Swollen lymph nodes during pregnancy require immediate assessment for toxoplasmosis — primary maternal infection in the first trimester can cause severe congenital disease, and treatment must begin within days of diagnosis.
Lymphadenopathy in a pregnant woman has a differential that includes the same causes as in non-pregnant individuals — but toxoplasmosis requires urgent exclusion because fetal consequences are severe. Primary Toxoplasma infection in the first trimester carries a 15% transmission risk with ~60% chance of severe fetal disease (hydrocephalus, chorioretinitis, developmental delay). In the third trimester, transmission risk rises to 65% but fetal disease is usually milder.
Primary infection during pregnancy is the critical concern. Painless cervical lymphadenopathy with mild fatigue — serology (IgG/IgM + avidity test) required urgently.
EBV (Infectious mononucleosis)
Generalised lymphadenopathy with sore throat, fatigue, and low-grade fever. Monospot test and EBV serology diagnostic. Generally safe in pregnancy.
CMV infection
Often asymptomatic or mild. Primary CMV in pregnancy carries fetal risk (congenital CMV — hearing loss, neurological). Serology required.
Rubella
Post-auricular lymphadenopathy with rash and fever. Primary rubella in first trimester causes severe congenital defects. Vaccination status must be checked.
HIV (primary)
Generalised lymphadenopathy with flu-like illness. Must be excluded — especially in high-risk patients. Routine HIV testing recommended in pregnancy.
Normal pregnancy immune changes
Some mild lymph node awareness is reported in normal pregnancy from immune activation. However, palpable lymphadenopathy should always be investigated.
Yes. Toxoplasmosis is a key cause of painless cervical lymphadenopathy in pregnancy. Primary infection is usually mild or asymptomatic in the mother — a pregnant woman may notice only slightly swollen neck glands and mild fatigue. This is why toxoplasma IgG/IgM serology is recommended for any lymphadenopathy in pregnancy, and many countries include it in routine antenatal testing.
Treatment should begin as soon as primary infection is confirmed (rising IgG titres + positive IgM + low avidity). Spiramycin is started immediately to reduce placental transmission — it concentrates in the placenta and reduces transmission by 60%. If fetal infection is confirmed by amniocentesis PCR, pyrimethamine/sulfadiazine combination is added.
Toxoplasma is acquired from cat faeces (oocysts) and raw/undercooked meat (cysts). Prevention: do not empty cat litter trays (or use gloves/mask); cook all meat to >71°C; wash hands thoroughly after handling raw meat; avoid gardening without gloves; wash all fruit and vegetables. Do not eat raw cured meats, sushi, or unpasteurised products during pregnancy.
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