Environmental exposures before and during pregnancy: implications for maternal and child health and the role of gynecologists in Italy

Background The preconception and pregnancy periods are critical windows during which environmental exposures may influence reproductive function, placental development, fetal growth, and long-term child health. Air pollution, endocrine-disrupting chemicals, per- and polyfluoroalkyl substances, pesticides, metals, and indoor pollutants are widespread, while opportunities for clinical prevention are often missed. Objective To summarize the evidence on environmentally relevant exposures before and during pregnancy and to define the role of gynecologists in exposure assessment, risk communication, counselling, and referral as an upstream strategy to protect fetal, neonatal, and child health, with particular attention to the Italian setting. Methods A targeted narrative review of peer-reviewed literature indexed in PubMed/MEDLINE and Scopus was conducted to inform a clinically oriented synthesis. Priority was given to systematic reviews and meta-analyses, professional recommendations, large prospective cohorts, and studies from Italy or comparable European settings. Evidence was synthesized narratively because of heterogeneity in exposure assessment, timing, populations, and outcomes. No formal systematic-review procedures or meta-analysis were undertaken. Results Environmental exposures occurring before conception and during pregnancy have been associated with reduced fertility, miscarriage, hypertensive disorders of pregnancy, gestational diabetes, impaired placentation, fetal growth restriction, preterm birth, and adverse respiratory, neurodevelopmental, endocrine, and immune outcomes in children. The strength of evidence differs across pollutants and outcomes, and causal inference remains challenging for complex chemical mixtures. Nevertheless, several low-burden preventive actions are reasonable, particularly for women and couples with occupational, residential, or lifestyle-related circumstances suggesting elevated exposure. Conclusions Gynecologists are well positioned to incorporate a brief environmental history into preconception and antenatal care, identify potentially high-risk situations, provide proportionate and evidence-based counselling, and coordinate referral when appropriate. In Italy, integrating environmental health into routine reproductive care could strengthen upstream pediatric prevention across the life course and contribute to healthier pregnancies and children.