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Just when you thought you were on top of every pregnancy concern you could possibly have, health officials across the United States are investigating a parasite outbreak that’s been causing some very unpleasant GI symptoms. Hearing about a foodborne illness outbreak while pregnant can feel scary. But it’s important to understand the risks to keep you and your baby safe.
Caused by the parasite Cyclospora, cyclosporiasis outbreaks are typically seasonal, with spikes in the spring and summer. In Michigan, more than 170 cases have been reported in the past couple of weeks — when typically the state only sees about 50 cyclosporiasis cases in a full year.
In New York, more than 300 cases have been reported since May, though "New York's current case counts do not represent a major deviation from the norm this time of year," the New York State Department of Health wrote in a statement to What to Expect.
Local public health agencies, along with the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC), are investigating the cause of the outbreaks — but no single source has been identified.
The parasite behind the illness isn't usually dangerous for most healthy adults, but severe diarrhea (potentially lasting several weeks) is the most common symptom, which can cause issues during pregnancy.
Here's what doctors and public health experts want you to know about cyclosporiasis, how to protect yourself and your baby, and what to do if you think you've been infected.
What is cyclosporiasis?
Cyclosporiasis is a gastrointestinal illness caused by the parasite Cyclospora (similar to how Listeria bacteria causes listeriosis). It's spread by consuming food or water contaminated by the parasite.
In the United States, cyclosporiasis outbreaks are typically connected to fresh produce. While it's still unknown exactly what foods are causing the current outbreaks, the Michigan Department of Health and Human Services recommends taking extra precautions with the following raw produce to reduce the risk of exposure to the parasite:
- Lettuce and leafy greens
- Cilantro
- Basil
- Green onions
- Raspberries
- Snow peas
It's always best to rinse fresh produce under running water before you eat it, but that may not completely remove Cyclospora bacteria. It's resistant to chlorine washes and can hide away in the crevices of berries and herbs, warns Amos Grünebaum, M.D., FACOG, a professor of obstetrics and gynecology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.
Cooking does kill the parasite, though — so if you live in an area experiencing an active outbreak of cyclosporiasis, you might consider playing it safe and cooking produce that could be contaminated (like the above fruits, veggies, and herbs) thoroughly before eating. See if there's an outbreak in your state by checking the CDC's cyclosporiasis surveillance page or your state's health department website.
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What are symptoms of cyclosporiasis?
Cyclosporiasis typically feels like a nasty stomach bug. The most common symptoms are:
- Watery, sometimes explosive diarrhea
- Loss of appetite
- Weight loss
- Cramping
- Bloating and gas
- Nausea
- Fatigue
It usually takes about a week for symptoms to show up after you're infected. Symptoms might last only a few days, or they can drag on for weeks — and they can go away and come back.
What if you get cyclosporiasis while pregnant?
If you catch cyclosporiasis while pregnant, the good news is it doesn't pose any direct harm to your baby: "Cyclospora lives in the gut and is not known to cross the placenta or infect the baby the way some other parasites do," Dr. Grünebaum says.
The main concern is treatment options: The antibiotic trimethoprim-sulfamethoxazole, the treatment of choice for cyclosporiasis, typically isn't recommended during pregnancy or if you're trying to conceive. And other antibiotics haven't proven to be effective in treating the parasite.
Early in the first trimester, it can prevent your baby from getting enough folate, which can, in turn, lead to neural tube defects. And if you take it in the third trimester, it increases the risk of your baby getting jaundice. However, it's usually fine to take the antibiotic later in the first trimester and in the second trimester.
Without taking trimethoprim-sulfamethoxazole, the illness will typically pass on its own — but you may be in for an unpleasant few days (or even weeks) of diarrhea, which comes with its own risks.
"It's important to remember that a healthy baby depends on a healthy mother," advises Michael Carson, M.D., FACP, professor of medicine and obstetrics/gynecology at Hackensack Meridian School of Medicine and member of the What to Expect Medical Review Board.
If you're pregnant and suffering from diarrhea, it's important to stay hydrated (aim for eight to 10 8-ounce glasses of water a day) and to see your doctor. They'll be able to talk through all of your options and help you decide what's best for you and your baby.
"Dehydration from days or weeks of heavy diarrhea can reduce blood flow to the placenta and set off early contractions," warns Dr. Grünebaum. "This is a genuine judgment call weighing a prolonged, draining illness against a drug we would rather not use, and it belongs in a conversation between a woman and her obstetrician."
What to do if you think you have cyclosporiasis
If you live in an area with an active cyclosporiasis outbreak and you're experiencing symptoms, call your doctor right away.
"Don't wait the illness out in silence — get tested, and make sure whoever treats you knows your reproductive status before any prescription is written," Dr. Grünebaum says. And be sure to let your doctor know you think you might have cyclosporiasis — they'll take a stool sample for testing to be sure.
"Reassuringly, for most healthy adults, this is a miserable week or two and then it's over," says Dr. Grünebaum. "The honest caution is that 'usually mild' and 'usually easy to cure' don't describe the woman who is newly pregnant, trying to be, or just delivered — for her, both the illness and its treatment carry a cost that depends on exactly where she stands in that arc."
