Epigenetics, environmental teratogens and congenital diseases: A narrative review of Italian legislation and pediatric public health implications

Background : Congenital anomalies are a leading cause of infant morbidity and mortality and arise from complex interactions between genetic susceptibility and prenatal environmental exposures. Increasing evidence indicates that these teratogens induce epigenetic alterations, including changes in DNA methylation, histone modifications, and non-coding RNA expression, thereby disrupting fetal gene regulation. In Italy, congenital malformations affect approximately 2-3% of live births, with environmental factors accounting for a relevant proportion of preventable cases. Methods : This narrative review was structured on a literature search conducted between October and December 2025 using PubMed, Scopus, and Web of Science. Scientific publications addressing epigenetic mechanisms, teratogenic exposures, congenital anomalies, maternal health, and pediatric prevention were identified and narratively synthesized. In parallel, Italian legislation, constitutional amendments, legislative decrees, and international directives were qualitatively reviewed to examine the evolution of public health and maternal-child protection policies. Results : Prenatal exposures may be responsible for altered fetal development through epigenetic mechanisms occurring during critical stages of embryogenesis. The Italian regulatory framework has progressively strengthened Public Health, occupational safety, and maternal protection measures, reducing avoidable prenatal hazards. Conclusions : As leaders in Child Health, Pediatricians are uniquely positioned to identify modifiable prenatal risk factors, counsel families, and promote evidence-based clinical strategies, translating scientific advances into preventive action to reduce the burden of congenital diseases.