Environmental Science and Pollution Research

, Volume 26, Issue 20, pp 20137–20147 | Cite as

The associations of air pollution exposure during pregnancy with fetal growth and anthropometric measurements at birth: a systematic review and meta-analysis

  • Li Fu
  • Yi Chen
  • Xinyi Yang
  • Zuyao Yang
  • Sha Liu
  • Lei Pei
  • Baixiang Feng
  • Ganxiang Cao
  • Xin Liu
  • Hualiang Lin
  • Xing Li
  • Yufeng Ye
  • Bo Zhang
  • Jiufeng Sun
  • Xiaojun Xu
  • Tao LiuEmail author
  • Wenjun MaEmail author
Review Article


Fetal growth has been demonstrated to be an important predictor of perinatal and postnatal health. Although the effects of maternal exposure to air pollution during pregnancy on fetal growth have been investigated using ultrasound in many previous studies, the results were inconsistent and disputable. We aimed to qualitatively and quantitatively investigate the associations of air pollution exposure during different periods of pregnancy with fetal growth and anthropometric measurements at birth. We searched for all studies investigating the associations of air pollution exposure during pregnancy with fetal growth and birth anthropometric measurements in English and Chinese databases published before July 31, 2017. A random-effects model was employed in the meta-analysis to estimate the pooled effects of each 10 μg/m3 increment in air pollutant exposure. The ACROBAT-NRSI tool was applied to assess the quality of each included study, and the GRADE tool was employed to assess the overall quality of the meta-analysis. Maternal PM2.5 exposure (10 μg/m3) during the entire pregnancy was negatively associated with head circumference at birth (β = − 0.30 cm, 95% CI − 0.49, − 0.10), and NO2 exposure during the entire pregnancy was significantly linked to shorter length at birth (β = − 0.03 cm, 95% CI − 0.05, − 0.02). Maternal exposure to higher NO2 and PM2.5 during pregnancy may impair neonatal head circumference and length development, respectively. More studies are needed to confirm the effects of NO2 and PM2.5 and to identify the sources and major toxic components of PMs.


Air pollutants Fetal growth Maternal exposure Meta-analysis Neonatal Ultrasound measurements 



A Cochrane Risk of Bias Assessment Tool: for Non-Randomized Studies of Interventions


Grading of Recommendations, Assessment, Development, and Evaluation


Head circumference


Abdomen circumference


Biparietal diameter


Femur length


Standard error


Risk of bias


Small for gestational age


Authors’ contributions

LF and YC reviewed the literature and drafted the manuscript. XY, SL, LP, BF, GC, XL, XL, YY, JS, and XX checked and managed the data. ZY, HL, and BZ provided critical input to the manuscript. TL and WM provided lead supervision of the project, provided expert review of the manuscript, and reviewed and approved the manuscript. All authors contributed to the research article and approved the final version.


This work was supported by the National Key Research and Development Program (2016YFC0207001), the National Natural Science Foundation of China (81502819,81874276), the Natural Science Foundation of Guangdong Province (2015A030310220), the Science and Technology Program of Guangdong Province (2016A020223008), and the Science and Technology Program of Guangzhou (201607010004).

Compliance with ethical standards

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors that they have no competing interests.

Supplementary material

11356_2019_5338_MOESM1_ESM.docx (323 kb)
ESM 1 (DOCX 323 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Li Fu
    • 1
  • Yi Chen
    • 2
  • Xinyi Yang
    • 1
  • Zuyao Yang
    • 3
  • Sha Liu
    • 1
  • Lei Pei
    • 1
  • Baixiang Feng
    • 1
  • Ganxiang Cao
    • 1
  • Xin Liu
    • 1
  • Hualiang Lin
    • 4
  • Xing Li
    • 1
  • Yufeng Ye
    • 2
  • Bo Zhang
    • 5
    • 6
  • Jiufeng Sun
    • 1
  • Xiaojun Xu
    • 7
  • Tao Liu
    • 8
    • 1
    Email author
  • Wenjun Ma
    • 1
    • 8
    Email author
  1. 1.Guangdong Provincial Institute of Public HealthGuangdong Provincial Center for Disease Control and PreventionGuangzhouChina
  2. 2.Guangzhou Panyu Central HospitalGuangzhouChina
  3. 3.Division of Epidemiology, The Jockey Club School of Public Health and Primary CareThe Chinese University of Hong KongSha TinChina
  4. 4.Department of Preventive Medicine, School of Public HealthSun Yat-Sen UniversityGuangzhouChina
  5. 5.Center for Food Safety and Health, School of Public HealthSouthern Medical UniversityGuangzhouChina
  6. 6.Guangzhou Key Laboratory of Environmental Pollution and Health Risk AssessmentGuangzhouChina
  7. 7.Guangdong Provincial Center for Disease Control and PreventionGuangzhouChina
  8. 8.General Practice Center, Nanhai HospitalSouthern Medical UniversityFoshanChina

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