infection during pregnancy since the 1970s (Jeannel, Costagliola, Neil, Hubert, & Danis, 1990). In the UK women who are concerned can request a screening test from their GP.

In addition to the paediatric, perinatal, developmental, neurological and infectious diseases research carried out in this area, the contrasting approaches between countries also highlight an issue for reproductive psychology in relation to the impact of screening and identification of toxoplasma and other infections on maternal wellbeing, psychological functioning and longer term outcome. The evidence regarding the broader psychological consequences is disparate and at times equivocal, for example, Lafferty (2005). While there is evidence to suggest a broad range of potential impact of Toxoplasma infection on domains of relevance to the psychologist through the life course, including behavioural disorders, neurocognitive impairment and psychosis (Fekadu, Shibre, & Cleare, 2010; Henriquez, Brett, Alexander, Pratt, & Roberts, 2009), there is relatively little research on the psychological and reproductive issues associated with screening, treatment and the psychosocial impact when the infection was not recognised or treated. The often non-specific and unpredictable effects of what can seem like a mild, often unnoticed infection, emphasise the complex and interdependent relationships in the area of health between underlying physiological and neurological processes and psychological functioning and mental well-being. Addressing the issue of biological change states caused by, for example, infection, may result in significant and insightful contributions within the sphere of psychobiology. It is surprising that reproductive psychology, which by definition is wedded to the dynamics of physiological change states, particularly over the course of pregnancy and the postpartum, though navigating the physiological highways relevant to the perinatal period, appears more averse to exploring the biological side roads less travelled. This is clearly evidenced by the scant penetration within the literature of high-quality, psychologically orientated research that explores the diverse impacts of even common infections which may dramatically affect the experiences and quality of life of mothers, their babies and families. Addressing the challenges and opportunities that exist in this area may not only promote useful and evidenced-based insights into the development of appropriate and context-specific psychologically-orientated interventions, but also, in the best tradition of neuropsychology, promote the accumulation of generalisable evidence on the underlying mechanisms of normal and adaptive psychological functioning and development. Adding substance to this argument is the enduring evidence, that generally the most vulnerable to the impact of infective agents such as toxoplasma, is the developing foetus (Kravetz, 2008).

This edition of the Journal of Reproductive and Infant Psychology offers a broad range of topical articles engaging a number of areas of interest and importance for those working in the reproductive psychology area. Unlocking the rationale and reasoning processes in relation to timing for wanting a child is explored in the study of Sol Olafsdottir et al. Addressing key cultural dimensions associated with postnatal depression provides the context for the investigation of Wittkowski et al. Illumination of the religious aspects of pregnancy planning is central to Younwanichsetha’s article from Thailand. The main body of this editorial has highlighted some of the issues of relevance to the understanding of the biological and physiological processes that are of concern to reproductive psychology, the contribution of Letourneau et al. revealing the hormonal components of this relationship in relation to the experience of depression in both mothers and their infants. The themes of significant psychological distress are emphasised by the articles of Bambina et al. and Rousset et al. The complex issue of infant sleep is explored by Loutzenhiser et al., while finally, the evergreen topic of measurement, central to psychology as an evidenced-based discipline, is the focus of Roncolato and McMahon’s article on maternal orientation measures. The spectrum of topics covered in this edition of the journal serves to remind all of us working in this area of the enduring, expansive and engaging focus that reproductive psychology both enjoys and represents, factors which translate directly and importantly to women, their babies and their families.