This article presents the results of a retrospective cohort study conducted in perinatal centers of Stavropol and Vladikavkaz between 2023 and 2025. The study aimed to compare pregnancy, delivery, and neonatal outcomes during the first three months of life in women with primary toxoplasmosis based on whether they received specific therapy. The study included 110 women who received treatment, 40 women who declined therapy, and 48 non-infected pregnant women as a control group. In the treatment group, the rate of vertical transmission was 8.2%, no symptomatic forms of congenital toxoplasmosis were observed, and pregnancy complications occurred at the same frequency as in the control group. In the group that declined treatment, the risk of vertical transmission reached 50.0%, symptomatic disease developed in 35% of infected children, and among those infected during the first trimester, severe central nervous system and ocular lesions were observed in 80% of newborns. Half of the children with congenital infection required hospitalization during the first three months of life. Multivariate analysis confirmed that the absence of therapy increased the risk of vertical transmission by 12.4-fold. Timely administration of spiramycin or combination therapy reduces the risk of fetal infection by more than sixfold and completely prevents the development of symptomatic forms of congenital toxoplasmosis. These findings justify the need for mandatory toxoplasmosis screening during pregnancy, immediate initiation of therapy upon detection of primary infection, and long-term follow-up of children infected in utero.
