Table 1. Characteristics of included studies evaluating the association between pesticide exposure and child growth.
| Author, year | Country | Study design | Sample size | Population assessed | Type of exposure | Method of exposure assessment | Timing of exposure assessment | Pesticides reported Outcomes assessed | Summary of findings | Confounding factors | GRADE study risk of bias | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Anand and Taneja (2020) | India | Cross-sectional | 90 | Pregnant women who delivered in a hospital in Agra | Occupational; accidental | Placenta sample | At birth | α-HCH, β-HCH, γ-HCH, δ-HCH, total-HCH, p, p’-DDE, p,p’-DDT, p,p’-DDD, total-DDT | Birth weight, birth length | Higher prenatal concentrations of α-HCH, β-HCH, γ-HCH, total-HCH, p, p’-DDD, and total-DDT were associated with significantly lower birth weight. No significant associations between prenatal HCH and DDT and birth length. | Not reported | Serious |
| Arrebola et al. (2016) | Bolivia | Prospective cohort | 200 | Pregnant women | Not reported | Cord blood | Prenatally at last antenatal care visit before birth | o,p′-DDT and p,p′-DDE | Birth weight, birth length | Higher prenatal concentrations of α-HCH, β-HCH, γ-HCH, total-HCH, p, p’-DDD, and total-DDT were associated with significantly lower birth weight. No significant associations between prenatal HCH and DDT and birth length. | Gestational weight and age, maternal age, parity, smoking habit, BMI | Not serious |
| Bravo et al. (2019) | Russia | Cross-sectional | 250 | Pregnant women | Not reported | Blood sample | Prenatally in the last week of pregnancy | HCB, α-HCH, β-HCH, p, p′-DDE, p,p′-DDT, mirex | Birth weight, birth length | Higher prenatal concentrations of p, p’-DDT were associated with significantly higher birth weight and birth length. | Gestational age, maternal age, parity, smoking, and alcohol consumption | Not serious |
| Cecchi et al. (2021) | Argentina | Prospective cohort | 776 | Pregnant women living in a rural food production zone in northern Patagonia for at least four years but not involved in agricultural work | Residential proximity to fruit croplands with intense pesticide application | Residential location; self-reported | Prenatally | Organophosphates (e. g., chlorpyrifos, azinphos-methyl) and carbamates (e.g., carbofuran, pirimicarb) were most frequently used in the exposed area | Birth weight, birth length, low birth weight, preterm birth, small-for-gestational age | Living in an exposed area was associated with significantly lower birth length. No significant associations with birth length, PTB, LBW, or SGA. | Not accounted for | Serious |
| Cioroiu et al. (2010) | Romania | Cross-sectional | 63 | Pregnant women | Not reported | Colostrum | Prenatally in the first week after delivery | HCB, α-HCH, β-HCH, γ-HCH, δ-HCH, total-HCH, o,p’-DDE, p,p’-DDE, o,p’-DDD, p,p’-DDT, o,p’-DDT, p,p’-DDD, total-DDT, | Preterm birth | Higher colostrum concentrations of total HCH were significantly higher in women with normal births than in women with preterm births. Higher colostrum concentrations of total DDT were significantly lower in women with normal births than in women with preterm births. | Not accounted for | Serious |
| Cupul-Uicab et al. (2010) | Mexico | Cross-sectional | 788 | Pregnant women living in Tapachula, Chiapas who gave birth to boys | Not reported | Blood sample | Prenatally at birth | p,p’-DDE, DDT | Height | Higher prenatal concentrations of p, p’-DDE and DDT were not associated with child height. | Smoking habit, hospital recruitment, rural residence, gestational age, maternal height, education | Not serious |
