{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T16:45:38Z","timestamp":1782492338847,"version":"3.54.5"},"reference-count":30,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"unspecified","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Deparment Chirurgie, University of Basel","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,23]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Congenital malformations (CMs) are the leading cause of infant mortality. Still, the aetiology remains unknown in 70% of cases. The most accepted hypothesis is that hereditary and environmental elements concur in altering embryo-fetal development. Recently, the role of the environment has been emphasised.<\/jats:p>\n                    <jats:p>Women are exposed to several xenobiotics during pregnancy. This review aims to study the available literature on the exposure of pregnant women to pesticides through drinking water to see if there is any evidence of correlation to the onset of any kind of congenital anomalies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will conduct a systematic literature review in The Cochrane Library, Embase and PubMed for studies published between 1 January 2005 and 31 January 2026. Articles will be included if they examine pregnant women as the study population, exposure to pesticide active ingredients and metabolites present in drinking water, and any type of CM in their children as the main outcome. The screening of title, abstract and full text as well as the data extraction will be conducted independently through two investigators. A third investigator will resolve any eventual conflicts. Each included study will be evaluated according to the NIH\u2019s quality assessment tools. Grading of Recommendations Assessment, Development and Evaluation approach will be used for summarising and assessing certainty in the bodies of evidence produced by the review. This study is registered with PROSPERO, CRD420251063011.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The completed work will be published in a scientific journal for dissemination. Due to the nature of the study, an ethical approval is not necessary since no patient data or other information will be directly collected.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-112922","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T14:10:41Z","timestamp":1779286241000},"page":"e112922","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Exposure to pesticides in drinking water during pregnancy and risk of congenital malformations: a systematic review protocol"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0721-2463","authenticated-orcid":false,"given":"Cristiana","family":"Riboni","sequence":"first","affiliation":[{"name":"Pediatric Surgery, UKBB, Basel, Switzerland"},{"name":"Department of Clinical Research, University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Paganetti","sequence":"additional","affiliation":[{"name":"Department of Visceral Surgery, Cantonal Hospital Basel-Land, Liestal, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan G","family":"Holland-Cunz","sequence":"additional","affiliation":[{"name":"Pediatric Surgery, UKBB, Basel, Switzerland"},{"name":"Department of Clinical Research, University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie J","family":"Gros","sequence":"additional","affiliation":[{"name":"Pediatric Surgery, UKBB, Basel, Switzerland"},{"name":"Department of Clinical Research, University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"2026062608323411000_16.5.e112922.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.2008.01207.x"},{"key":"2026062608323411000_16.5.e112922.2","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1002\/bdr2.1448","article-title":"Maternal residential exposure to specific agricultural pesticide active ingredients and birth defects in a 2003-2005 North Carolina birth cohort","volume":"111","author":"Rappazzo","year":"2019","journal-title":"Birth Defects Res"},{"key":"2026062608323411000_16.5.e112922.3","first-page":"1","article-title":"Environmental and individual exposure and the risk of congenital anomalies: a review of recent epidemiological evidence","volume":"42","author":"Baldacci","year":"2018","journal-title":"Epidemiol Prev"},{"key":"2026062608323411000_16.5.e112922.4","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph19148584","article-title":"Risk Assessment for Birth Defects in Offspring of Chinese Pregnant Women","volume":"19","author":"Qu","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2026062608323411000_16.5.e112922.5","doi-asserted-by":"crossref","DOI":"10.3390\/toxics13010034","article-title":"A Systematic Review of Parental Occupational Pesticide Exposure and Geographical Proximity to Agricultural Fields in Association with Neural Tube Defects","volume":"13","author":"Felisbino","year":"2025","journal-title":"Toxics"},{"key":"2026062608323411000_16.5.e112922.6","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-084122","article-title":"Exposure to drinking water pollutants and non-syndromic birth defects: a systematic review and meta-analysis synthesis","volume":"14","author":"Jauniaux","year":"2024","journal-title":"BMJ Open"},{"key":"2026062608323411000_16.5.e112922.7","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1007\/s40572-016-0085-0","article-title":"Agricultural Compounds in Water and Birth Defects","volume":"3","author":"Brender","year":"2016","journal-title":"Curr Environ Health Rep"},{"key":"2026062608323411000_16.5.e112922.8","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2024.1489365","article-title":"Maternal pesticide exposure and risk of birth defects: a population-based cross-sectional study in China","volume":"12","author":"Liu","year":"2024","journal-title":"Front Public Health"},{"key":"2026062608323411000_16.5.e112922.9","doi-asserted-by":"publisher","DOI":"10.1136\/oemed-2020-106627"},{"key":"2026062608323411000_16.5.e112922.10","doi-asserted-by":"crossref","unstructured":"Carlson JC , Shaffer JR , Deleyiannis F , et al . 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