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

<b>Background:</b> Congenital toxoplasmosis remains a significant cause of fetal morbidity worldwide. This case-control study aimed to identify sociodemographic, dietary, and behavioral factors associated with <i>Toxoplasma gondii</i> 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. <b>Methods:</b> This case-control study included 201 pregnant women (100 with <i>T. gondii</i> 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. <b>Results:</b> Sociodemographic and obstetric characteristics did not differ between groups. Infected women were more likely to live in rural areas (<i>p</i> < 0.001), have a lower educational level (<i>p</i> = 0.009), consume unpasteurized dairy products and cured meats (<i>p</i> < 0.05), purchase food from farmers or butchers (<i>p</i> = 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 (<i>p</i> < 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. <b>Conclusions:</b> 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.