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The role of maternal infection in the development of infantile infection with Chlamydia trachomatis (C. trachomatis) was investigated by prospective and retrospective studies. Cervical infection with C. trachomatis was proven in 8(1.6%) of 487 pregnant women based on the results of isolation of C. trachomatis in cycloheximide-treated McCoy cell cultures. Three of the 8 infants born to the cervically infected mothers developed conjunctivitis in the neonatal period, but none of them had pneumonia during the follow-up period of 3 months or more. C. trachomatis was isolated from conjunctiva in 2 of the 8 infants. In a separate study, C. trachomatis was isolated from conjunctiva in 12(14%) of 87 infants under the age of one month having conjunctivitis. The immunotype of the tissue culture-adapted strain was determined as serovar D. Ig G antibody to C. trachomatis was demonstrated in 13(87%) of 15 mothers of infants who had conjunctival or respiratory tract infection with C. trachomatis, whereas only 68(23%) of 290 normal pregnant women had the antibody. Moreover, C. trachomatis was detectable in cervical swab specimens from 4(80%) of the 5 mothers examined. Thus the incidence of chlamydial infection of the cervix in pregnant women in Japan is relatively low at the present time as compared with that in other countries. However, the findings from the prospective and retrospective studies indicate that vertical transmission from maternal genital shedding of C. trachomatis plays an important role in infantile chlamydial infection.