Maternal, Behavioral, and Environmental Factors Associated with Toxoplasma gondii Infection in Pregnancy in Italy: A Case–Control Study

TL;DR

The study finds that behaviors and environmental factors like rural living and unpasteurized food increase Toxoplasma gondii infection risk in pregnant Italian women.

Contribution

The study identifies modifiable behavioral and environmental risk factors for T. gondii infection during pregnancy in Italy.

Findings

Infected women were more likely to live in rural areas and consume unpasteurized dairy and cured meats.

Lower educational level and poor food preparation practices were associated with infection.

High-risk animal-related behaviors were more common among infected women.

Abstract

Background: Congenital toxoplasmosis remains a significant cause of fetal morbidity worldwide. This case–control study aimed to identify sociodemographic, dietary, and behavioral factors associated with Toxoplasma gondii infection during pregnancy in Italy by comparing infected women with seronegative controls, and to evaluate modifiable risk behaviors and treatment-related outcomes among affected patients. Methods: This case–control study included 201 pregnant women (100 with T. gondii infection and 101 seronegative controls). Participants completed a structured questionnaire on sociodemographic factors, diet, environmental exposures, and preventive behaviors. Clinical data were collected for infected women and analyzed using SPSS v27.0. Results: Sociodemographic and obstetric characteristics did not differ between groups. Infected women were more likely to live in rural areas (p < 0.001), have a lower educational level (p = 0.009), consume unpasteurized dairy products and cured meats (p < 0.05), purchase food from farmers or butchers (p = 0.01), and do not check food preparation practices when eating outside the home. High-risk animal-related behaviors were also more common among cases (p < 0.001). Despite similar baseline awareness, adherence to preventive measures was lower among cases; most infections were diagnosed in the first trimester and treated with spiramycin with good tolerability. Conclusions: Maternal toxoplasmosis is mainly associated with modifiable behavioral and environmental factors, underscoring the need for targeted, preconception counseling to reduce the risk of congenital infection.