Prenatal Exposure to Ambient Fine Particulate Matter (PM₂.₅) and Adverse Perinatal Outcomes: A Literature Review
DOI:
https://doi.org/10.12775/JES.2026.87.67811Keywords
prenatal exposure, small for gestational age, low birth weight, preterm birth, air pollution, PM₂.₅Abstract
Background. Prenatal exposure to fine particulate matter (PM₂.₅), composed of airborne particles smaller than 2.5 micrometers, is a significant environmental risk that can adversely affect pregnancy. Exposure to PM₂.₅ during pregnancy has been associated with a number of adverse birth outcomes, including small for gestational age (SGA), low birth weight (LBW), and preterm birth (PTB). This literature review summarizes evidence published between 2020 and 2025 regarding the relationship between prenatal PM₂.₅ exposure during different pregnancy trimesters and the risk of PTB, LBW, and SGA.
Aim of the review. This review gathers and evaluates epidemiological studies from 2020 to 2025 examining the connection between prenatal exposure to PM₂.₅ and adverse perinatal outcomes such as SGA, LBW, and PTB
Methods. In our review, we included case-control and cohort primary epidemiological studies that were published between 2020 and 2025. Maternal exposure to ambient PM₂.₅ in connection with PTB, LBW, or SGA was evaluated in eligible studies.
Results. Across the reviewed studies, prenatal exposure to PM₂.₅ was linked to an increased risk of LBW and SGA, with heightened susceptibility in the first and second trimesters. Associations with PTB were also noted but more variable. Many large population-based studies found small but statistically significant effects, especially those using thorough exposure assessment methods.
Conclusions. The current evidence suggests that maternal exposure to ambient PM₂.₅ during pregnancy is associated with an increased risk of adverse birth outcomes, especially indicators of restricted fetal growth. These findings highlight the need for further study to clarify critical exposure windows, underlying biological processes, and effective strategies to reduce exposure during pregnancy. They also support the importance of air quality as a controllable environmental factor for maternal and offspring health.
References
1. Parasin N, Amnuaylojaroen T, Saokaew S. Prenatal PM2.5 Exposure and Its Association with Low Birth Weight: A Systematic Review and Meta-Analysis. Toxics. 2024;12(7). doi:10.3390/toxics12070446
2. Li S, Li L, Zhang C, et al. PM2.5 leads to adverse pregnancy outcomes by inducing trophoblast oxidative stress and mitochondrial apoptosis via KLF9/CYP1A1 transcriptional axis. Nicolás M, Harper DM, eds. eLife. 2023;12:e85944. doi:10.7554/eLife.85944
3. Jiao A, Reilly AN, Benmarhnia T, et al. Fine Particulate Matter, Its Constituents, and Spontaneous Preterm Birth. JAMA Netw Open. 2024;7(11):e2444593. doi:10.1001/jamanetworkopen.2024.44593
4. Guxens M, Botella N, Stafoggia M, et al. Particulate matter exposure during pregnancy and birth outcomes: exposure windows of susceptibility and socioeconomic inequalities. Eur J Epidemiol. 2025;40(9):1105-1121. doi:10.1007/s10654-025-01274-1
5. Mitku AA, Zewotir T, North D, et al. Impact of ambient air pollution exposure during pregnancy on adverse birth outcomes: generalized structural equation modeling approach. BMC Public Health. 2023;23(1):45. doi:10.1186/s12889-022-14971-3
6. Bravo MA, Miranda ML. A longitudinal study of exposure to fine particulate matter during pregnancy, small-for-gestational age births, and birthweight percentile for gestational age in a statewide birth cohort. Environ Health. 2022;21(1):9. doi:10.1186/s12940-021-00823-x
7. Tapia VL, Vasquez BV, Vu B, Liu Y, Steenland K, Gonzales GF. Association between maternal exposure to particulate matter (PM2.5) and adverse pregnancy outcomes in Lima, Peru. J Expo Sci Environ Epidemiol. 2020;30(4):689-697. doi:10.1038/s41370-020-0223-5
8. Chen X, Chen S, Zhu Z, et al. Identifying the critical windows and joint effects of temperature and PM2.5 exposure on small for gestational age. Environ Int. 2023;173:107832. doi:10.1016/j.envint.2023.107832