| Ding et al. (2015) | China | Prospective cohort | 454 | Pregnant women | Occupational, food | Urine sample | Prenatally | cis-DCCA, trans-DCCA, 3-PBA, 4-fluoro-3-PBA, cis-DBCA, total pyrethroids | Birth weight, birth length | Higher prenatal concentrations of total pyrethroids were associated with significantly lower birth weight, but not with birth length. | Infant sex, parity, pre-pregnancy BMI and weight gain, maternal age, smoking habit, length of gestation, household income | Not serious |
| Dwivedi et al. (2022) | India | Cross-sectional | 221 | Pregnant women living in Uttar Pradesh | Non-occupational | Blood and cord blood samples | Prenatally | α-HCH, β-HCH, γ-HCH, p,p’-DDE, o,p’-DDE, o, p’-DDT, aldrin, dieldrin, endrin aldehyde | Birth weight | Higher prenatal blood concentrations of α-HCH, γ-HCH, p, p’-DDE, o,p’-DDE, o, p’-DDT and dieldrin were significantly negatively correlated with birth weight. Higher prenatal cord blood concentrations of p,p’-DDE, o,p’-DDT, and dieldrin were significantly negatively correlated with birth weight. | Not accounted for | Serious |
| Fang et al. (2019) | China | Prospective cohort | 1028 | Pregnant women resident of Wuhan City | Not reported | Cord serum | Prenatally at delivery | α-HCH, β-HCH, γ-HCH, total-HCH, p,p’-DDE, p,p’-DDT, p,p’-DDD, total-DDT | Birth weight, birth length | Higher prenatal concentrations of HCH and DDT isomers were not associated with birth weight or birth length in adjusted models. Higher prenatal concentrations of β-HCH and total HCH were associated with significantly lower birth weight among boys but not girls in adjusted models | Pre-pregnancy BMI and weight gain, maternal age, parity, education, smoking habit, gestational age, family income and infant sex | Not serious |
| Garced et al. (2012) | Mexico | Prospective cohort | 253 | Pregnant women living in the state of Morelos | Not reported | Blood sample | Prenatally at enrolment and each trimester visit | p,p’-DDE, DDT | Length-for-age Z-score, weight-for-age Z-score, weight-for-length Z-score, body mass index Z-score from birth to 1 year of age | Higher prenatal concentrations of p, p’-DDE were not associated with LAZ, WAZ, WHZ, or BMIZ | Age at evaluation, maternal age, height, and parity | Not serious |
| Gladen et al. (2003) | Ukraine | Cross-sectional | 197 | Pregnant women | Not reported | Breast milk | Prenatally, 4–5 days after birth | p,p’-DDT, p,p’-DDE, β-HCH, HCB, trans-nonachlor, oxychlordane, heptachlor epoxide | Birth weight | Mean birth weight was significantly different by tertile of prenatal concentrations of β-HCH with no pattern of a dose response: infants in the lowest tertile were small, infants in the middle tertile were large, and children in the upper tertile were average. Other pesticides showed no significant patterns | City, parity, maternal age, height, pre-pregnancy BMI, and infant gender | Not serious |
| Guo et al. (2014) | China | Cross-sectional | 81 | Pregnant women | Not reported | Blood and cord blood samples | Prenatally | p,p’-DDT, o,p’-DDT, p, p’-DDE, o,p’-DDE, p,p’-DDD, o,p’-DDD, α-HCH, β-HCH, γ-HCH, δ-HCH, total HCH, HCB, heptachlor, heptachlor epoxide B, α-chlordanes, γ-chlordanes, oxychlordane, endosulfan I, mirex | Birth weight | No significant associations between prenatal concentrations of examined pesticides and birth weight | Maternal age, BMI at delivery, infant gender, and gestational week | Not serious |
| Guo et al. (2016) | China | Cross-sectional | 1100 | Mother-child pairs | Not reported | Urine sample | Prenatally at birth | 2,5-DCP, 2,4-DCP, 2,4,5-TCP, 2,4,6-TCP and PCP | Birth weight | Higher prenatal concentrations of 2,4,6-TCP and PCP were associated with significantly lower birth weight in boys but not girls. Higher prenatal concentrations of PCP were associated with significantly lower birth length in boys but not girls. | Gestational age, pre-pregnancy BMI, maternal age, parity, gestational weight gain, family income, education, occupation, smoking habits, child sex, sex x log 10-(each CP) concentration | Not serious |
