Q: My wife had a missed abortion in about six weeks of pregnancy 14 months ago. She is a call centre executive who travels 110 km (4 hours) each day and works exclusively in the night shift. After the abortion, she was diagnosed with Toxoplasma (3.78 IgM). Our doctor said that the infection was the most likely cause. She was put on Rovamycin (1.5 mg BD) for 12 weeks. But she did not respond well to the treatment and still had 1.78 IgM when measured 3 months ago. Another doctor said that there can be little co-relation with the infection and miscarriage and the physical strain must be the reason. (She started working at the same time as the discovery of pregnancy.) She has again been put on Rovamycin for three weeks. We want to plan a baby. Is it advisable to wait for the infection to fall to normal level? Also, is it advisable to switch to a job with more regular job timings before we plan?

A:Neither physical strain nor the Toxoplasmosis infection has caused an abortion in your wife's case. Indeed physical exertion cannot and does not cause abortions. The titres you have written are not of much significance. Giving Rovamycin for an infection which if at all she did get, was one year ago (and detected after the abortion had already occurred) is scientifically (and medically) meaningless. Toxoplasmosis is once a lifetime infection and is harmful only if contacted during pregnancy. Now it will not harm her or any other future pregnancy even if she had the infection (which is not very definite). The antibiotics now and last year (after the abortion) was not only useless but actually harmful, please avoid all such potentially dangerous treatments. The big question is why she had an abortion? Very little is known about these early abortions which occur spontaneously in almost 22% of all pregnancies. In most cases of early abortion the fetus formed is less than perfect and nature aborts these pregnancies as a process of natural selection (basic Darwinism). These are not avoidable and in most cases (as indeed in your wife's case) no cause is found. Please stop all the irrational therapies and plan a pregnancy as soon as you want. Please do not tell your wife to give up her job or take rest during pregnancy unless she wants to for other (non-medical) reasons. Rest is harmful to a healthy pregnancy and working is good for her self-esteem and well being. In the next pregnancy please do not get too paranoid and get millions of tests or treatments. Please have faith in nature and allow the pregnancy grow naturally and avoid all medicines like hormones and antibiotics. Please take Folic acid daily while you plan a pregnancy and in early pregnancy till 14 weeks. Please do not give your wife any other medication since none of the hormones and other drugs used these days and marketed by drug companies in India have any proven use and all of them are potentially harmful. Before using any drug pleas check on the net whether it is really required and safe for the pregnancy, ideally no drugs should be taken especially in early pregnancy. Consult the RCOG site www.rcog.org.uk and the FDA site for drug safety. I wish you all the luck.