Systemic Oxidative Stress and Antioxidant Capacity in Pregnant Women Exposed to Air Pollution: A Case-Control Study in Western Macedonia, Greece

Background: Long-term exposure to ambient air pollution during pregnancy has been strongly associated with oxidative-stress-mediated adverse maternal and fetal outcomes. Aim: The present study aimed to evaluate systemic oxidative stress and antioxidant capacity in pregnant women residing in a highly polluted area (Kozani) compared with a less polluted region (Grevena) in Western Macedonia, Greece. Methods: Oxidative stress was assessed using derivatives of reactive oxygen metabolites (d-ROMs), while antioxidant capacity was evaluated through biological antioxidant potential (BAP). Results: The findings of the study demonstrated that pregnant women in the polluted area exhibited elevated d-ROMs levels and significantly reduced BAP levels compared with controls. Although unadjusted oxidative stress differences were not statistically significant, adjusted analyses revealed significantly higher oxidative stress in the exposed group. These results suggest that air pollution exposure is associated with systemic redox homeostasis, primarily through depletion of antioxidant defenses. Conclusions: This study provides novel biomonitoring evidence linking environmental exposure to redox imbalance during pregnancy. As Western Macedonia transitions to a post-lignite era, the decrease in air pollution is anticipated to lead to significant improvements in public health, while these findings establish an important baseline for evaluating the effectiveness of environmental and public health interventions.