Water Pollution and Perinatal or Neonatal Outcomes: A Scoping Review

Water pollution is an increasingly important but underintegrated determinant of maternal and newborn health. Drinking-water contaminants such as heavy metals, nitrates, disinfection by-products, pesticides, per- and polyfluoroalkyl substances (PFAS), and industrial pollutants have been linked with adverse perinatal and neonatal outcomes, but the evidence is dispersed across pollutant classes, outcomes and regions. We aimed to map the scope and nature of the published evidence on water pollution and perinatal or neonatal outcomes.

We conducted a scoping review using Joanna Briggs Institute methodology and reported the review in line with PRISMA-ScR guidance. PubMed, Embase and Scopus were searched through December 2024, with supplementary hand-searching of reference lists. Eligible studies evaluated exposure to water pollutants through drinking water or water supply systems and reported perinatal or neonatal outcomes. Two reviewers independently screened records and extracted data using a standardised form. Findings were synthesised descriptively.

Of 138 records identified, 95 remained after duplicate removal, 65 underwent full-text review and 42 studies were included. The evidence came from 26 countries across six continents. Prospective cohort, cross-sectional and case-control designs accounted for most studies. Heavy metals dominated the literature, especially arsenic and lead, while PFAS was the most prominent emerging contaminant group. Preterm birth, low birth weight and congenital anomalies were the most frequently examined outcomes. Across studies, higher exposure levels were repeatedly associated with adverse outcomes, with signals strongest for arsenic, lead, PFAS, cadmium, mercury, nitrates and mixed-pollutant exposure.

The available evidence consistently suggests that water pollution is relevant to perinatal and neonatal risk. The literature is strongest for growth restriction, prematurity, birth defects and mortality-related outcomes, but important gaps remain in exposure standardisation, mixture analysis, neonatal phenotyping and intervention research. Water quality should be considered part of routine maternal-child health protection, especially in high-burden settings.