Maternal Trypanosoma cruzi infection is associated with significant placental remodeling regardless of vertical transmission.

Chagas disease is a major protozoan infection in the Americas, causing approximately 12,000 deaths each year. It is caused by Trypanosoma cruzi, and can be transmitted transplacentally, leading to congenital Chagas disease, a silent route that carries substantial risk for newborns. However, the mechanisms underlying congenital Chagas transmission are poorly understood. Here, we evaluated whether T. cruzi infection alters the placental microenvironment and systemic physiology, and whether such alterations are associated with congenital transmission. Integrating bulk RNA sequencing, proteomics, and spatial transcriptomics, we show that T. cruzi infection elicits profound molecular remodeling in both placenta and peripheral blood, regardless of transmission status. Transmitting mothers exhibit a distinct transcriptional signature enriched for inflammatory and tissue-remodeling pathways. Notably, peripheral blood profiles mirrored some placental alterations. A panel of inflammatory serum proteins showed promising predictive potential for transmission risk, with implications for prenatal monitoring. Together, these findings support a fundamental shift in the conceptual framework of congenital Chagas disease, from a transmission-centered model to one that recognizes infection-driven placental damage as a pathological spectrum and identifies peripheral blood as a promising, non-invasive source of predictive biomarkers for adverse pregnancy outcomes. This framework motivates the further application of single-cell-resolution approaches to refine models of congenital Chagas pathogenesis and the systematic analysis of maternal peripheral blood during pregnancy to enable early risk stratification and the development of predictive tools for adverse outcomes.