| Abdel Hamid et al. (2020) | Egypt | Cross-sectional | 81 | Pregnant women for a hospital in Cairo | Not reported | Blood and cord blood samples | Prenatally | p,p’-DDT, p,p’-DDE, p, p’-DDD, α-HCH, β-HCH, γ-HCH, δ-HCH, HCB, heptachlor, heptachlor epoxide, endosulfan, endosulfan I, endosulfan II, endosulfansulphate, chlordane, aldrin, aldrin A, dieldrin, endrin, endrinaldehyde, methoxychlor | Birth weight, birth length | No significant associations between prenatal concentrations of examined pesticides and birth weight or birth length | Not accounted for | Serious |
| Hanke et al. (2003) | Poland | Cross-sectional | 104 | Pregnant women living in Zadzim district, Central Poland | Residential (agricultural district) | Self-reported | Prenatally and pre-conceptionally | Phenoxyacetic acid derivatives, synthetic pyrethroids, benzene thiosulphonate derivatives, organo-phosphorus compounds, inorganic derivatives of copper | Birth weight | Prenatal exposure to synthetic pyrethroids was associated with significantly lower birth weight | Pregnancy duration, infant gender, maternal age, pre-pregnancy weight, smoking habit, year of birth, women’s direct field work involvement, farming type | Not serious |
| Jaacks et al. (2019) | Bangladesh | Prospective cohort | 289 | Pregnant women from two rural districts | Drinking water | Urine sample | Prenatally at <16 weeks’ gestation | 2,4-D, TCPY, MDA, IMPY, 4-F-3-PBA, 3-PBA, trans-DCCA | Low birth weight, preterm birth, small-for-gestational age birth weight, length-for-age Z-score at 1 and 2 y, stunting at 1 and 2 y, weight-for-age Z-score at 1 and 2 y, weight-for-length Z-score at 1 and 2 y | Higher prenatal concentrations of 4-nitrophenol were associated with significantly higher risk of small-for-gestational age and preterm birth. Higher prenatal concentrations of 3-PBA were associated with significantly higher risk of small-for-gestational age. Higher prenatal concentrations of IMPY were associated with significantly higher risk of low birth weight. None of the pesticides assessed were associated with birth weight, LAZ at 1 or 2 years of age, or stunting at 1 or 2 years of age in adjusted models. | Household income, maternal education, dietary intake, and infection | Not serious |
| Jurewicz et al. (2005) | Poland | Cross-sectional | 460 | Pregnant women who had been working for a period of at least two years in greenhouses | Occupational (greenhouse workers) | Reported by those responsible for greenhouse chemical protection | 17 pesticides classified as reproductive and developmental toxins were applied in the greenhouses (mancozeb, fenbutatin-oxide, triforine, benomyl, thiophanate-methyl, zineb, permethrin, bifenthrin, thiram, oxythiquinox, vinclozolin, dinocap, dimethoate, amitraz, diazinon, cyhexatin, propargite) | Low birth weight, term low birth weight, birth weight, preterm birth, | No significant associations between working in greenhouses and any of the outcomes | Maternal weight, age, smoking habits, education and the place of residence (birth weight model only) | Serious | |
| Liu et al. (2016) | China | Prospective cohort | 310 | Pregnant women and their children 2 years of age living in an agricultural region producing cotton and rice | Residential (agricultural region), indoor insecticide use, occupational (farming) | Urine sample | Prenatally prior to delivery and postnatally when the child was 2 years of age | DMP, DMTP, DMDTP, DEP, DETP, DEDTP | Birth weight, birth length | No significant associations between prenatal exposure to organophosphates and birth weight or length. No differences between boys and girls. | Maternal age, education, gestational age, pregnancy weight gain, pre-pregnancy BMI, parity, delivery mode, child sex, smoking, maternal and paternal work status, family income, cord blood lead values, sampling season, inhabitation | Not serious |
