Decoding neurodevelopment risks of exposures to intoxication, infection, and trauma during pregnancy

The maternal environment plays a pivotal role in fetal neurodevelopment, but adverse conditions during pregnancy may disrupt key developmental processes. Conditions such as intoxication, infection, or trauma during pregnancy have been associated with impaired fetal oxygenation, altered immune signaling, and disrupted placental function, which may contribute to long-term neurodevelopmental alterations. This review examines evidence suggesting how prenatal exposures to alcohol, cocaine, Zika virus, rubella virus, Toxoplasma gondii, influenza, and traumatic brain injury can impact fetal brain development. These exposures often intersect with negative social determinants of health, increasing the risk for adverse outcomes. We focus on cellular and molecular mechanisms that contribute to outcomes such as microcephaly, cognitive impairment, and neurodevelopmental disorders, including schizophrenia and autism spectrum disorder. Although clinical epidemiology studies and preclinical investigations provide novel insights, major gaps in knowledge about how real-world exposures affect fetal outcomes remain. This review integrates comprehensive research and epidemiological evidence of risk to emphasize the need for inclusive studies and targeted prevention strategies to protect fetal brain development.