9. Ahn TG, Kim YJ, Lee G, et al. Association Between Individual Air Pollution (PM10, PM2.5) Exposure and Adverse Pregnancy Outcomes in Korea: A Multicenter Prospective Cohort, Air Pollution on Pregnancy Outcome (APPO) Study. J Korean Med Sci. 2024;39(13). doi:10.3346/jkms.2024.39.e131
10. Zhang Y, Ye T, Yu P, et al. Preterm birth and term low birth weight associated with wildfire-specific PM2.5: A cohort study in New South Wales, Australia during 2016–2019. Environ Int. 2023;174:107879. doi:10.1016/j.envint.2023.107879
11. Zhu Z, Hu H, Benmarhnia T, et al. Gestational PM2.5 exposure may increase the risk of small for gestational age through maternal blood pressure and hemoglobin: A mediation analysis based on a prospective cohort in China, 2014–2018. Ecotoxicol Environ Saf. 2022;242:113836. doi:10.1016/j.ecoenv.2022.113836
12. Thaichana P, Sripan P, Rerkasem A, Tongsong T, Sangsawang S. Association of Maternal PM2.5 Exposure with Preterm Birth and Low Birth Weight: A Large-Scale Cohort Study in Northern Thailand (2016–2022). Toxics. 2025;13(4). doi:10.3390/toxics13040304
13. Picciotto S, Huang S, Lurmann F, et al. Pregnancy exposure to PM2.5 from wildland fire smoke and preterm birth in California. Environ Int. 2024;186:108583. doi:10.1016/j.envint.2024.108583
14. You YA, Park S, Kwon E, et al. Maternal PM2.5 exposure is associated with preterm birth and gestational diabetes mellitus, and mitochondrial OXPHOS dysfunction in cord blood. Environ Sci Pollut Res. 2024;31(7):10565-10578. doi:10.1007/s11356-023-31774-0
15. Bravo MA, Zephyr PD, Fiffer MR, Miranda ML. Weekly prenatal PM2.5 and NO2 exposures in preterm, early term, and full term infants: Decrements in birth weight and critical windows of susceptibility. Environ Res. 2024;240(Pt 1):117509. doi:10.1016/j.envres.2023.117509
16. Li F, Liu X, Gong S, et al. The silent threat: effects of PM2.5 exposure on perinatal complications and neonatal outcomes. BMC Pregnancy Childbirth. 2025;25(1):686. doi:10.1186/s12884-025-07767-x
17. Fan Z, Yuan M, Zhang J, et al. Air pollution exposure during pregnancy and low birth weight and macrosomia: the role of gestational diabetes mellitus. Reprod Health. 2025;22(1):208. doi:10.1186/s12978-025-02171-2
18. Jana A, Pramanik M, Maiti A, Chattopadhyay A, Ahad MAA. In-utero exposure to PM2.5 and adverse birth outcomes in India: Geostatistical modelling using remote sensing and demographic health survey data 2019–21. PLOS Glob Public Health. 2025;5(7):e0003798. doi:10.1371/journal.pgph.0003798
19. Ho TH, Van Dang C, Pham TTB, Thi Hien T, Wangwongwatana S. Ambient particulate matter (PM2.5) and adverse birth outcomes in Ho Chi Minh City, Vietnam. Hyg Environ Health Adv. 2023;5:100049. doi:10.1016/j.heha.2023.100049
20. Yuan X, Liang F, Zhu J, et al. Maternal Exposure to PM2.5 and the Risk of Congenital Heart Defects in 1.4 Million Births: A Nationwide Surveillance-Based Study. Circulation. 2023;147(7):565-574. doi:10.1161/CIRCULATIONAHA.122.061245
21. Yitshak-Sade M, Kloog I, Schwartz JD, Novack V, Erez O, Just AC. The effect of prenatal temperature and PM2.5 exposure on birthweight: Weekly windows of exposure throughout the pregnancy. Environ Int. 2021;155:106588. doi:10.1016/j.envint.2021.106588
22. Byun G, Choi Y, Lee JT, Bell ML. Effects of Prenatal Exposure to PM2.5 Chemical Components on Adverse Birth Outcomes and Under-5 Mortality in South Korea. Epidemiology. 2025;36(4):531. doi:10.1097/EDE.0000000000001868
23. Smith RB, Beevers SD, Gulliver J, et al. Impacts of air pollution and noise on risk of preterm birth and stillbirth in London. Environ Int. 2020;134:105290. doi:10.1016/j.envint.2019.105290
24. Tong L, Wang Y, Huang Y, Zhang Y, Mayvaneh F, Zhang Y. Interactive and joint associations of prenatal ozone and PM2.5 exposure with fetal growth restriction: an Iranian nationwide birth cohort study. BMC Public Health. 2025;25(1):4281. doi:10.1186/s12889-025-25579-8
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Copyright (c) 2026 Anhelina Korolchuk, Bartosz Palacz, Maria Magdalena Teper, Natalia Marianna Kubiś, Julia Anna Wrona, Wiktor Perz, Aleksander Polus, Jędrzej Piotrowski, Anna Gluzicka, Liwia Olczyk

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