| Moreno-Banda et al. (2009) | Mexico | Cross-sectional | 328 | Women with at least one pregnancy in the 10 years prior to the time of the interview who were floriculturists or partners of floricultural workers | Occupational (floriculture) | Self-reported | Prenatally in each trimester | Most commonly used insecticides were endosulphan, diazinon, metamidophos, omethoate, methyl parathion, carbofuran, methomyl, oxamyl, bifenthrin, permethrin, imidacloprid and abamectin. Most commonly used fungicides were benomyl, carbendazim, methyl thiophanate, mancozeb, triadimephon, captan, chlorotalonyl, iprodione, triforine and metalaxyl. | Low birth weight | Exposure to floricultural work at any time during the pregnancy was not associated with low birth weight | Child sex, adverse reproductive history, PON1 192RR | Not serious |
| Naksen et al. (2015) | Thailand | Prospective cohort | 52 | Pregnant women who were farmers and lived in Fang district | Occupational (farm workers) | Urine sample | Prenatally | DMP, DMTP, DMDTP, DEP, DETP, DEDTP | Birth weight, birth length | Among mothers with low PON1 activity, maternal sum DEAP (DEP, DETP, DETPD) and DAP (all six) levels were associated with significantly lower birth weight. No significant associations between maternal DAP levels and birth weight or length were observed in the high maternal PON1 activity group. | Maternal age, pre-pregnancy BMI, weight gain and gestational age | Not serious |
| Rahimi et al. (2020) | Iran | Cross-sectional | 645 | Women of reproductive | Occupational (greenhouse workers) | Greenhouse workers with ≥1 year work experience and ≥1 year marriage were compared to housewives | Prenatally | Not reported | Low birth weight, preterm birth | Significantly higher prevalence of LWB and PTB was observed among greenhouse workers than housewives. | Not accounted for | Very serious |
| Silvia et al. (2020) | Argentina | Cross-sectional | 53 | Pregnant women | Residential (agricultural region) | Residential location | Prenatally during the third trimester | Organophosphates such as chlorpyrifos and azinphos-methyl and carbamates such as carbofuran and pirimicarb are most frequently used in this region. | Birth weight, birth length, low birth weight, preterm birth, small-for-gestational age | No differences in birth weight, birth length, or small for gestational age between women assessed during the spraying season and women assessed during the non-spraying season. Higher proportion of births were low birth weight or preterm in women assessed during the spraying season than in women assessed during the non-spraying season. | Gestational age and child sex in the models for birth weight and length. | Serious |
| Steinholt et al. (2020) | Cambodia | Cross-sectional | 198 | Pregnant women | Dietary; residential (living in rice farming communities, insecticide use at home) | Blood and urine samples | Prenatally | HCB, heptachlor, o,p’-DDE, p,p’-DDE, o,p’-DDD, p,p’-DDD, p,p’-DDT, aldrin, mirex | Birth weight, birth length | Higher prenatal concentrations of o, p’-DDD were associated with significantly higher birth weight and significantly lower birth length. Higher prenatal concentrations of p, p’-DDD were associated with significantly lower birth length. Higher prenatal concentrations of Aldrin were associated with significantly higher birth length. Other pesticides showed no significant patterns. | Gestational age, maternal age, parity, BMI, residence area, education, and occupation | Not serious |
| Toichuev et al. (2018) | Kyrgyzstan | Cohort | 508 | Pregnant women | Residential (living in a cotton growing region); dietary | Placenta sample | Prenatally | α-HCH, γ-HCH, β-HCH, and δ-HCH; DDT, DDE and DDD; aldrin, dieldrin, and heptachlor | Low birth weight | