{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:40:16Z","timestamp":1792809616052,"version":"4.5.0"},"reference-count":61,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T00:00:00Z","timestamp":1753401600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Despite extensive global evidence linking air pollution to adverse birth outcomes, a comprehensive synthesis of China-specific epidemiological insights\u2014particularly across its regionally diverse pollution landscapes and susceptible populations\u2014remains limited. This systematic review integrates evidence from Chinese epidemiological and retrospective studies (2011\u20132023) retrieved via PubMed, Web of Science, and CNKI, to address critical gaps in contextual understanding of how air pollution uniquely impacts birth outcomes in China. We identify robust associations between exposure to pollutant and risks of miscarriage, preterm birth, low birth weight, and birth defects in Chinese cohorts, while revealing understudied areas such as ozone, heavy metals, and gene\u2013environment interactions. Crucially, our analysis demonstrates how regional policy intervention attenuated birth risks in high-exposure zones, offering actionable models for policymakers. To resolve mechanistic uncertainties, we propose integrating machine learning and multi-omics approaches in future research. This review provides the first China-focused roadmap for optimizing environmental regulations and prenatal protections, directly informing public health strategies tailored to its demographic and pollution realities.<\/jats:p>","DOI":"10.3389\/fpubh.2025.1616787","type":"journal-article","created":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T06:17:41Z","timestamp":1753424261000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Air pollution\u2019s toll on adverse birth outcomes: key research insights from Chinese epidemiological studies"],"prefix":"10.3389","volume":"13","author":[{"given":"Hui","family":"Chang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanting","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanru","family":"Yue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhua","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,25]]},"reference":[{"key":"ref1","first-page":"54","article-title":"Analysis on the formation of air pollution and comprehensive treatment methods","volume":"15","author":"Guo","year":"2020","journal-title":"Chem Enterp Manag"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.16462\/j.cnki.zhjbkz.2015.10.020","article-title":"The progress of research in the association of ambient air pollution and stillbirth","volume":"19","author":"Bao","year":"2015","journal-title":"Chin J Dis Control Prev"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1007\/s40572-017-0168-6","article-title":"The interplay of climate change and air pollution on health","volume":"4","author":"Orru","year":"2017","journal-title":"Curr Environ Health Rep"},{"key":"ref4","year":"2020"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e1003718","DOI":"10.1371\/journal.pmed.1003718","article-title":"Ambient and household PM2.5 pollution and adverse perinatal outcomes: a meta-regression and analysis of attributable global burden for 204 countries and territories","volume":"18","author":"Ghosh","year":"2021","journal-title":"PLoS Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1007\/978-981-10-5657-4_8","article-title":"The associations between air pollution and adverse pregnancy outcomes in China","volume":"1017","author":"Tan","year":"2017","journal-title":"Adv Exp Med Biol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"3497","DOI":"10.1038\/s41598-025-87955-z","article-title":"The effect of air pollution exposure on foetal growth restriction in pregnant women who conceived by in vitro fertilization a cross-sectional study","volume":"15","author":"Jiang","year":"2025","journal-title":"Sci Rep"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"178999","DOI":"10.1016\/j.scitotenv.2025.178999","article-title":"Maternal mechanisms in air pollution exposure-related adverse pregnancy outcomes: a systematic review","volume":"970","author":"Syama","year":"2025","journal-title":"Sci Total Environ"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1592S","DOI":"10.1093\/jn\/133.5.1592S","article-title":"The epidemiology of adverse pregnancy outcomes: an overview","volume":"133","author":"Kramer","year":"2003","journal-title":"J Nutr"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1007\/s11910-018-0862-2","article-title":"Neurologic consequences of preterm birth","volume":"18","author":"Ream","year":"2018","journal-title":"Curr Neurol Neuro Sci Rep"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1111\/j.1440-1681.2006.04359.x","article-title":"Respiratory consequences of preterm birth","volume":"33","author":"Moss","year":"2006","journal-title":"Clin Exp Pharmacol Physiol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1542\/peds.92.6.787","article-title":"Ocular sequelae in premature infants","volume":"92","author":"Page","year":"1993","journal-title":"Pediatrics"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"518","DOI":"10.5271\/sjweh.3423","article-title":"Air pollution exposure and adverse pregnancy outcomes in a large UK birth cohort: use of a novel spatio-temporal modelling technique","volume":"40","author":"Hannam","year":"2014","journal-title":"Scand J Work Environ Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"41039","DOI":"10.1007\/s11356-021-13621-2","article-title":"Long-term impact of ambient air pollution on preterm birth in Xuzhou, China: a time series study","volume":"28","author":"Li","year":"2021","journal-title":"Environ Sci Pollut Res Int"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"4326","DOI":"10.3390\/ijerph18084326","article-title":"The association between preterm birth and ambient air pollution exposure in Shiyan, China, 2015-2017","volume":"18","author":"Chen","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"51679","DOI":"10.1007\/s11356-023-25624-2","article-title":"The short-term effects of air pollution exposure on preterm births in Chongqing, China:2015-2020","volume":"30","author":"Ming","year":"2023","journal-title":"Environ Sci Pollut Res Int"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/j.ijheh.2015.11.003","article-title":"Ambient air pollution and preterm birth: a prospective birth cohort study in Wuhan, China","volume":"219","author":"Qian","year":"2016","journal-title":"Int J Hyg Environ Health"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"105242","DOI":"10.1016\/j.envint.2019.105242","article-title":"Maternal ambient air pollution exposure with spatial-temporal variations and preterm birth risk assessment during 2013-2017 in Zhejiang Province, China","volume":"133","author":"Sun","year":"2019","journal-title":"Environ Int"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1016\/j.ecoenv.2018.04.002","article-title":"Maternal air pollution exposure and preterm birth in Wuxi, China: effect modification by maternal age","volume":"157","author":"Han","year":"2018","journal-title":"Ecotox Environ Safe"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"19028","DOI":"10.1007\/s11356-018-2061-8","article-title":"Analysis of short-term and sub-chronic effects of ambient air pollution on preterm birth in Central China","volume":"25","author":"Li","year":"2018","journal-title":"Environ Sci Pollut Res Int"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"117629","DOI":"10.1016\/j.envpol.2021.117629","article-title":"Ambient fine particulate matter air pollution and the risk of preterm birth: a multicenter birth cohort study in China","volume":"287","author":"Chu","year":"2021","journal-title":"Environ Pollut"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.envres.2018.11.007","article-title":"Nitrogen dioxide air pollution and preterm birth in Shanghai, China","volume":"169","author":"Ji","year":"2019","journal-title":"Environ Res"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"109639","DOI":"10.1016\/j.ecoenv.2019.109639","article-title":"Combined effects of traffic air pollution and home environmental factors on preterm birth in China","volume":"184","author":"Lu","year":"2019","journal-title":"Ecotox Environ Safe"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"9331","DOI":"10.1007\/s11356-022-24520-5","article-title":"Risks of preterm birth and low birth weight and maternal exposure to NO2\/PM2.5 acquired by dichotomous evaluation: a systematic review and meta-analysis","volume":"30","author":"Hung","year":"2023","journal-title":"Environ Sci Pollut Res Int"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"3365","DOI":"10.3390\/ijerph16183365","article-title":"Air pollution and preterm birth: do air pollution changes over time influence risk in consecutive pregnancies among low-risk women?","volume":"16","author":"Mendola","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1097\/JOM.0000000000000630","article-title":"Air pollution impact on pregnancy outcomes in Como, Italy","volume":"58","author":"Capobussi","year":"2016","journal-title":"J Occup Environ Med"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"111654","DOI":"10.1016\/j.envres.2021.111654","article-title":"Maternal air pollution exposure increases the risk of preterm birth: evidence from the meta-analysis of cohort studies","volume":"202","author":"Ju","year":"2021","journal-title":"Environ Res"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"110965","DOI":"10.1016\/j.envres.2021.110965","article-title":"Association between ambient air pollution and high-risk pregnancy: a 2015-2018 national population-based cohort study in Korea","volume":"197","author":"Kim","year":"2021","journal-title":"Environ Res"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"6717","DOI":"10.1007\/s11356-019-04157-7","article-title":"Ambient air pollution and the risk of stillbirth: a population-based prospective birth cohort study in the coastal area of China","volume":"26","author":"Zang","year":"2019","journal-title":"Environ Sci Pollut Res Int"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1016\/j.ijheh.2018.01.014","article-title":"Ambient air pollution the risk of stillbirth: a prospective birth cohort study in Wuhan, China","volume":"221","author":"Yang","year":"2018","journal-title":"Int J Hyg Environ Health"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"115841","DOI":"10.1016\/j.envres.2023.115841","article-title":"Prenatal ambient air pollutants exposure and the risk of stillbirth in Wuhan, central of China","volume":"228","author":"Tan","year":"2023","journal-title":"Environ Res"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"105290","DOI":"10.1016\/j.envint.2019.105290","article-title":"Impacts of air pollution and noise on risk of preterm birth and stillbirth in London","volume":"134","author":"Smith","year":"2020","journal-title":"Environ Int"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"116752","DOI":"10.1016\/j.envpol.2021.116752","article-title":"Ambient air pollution and stillbirth: An updated systematic review and meta-analysis of epidemiological studies","volume":"278","author":"Zhang","year":"2021","journal-title":"Environ Pollut"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1809","DOI":"10.1093\/humrep\/dez111","article-title":"Air pollution exposure and risk of spontaneous abortion in the nurses' health study II","volume":"34","author":"Gaskins","year":"2019","journal-title":"Hum Reprod"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"112653","DOI":"10.1016\/j.ecoenv.2021.112653","article-title":"Association of maternal exposure to ambient particulate pollution with incident spontaneous pregnancy loss","volume":"224","author":"Wang","year":"2021","journal-title":"Ecotoxicol Environ Saf"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e15","DOI":"10.1016\/S2542-5196(20)30268-0","article-title":"Estimation of pregnancy losses attributable to exposure to ambient fine particles in South Asia: an epidemiological case-control study","volume":"5","author":"Xue","year":"2021","journal-title":"Lancet Planet Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"e219","DOI":"10.1016\/S2542-5196(19)30047-6","article-title":"Association between pregnancy loss and ambient fine particles in Africa: findings from a longitudinal study, 1998-2016","volume":"3","author":"Xue","year":"2019","journal-title":"Lancet Planet Health"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"131802","DOI":"10.1016\/j.chemosphere.2021.131802","article-title":"The correlation between chronic exposure to particulate matter and spontaneous abortion: a meta-analysis","volume":"286","author":"Zhu","year":"2022","journal-title":"Chemosphere"},{"key":"ref39","first-page":"39","article-title":"Progress in researches on correlation between birth defects and major ambient air pollutants","volume":"33","author":"Huang","year":"2017","journal-title":"Chin J Public Health"},{"key":"ref40","first-page":"89","article-title":"Study on disease composition and birth defect intervention measures of disabled children in Bijie City from 2008 to 2014","volume":"31","author":"Xin","year":"2016","journal-title":"Matern Child Health Care China"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"113898","DOI":"10.1016\/j.ijheh.2021.113898","article-title":"Maternal air pollution exposure and neonatal congenital heart disease: a multi-city cross-sectional study in eastern China","volume":"240","author":"Li","year":"2022","journal-title":"Int J Hyg Environ Health"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"143821","DOI":"10.1016\/j.scitotenv.2020.143821","article-title":"Associations between weekly air pollution exposure and congenital heart disease","volume":"757","author":"Zhang","year":"2021","journal-title":"Sci Total Environ"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"106548","DOI":"10.1016\/j.envint.2021.106548","article-title":"Maternal exposure to ambient air pollution and congenital heart defects in China","volume":"153","author":"Yang","year":"2021","journal-title":"Environ Int"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.27652\/d.cnki.gzyku.2020.001695","article-title":"The study of the relationship between air pollution exposure and congenital heart defects and neural tube defects that cause of death in children under five in Shenyang","author":"Zhou","year":"2020","journal-title":"China Med Univ"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1017644","DOI":"10.3389\/fpubh.2022.1017644","article-title":"Maternal exposure to ambient air pollution and risk of congenital heart defects in Suzhou, China","volume":"10","author":"Sun","year":"2023","journal-title":"Front Public Health"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"113070","DOI":"10.1016\/j.ecoenv.2021.113070","article-title":"Maternal exposure to air pollution and congenital heart diseases in Henan, China: a register-based case-control study","volume":"229","author":"Zhang","year":"2022","journal-title":"Ecotoxicol Environ Saf"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1007\/s00441-016-2509-4","article-title":"Before the first breath: prenatal exposures to air pollution and lung development","volume":"367","author":"Veras","year":"2017","journal-title":"Cell Tissue Res"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.prrv.2016.08.008","article-title":"Air pollution during pregnancy and lung development in the child","volume":"21","author":"Korten","year":"2017","journal-title":"Paediatr Respir Rev"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"e130","DOI":"10.1097\/EE9.0000000000000130","article-title":"Maternal exposure to PM2.5 during pregnancy and asthma risk in early childhood: consideration of phases of fetal lung development","volume":"5","author":"Hazlehurst","year":"2021","journal-title":"Environ Epidemiol"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1164\/rccm.201804-0694OC","article-title":"Prenatal household air pollution is associated with impaired infant lung function with sex-specific effects. Evidence from GRAPHS, a cluster randomized Cookstove intervention trial","volume":"199","author":"Lee","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"ref51","first-page":"308","article-title":"Relationship between air pollution and Perineonate death and birth defects in Tianjin","volume":"39","author":"Chen","year":"2012","journal-title":"J Int Obstet Gynecol"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.envres.2018.07.008","article-title":"Ambient air pollution and pregnancy outcomes: a comprehensive review and identification of environmental public health challenges","volume":"167","author":"Klepac","year":"2018","journal-title":"Environ Res"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"3866","DOI":"10.1038\/s41467-019-11654-3","article-title":"Ambient black carbon particles reach the fetal side of human placenta","volume":"10","author":"Bov\u00e9","year":"2019","journal-title":"Nat Commun"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"36","DOI":"10.3389\/fped.2016.00036","article-title":"Endogenous and exogenous stem\/progenitor cells in the lung and their role in the pathogenesis and treatment of pediatric lung disease","volume":"4","author":"Leibel","year":"2016","journal-title":"Front Pediatr"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1289\/ehp.99107s3451","article-title":"Molecular epidemiologic research on the effects of environmental pollutants on the fetus","volume":"107","author":"Perera","year":"1999","journal-title":"Environ Health Perspect"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"1212","DOI":"10.1289\/ehp.7751","article-title":"Local variations in CO and particulate air pollution and adverse birth outcomes in Los Angeles County, California, USA","volume":"113","author":"Wilhelm","year":"2005","journal-title":"Environ Health Perspect"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1093\/toxsci\/kfab118","article-title":"Gestational exposure to ultrafine particles reveals sex- and dose-specific changes in offspring birth outcomes, placental morphology, and gene networks","volume":"184","author":"Behlen","year":"2021","journal-title":"Toxicol Sci"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"5144","DOI":"10.1007\/s11356-021-16054-z","article-title":"Prenatal air pollution exposure increases the risk of macrosomia: evidence from a prospective cohort study in the coastal area of China","volume":"29","author":"Li","year":"2022","journal-title":"Environ Sci Pollut Res Int"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"1638","DOI":"10.1289\/ehp.8111","article-title":"Birth outcomes and prenatal exposure to ozone, carbon monoxide, and particulate matter: results from the children\u2019s health study","volume":"113","author":"Salam","year":"2005","journal-title":"Environ Health Perspect"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1111\/1471-0528.17727","article-title":"Ambient air pollution and adverse birth outcomes: a review of underlying mechanisms","volume":"131","author":"Fussell","year":"2024","journal-title":"BJOG"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"e0120594","DOI":"10.1371\/journal.pone.0120594","article-title":"Air pollution and stillbirth risk: exposure to airborne particulate matter during pregnancy is associated with fetal death","volume":"10","author":"DeFranco","year":"2015","journal-title":"PLoS One"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1616787\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T06:17:44Z","timestamp":1753424264000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1616787\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,25]]},"references-count":61,"alternative-id":["10.3389\/fpubh.2025.1616787"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1616787","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,25]]},"article-number":"1616787"}}