Mycotoxins, as prevalent contaminants in the food chain, exhibit diverse toxicological effects on both animals and humans. Chronic dietary exposure to mycotoxin-contaminated foods may result in the bioaccumulation of these toxins, posing substantial public health risks. This review systematically examines the contamination patterns of mycotoxins across major food categories, including cereals and related products, animal-derived foods, fruits, and medical food materials. Furthermore, we critically evaluated two methodological frameworks for assessing mycotoxin exposure risks: (1) dietary exposure models integrating contamination levels and consumption data and (2) human biomonitoring approaches quantifying mycotoxin biomarkers in biological samples. A key contribution lies in the stratified analysis of exposure disparities among population subgroups (adults, teenagers, children, and infants). Additionally, we summarize current research on the relationship between human mycotoxin biomonitoring and associated health impacts, with a particular emphasis on vulnerable groups such as pregnant women and infants. By elucidating the challenges inherent in existing studies, this synthesis provides a roadmap for advancing risk characterization and evidence-based food safety interventions.

Deoxynivalenol (DON) and Alternaria toxins (ATs) are two common types of mycotoxins in food. Although they are physiologically toxic to animals and various cell lines, data related to the exposure risks and health effects in the human population were still limited, especially for ATs. In this study, we combined food consumption data and human biomonitoring data of 200 pregnant volunteers from different districts of Shanghai to assess the exposure to DON and ATs. In addition, correlations between food consumption and urinary DON and ATs levels, urine biomarkers, and blood indexes were analyzed by regression analysis. For DON, the exposure assessment of the probable daily intake (PDI) indicated that a portion (37.5%) of all participants exceeded the Tolerable Daily Intake (TDI) proposed for DON. For ATs, the PDI values estimated based on the urinary concentrations indicated that 2–100% of all participants exceeded the threshold of toxicological concern (TTC) values for ATs. In addition, we innovatively found some associations between exposure to ATs and abnormal uric acid and high-density lipoprotein cholesterol indexes by regression analysis. Despite the inevitable uncertainties, these results make an important contribution to the understanding of DON and ATs exposure risks and potential health hazards in the pregnant women population.