Association of arsenic exposure with adverse birth outcomes: A meta-analysis and a benchmark dose analysis

Arsenic(As) exposure is a global health issue. Prior research has demonstrated that As exposure is associated with various adverse birth outcomes. Nevertheless, a systematic assessment of the health risks linked to adverse birth outcomes, especially congenital defects, caused by As exposure is still pending. In addition, it is also necessary to propose a clear safety threshold in terms of the prevention of As exposure in public policies. We searched five databases (PubMed、Web of Science、Wanfang, CNKI, and Weipu) to obtain studies published before June 2025. The meta-analysis comprised 76 studies (n = 4,164,491). As exposure was associated with adverse pregnancy outcomes (spontaneous abortion: OR = 1.50, 95 % CI: 1.14, 1.99; stillbirth: OR = 2.10, 95 % CI: 1.75, 2.52; preterm birth: OR = 1.19, 95 % CI: 1.05, 1.33; neonatal mortality: OR = 1.38, 95 % CI: 1.11, 1.70 and infant mortality: OR = 1.50, 95 % CI: 1.22, 1.85), an increased incidence of congenital cardiac disease was linked to As exposure (OR = 1.92, 95 % CI: 1.07, 3.52). Birth weight was lowered after As exposure (β = -12.67 g, 95 % CI: -19.93 -5.40). Our research findings suggest that As exposure is closely associated with various adverse birth outcomes. Using the Bayesian Benchmark Dose (BBMD) analysis system, we identified a dose-response relationship between As exposure from drinking water and adverse pregnancy outcomes. Neonatal mortality emerged as the most sensitive endpoint, with the lowest benchmark concentration lower limit (bmcl₁₀) found to be 27.73 μg/L.