Mitigating Maternal Risks from Environmental Contaminants: Feasibility and Strategies

Abstract

Traditional clinical and sociodemographic risk factors such as advanced maternal age, obesity, chronic hypertension, pregestational diabetes, prior obstetric complications, and limited prenatal care account for only part of the burden on maternal health. A growing body of evidence identifies environmental contaminants in water, housing, air, and consumer products, like nicotine in cigarettes, as modifiable contributors to adverse maternal and birth outcomes. This review examines synthesised evidence on exposure-outcome relationships, quantifies the preventable burden, and evaluates scaling strategies for evidence-based interventions for achieving elimination. A narrative review of studies linking prenatal environmental exposures to maternal outcomes, systematic reviews, meta-analyses examining effect sizes and remediation interventions, and case studies of successful contamination elimination programs in the United States was conducted. Studies show that lead exposure is associated with a 2-3-fold increased risk of gestational hypertension and preeclampsia, mercury exposure with a 1.5- 2.0-fold increased risk of gestational diabetes, and Per- and polyfluoroalkyl substances (PFAS) exposure with elevated odds of pre-eclampsia and pregnancy-induced hypertension. The study showed that Lead, mercury, and Per- and polyfluoroalkyl substances (PFAS) exposures contribute to tens of thousands of maternal complications annually in the U.S., including preeclampsia, gestational diabetes, and preterm birth, leading to significant health and economic impacts. Eliminating these exposures is feasible through interventions like lead service-line replacement and PFAS water treatment, but it requires sustained policy, funding, and community governance. Coordinated national action, focused on equity and accountability, can prevent harm, reduce maternal morbidity, and promote environmental and reproductive justice.