Ambient air pollution exposure and hypertensive disorders in pregnancy: A systematic review supporting SGDs 3 for maternal health

Abstract

Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and perinatal morbidity and mortality worldwide. There is an increasing body of evidence that ambient air pollution contributes to their development. The objective of this systematic review is to summarize the evidence for the association between exposure to ambient air pollution and HDP. The review was conducted following the PRISMA 2020 statement. Systematic search in PubMed, Scopus and Web of Science found a total of 760 records and 8 cohort studies were eligible. The association with HDP was most consistent for PM2,5, with effect estimates reported as modest to strong across studies, especially during preconception and first trimester. Proposed biological mechanisms included oxidative stress, systemic inflammation, endothelial dysfunction, impaired placental vascular remodelling and placental ischemia. Sensitivity of exposure was greatest in preconception and early pregnancy. This underscores the importance of including environmental exposure assessment in maternal health care and air quality policies to prevent HDPs, and contributes to the attainment of the Sustainable Development Goals (SDGs) 3 (Good Health and Well-being), 11 (Sustainable Cities and Communities) and 13 (Climate Action).