Maternal health outcomes are increasingly affected by the state of the planet itself. The planetary boundaries framework provides a powerful and underused lens through which to understand threats to maternal and perinatal health. This framework defines nine Earth system processes critical to maintaining a stable environment for human life, including climate change, biodiversity loss, land-system change, freshwater disruption, and the introduction of novel entities such as chemical pollutants. Each of these boundaries, and critically their interactions, maps onto distinct biological pathways affecting maternal health and the perinatal period. Extreme heat, air pollution, and food system disruption have been linked to preterm birth, low birth weight, gestational hypertension, and maternal mortality; biodiversity loss and land use change alter pathogen exposure, nutritional security, and local food systems; freshwater disruption affects sanitation and hydration during pregnancy; and chemical and plastic pollution, including endocrine-disrupting chemicals, microplastics, PFAS, and heavy metals, represents a rapidly growing body of maternal and fetal risk. Compounding these biological pathways, planetary boundary transgressions also act as a structural determinant of maternal health by undermining the resilience of the health systems that pregnant and postpartum populations depend on, shaping the accessibility and availability of maternal and child health services. Yet the evidence base remains fragmented, geographically skewed toward high-income settings, and rarely situated within this coherent multi-boundary frame. As several planetary boundaries are simultaneously transgressed, understanding their cumulative and intersecting effects on the most biologically and socially vulnerable moment in human life demands urgent, interdisciplinary attention.

This Research Topic aims to consolidate and advance the emerging evidence base on how planetary-scale environmental changes affect maternal health across the life course, from preconception through the postpartum period. Using the planetary boundaries framework as its organising structure, the collection seeks to move beyond siloed analyses of individual exposures to understand the cumulative and intersecting burden of multiple boundary transgressions on maternal and perinatal outcomes, including their effects on the resilience and functioning of the health systems that deliver maternal and child care.

The collection prioritises research from low- and middle-income countries and from communities experiencing compounded environmental and social vulnerabilities, where the planetary-maternal health nexus is most acute and least studied. We also aim to bridge evidence and action by inviting contributions that connect findings to maternal care delivery, including the resilience of antenatal care, skilled birth attendance, and postnatal services under planetary stress, and to policy frameworks that address these determinants in an integrated way. By centering equity and bringing together researchers, practitioners, and policymakers across disciplines, this collection seeks to catalyze an evidence base at the intersection of planetary boundary science and maternal health practice.

We welcome original research, systematic and scoping reviews, meta-analyses, commentaries, and policy analyses addressing the following themes, organised around the planetary boundaries framework:

• Impacts of climate exposures (extreme heat, flooding, drought, wildfire smoke, air pollution, and cumulative co-exposures) on maternal and perinatal outcomes
• Biodiversity loss, land-system change, and food system disruption as determinants of maternal nutrition, micronutrient deficiency, infectious disease risk, and perinatal outcomes
• Freshwater disruption, including altered water quality and availability during pregnancy, is a determinant of maternal and fetal health. Chemical contamination of drinking water, including arsenic, nitrates, microplastics, and chemical residues, has been linked to preterm birth, low birthweight, fetal growth restriction, and even stillbirth through mechanisms including placental dysfunction, oxidative stress, and epigenetic modification.
• Chemical and plastic pollution as emerging maternal and perinatal health risks, including endocrine-disrupting chemicals, microplastics, PFAS, heavy metals, and pesticide exposure across the preconception-to-postpartum period
• Cumulative and intersecting planetary boundary transgressions, examining the compound effects of multiple co-occurring environmental stressors on maternal and perinatal outcomes
• Environmental justice and the inequitable distribution of planetary health burdens on pregnant and postpartum populations
• Health system resilience and maternal care pathways under planetary stress, examining how planetary stressors affect the accessibility, availability, and continuity of maternal and child health services, including supply chains, workforce capacity, facility infrastructure, and referral networks, and how these systemic pressures disrupt antenatal care access, skilled birth attendance, and postnatal care continuity in LMIC settings, especially in hard-to-reach, vulnerable, and geographically underserved settings such as but not limited to mountain regions (such as the Hindu Kush Himalaya), conflict-affected and fragile settings, and forest-dependent ecosystems such as the Amazon basin.
• Indigenous and traditional ecological knowledge (TEK) in maternal health resilience, including its role in understanding environmental determinants, birth practices, and community-led adaptation. Perspectives, commentaries, and community-based case studies are especially welcomed.

Submissions from LMICs, Indigenous contexts, and underrepresented geographies are especially encouraged. Mixed-methods, participatory, and community-based research designs are welcome alongside quantitative approaches.

Are you interested in contributing a manuscript to this Research Topic?

Planetary Boundaries and Determinants of Maternal and Perinatal Health: Building an Integrated Evidence Base