Toxoplasmosis in pregnancy in France: epidemiological trends, prenatal screening and future perspectives

Abstract

Toxoplasma gondii infection during pregnancy remains a significant public health concern because of the risk of congenital toxoplasmosis. France, historically one of the European countries with the highest levels of exposure, has experienced a marked decline in seroprevalence among pregnant women, from approximately 54% in 1994 to below 26% in 2021. This trend has been attributed to improvements in livestock production systems, better biosecurity measures, changes in dietary habits and enhanced food hygiene practices. France has maintained a nationwide prenatal screening programme since 1992, providing systematic serological monitoring of susceptible pregnant women and generating one of the most comprehensive epidemiological databases on toxoplasmosis worldwide. Recent data from Lyon showed a reduction in seroprevalence from 26.4% in 2017 to 22.1% in 2023. However, despite declining cumulative exposure, the incidence of maternal infection during pregnancy remained relatively stable, suggesting that the increasing proportion of susceptible women may offset the benefits of reduced environmental contamination. Important demographic and geographical differences in exposure persist across population groups and regions. Prenatal screening has proven valuable for surveillance, identification of risk factors, prevention of congenital infection, and assessment of public health interventions. Economic evaluations indicate that systematic screening may be a cost-effective strategy that reduces the burden of congenital toxoplasmosis while generating healthcare savings. Continued preventive education, surveillance, and periodic evaluation of screening policies remain essential. Greater international harmonization of surveillance systems, diagnostic criteria, and follow-up protocols would improve comparability and strengthen the evidence base supporting prevention strategies.