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To assess further certainty of effects, this review examines the experimental literature base to identify mechanisms by which air pollution (particulate matter, nitrogen dioxide and ozone) could cause adverse effects on the developing fetus. It likely that this environmental insult impacts multiple biological pathways important for sustaining a healthy pregnancy, depending upon the composition of the pollutant mixture and the exposure window owing to changes in physiologic maturity of the placenta, its circulations and the fetus as pregnancy ensues. The current body of evidence indicates that the placenta is a target tissue, impacted by a variety of critical processes including nitrosative\/oxidative stress, inflammation, endocrine disruption, epigenetic changes, as well as vascular dysregulation of the maternal\u2010fetal unit. All of the above can disturb placental function and, as a consequence, could contribute to compromised fetal growth as well increasing the risk of stillbirth. Furthermore, given that there is often an increased inflammatory response associated with preterm labour, inflammation is a plausible mechanism mediating the effects of air pollution on premature delivery. In the light of increased urbanisation and an ever\u2010changing climate, both of which increase ambient air pollution and negatively affect vulnerable populations such as pregnant individuals, it is hoped that the collective evidence may contribute to decisions taken to strengthen air quality policies, reductions in exposure to air pollution and subsequent improvements in the health of those not yet born.<\/jats:p>","DOI":"10.1111\/1471-0528.17727","type":"journal-article","created":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T07:10:26Z","timestamp":1701414626000},"page":"538-550","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":105,"title":["Ambient air pollution and adverse birth outcomes: A review of underlying mechanisms"],"prefix":"10.1111","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0057-6654","authenticated-orcid":false,"given":"Julia C.","family":"Fussell","sequence":"first","affiliation":[{"name":"MRC Centre for Environment and Health, School of Public Health Imperial College London London UK"},{"name":"National Institute for Health and Care Research Health Protection Research Unit in Environmental Exposures and Health Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0925-7737","authenticated-orcid":false,"given":"Eric","family":"Jauniaux","sequence":"additional","affiliation":[{"name":"EGA Institute for Women's Health, Faculty of Population Health Sciences University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4000-2919","authenticated-orcid":false,"given":"Rachel B.","family":"Smith","sequence":"additional","affiliation":[{"name":"MRC Centre for Environment and Health, School of Public Health Imperial College London London UK"},{"name":"National Institute for Health and Care Research Health Protection Research Unit in Environmental Exposures and Health Imperial College London London UK"},{"name":"Mohn Centre for Children's Health and Wellbeing, School of Public Health Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8677-4143","authenticated-orcid":false,"given":"Graham J.","family":"Burton","sequence":"additional","affiliation":[{"name":"Department of Physiology, Development and Neuroscience University of Cambridge Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,11,30]]},"reference":[{"key":"e_1_2_14_2_1","unstructured":"World Health Organization (WHO).Air pollution. 2023 [cited 18 July 2023]. 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