Background <p>Intestinal parasitic infections (IPIs) pose a significant public health threat in endemic regions, where multiple species of parasites co-circulate, resulting in polyparasitism and an increased disease burden. Despite efforts to control these infections, the complex interactions between different intestinal parasites, and environmental determinants remain poorly understood. This study aimed to investigate the distribution and co-occurrence patterns of major intestinal parasites as well as associated factors influencing IPIs.</p> Methods <p>A retrospective facility-based study was conducted using hospital records of pregnant women over a 12-month period in Northern Ghana to assess the prevalence and associated factors of intestinal parasitic infections (IPIs). Stool samples had been examined using the formol-ether concentration microscopy technique. Data were cleaned and analyzed in R using descriptive statistics, chi-square tests, and logistic regression analyses to examine associations between IPIs and factors such as age group, malaria status, season, and stool consistency.</p> Results <p>A total of 1,606 participants were involved in the study. The overall prevalence of IPIs was 20.86% (95% CI: 18.94–22.91), while the co-infection rate was 1.74% (95% CI: 1.21–2.51). The most frequently identified parasites were <i>Entamoeba histolytica/dispar/moshkovskii</i> complex (<i>n</i> = 89, 5.5%), intestinal flagellates (<i>n</i> = 86, 5.4%), and <i>Giardia lamblia</i> (<i>n</i> = 33, 2.1%). The most common co-infections were <i>Entamoeba coli</i> with intestinal flagellates (<i>n</i> = 10, 0.6%) and <i>Entamoeba coli</i> with <i>Entamoeba histolytica/dispar/moshkovskii</i> complex (<i>n</i> = 9, 0.56%). Significant associations were observed between IPIs and the presence of red blood cells (RBCs) in stool (χ² = 31.92, df = 1, <i>p</i> &lt; 0.001), white blood cells (WBCs) in stool (χ² = 35.07, df = 1, <i>p</i> &lt; 0.001), and stool consistency (χ² = 21.41, df = 4, <i>p</i> &lt; 0.001). Other factors such as malaria status (χ² = 1.24, df = 1, <i>p</i> = 0.264), presence of yeast-like cells in stool (χ² = 0.89, df = 1, <i>p</i> = 0.345), and season (χ² = 1.33, df = 1, <i>p</i> = 0.248) were not significantly associated with IPIs.</p> Conclusion <p>This study demonstrates a considerable burden of IPIs among pregnant women in Northern Ghana, with protozoan parasites being the predominant Intestinal parasites identified. The findings highlight the importance of routine parasitological screening, the need to improve sanitation and hygiene interventions, and targeted health education during antenatal care to reduce the burden of IPIs and improve maternal health outcomes.</p> Clinical trial number <p>Not applicable.</p>