Prenatal PM2.5 exposure and hypertensive disorders of pregnancy: a systematic review and meta-analysis.

PURPOSE: This study endeavors to unravel the association between PM2.5 exposure and hypertensive disorders of pregnancy (HDP) via a comprehensive review of epidemiological studies.

METHODS

Pertinent studies investigating the association between PM2.5 exposure and HDP were retrieved from PubMed, Embase, Web of Science, and the Cochrane Library until June 20, 2024. In addition, one article was identified through an updated search on September 1, 2025. Our study utilized the Newcastle-Ottawa Scale (NOS) and the Journal of Biomedical Informatics (JBI) scale for eligible study quality assessment. Statistical analyses were enabled by R 4.3.2 and Stata 15.1.

RESULTS

Fifteen studies were encompassed, involving 78,427 patients. The meta-analysis revealed the following rates and 95% confidence intervals (CIs): preeclampsia (PE) at 3% (2.9-3.7%); gestational hypertension (GH) at 3% (1.9-4.4%); and HDP at 11.2% (2.1-26%). For the entire pregnancy period, analysis showed a positive association between PM2.5 and PE (OR: 1.11, 95% CI: 1.06, 1.15). In different pregnancy periods, analysis revealed a positive association of PM2.5 with PE (OR: 1.02, 95% CI: 1.01, 1.03). At PM2.5 levels in the third quartile (Q3), analysis showed a positive association with PE (OR: 1.12, 95% CI: 1.07, 1.18). Similarly, at PM2.5 levels in the fourth quartile (Q4), the association was significant (OR: 1.18, 95% CI: 1.12, 1.24). For PM2.5 levels in the second quartile (Q2), a positive association with HDP prevalence was observed (OR: 1.11, 95% CI: 1.00, 1.23). Other analyses suggested that PM2.5 is a risk factor for HDP, though our results lacked statistical significance.

CONCLUSION

Our study indicates that PM2.5 is a significant risk factor for HDP. Due to several limitations, it was anticipated that future large-scale, multicenter, prospective studies will provide further confirmation of these findings.