Early-Life Exposure to Air Pollution and Adverse Birth Outcomes in India: A Systematic Review

Abstract

Air pollution and climate change pose major environmental threats in India, where rising levels of ambient and household pollutants disproportionately affect pregnant women and infants. Exposure to fine particulate matter, gaseous pollutants and biomass fuel emissions has been linked to adverse birth outcomes, yet evidence remains scattered. This systematic review and meta-analysis consolidates existing research to assess the association between prenatal and early-life exposure to air pollution and adverse birth outcomes in the Indian context. from 2010 to June 2025. Eligible studies examined at least two themes: air pollution, climate change, and adverse birth outcomes (low birth weight, preterm birth, mortality, or early-life exposure) within India. Data were synthesized across study designs, pollutant types, exposure sources and reported health outcomes. Household exposure from solid cooking fuels, poor ventilation and indoor smoke was independently linked to reduced mean birthweight, increased low birth weight (LBW) prevalence, higher occurrence of preterm birth and elevated risk of stillbirth. The evidence strongly supports integrated action like combining clean air policies, climate adaptation strategies, clean cooking initiatives and maternal–child health programs, to mitigate risk and protect vulnerable populations. Strengthening national frameworks such as NCAP and NPCCHH with maternal and neonatal health evidence is essential to reduce pollution-related inequities and improve long-term population health.