Air Pollution's Toll on Adverse Birth Outcomes: Key Research Insights from Chinese Epidemiological Studies

Hui Chang¹Wanting Sun²Yuanyuan Tian¹Jing Wu¹Yanru Yue¹Wenhua Li¹Xin Zhao¹Xiaoan Zhang¹Jian Jin^1,2*

• ¹Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
• ²Zhengzhou University, Zhengzhou, Henan Province, China

Despite extensive global evidence linking air pollution to adverse birth outcomes, a comprehensive synthesis of China-specific epidemiological insights-particularly across its regionally diverse pollution landscapes and susceptible populations-remains limited. This systematic review integrates evidence from Chinese epidemiological and retrospective studies (2011-2023) 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-environment 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.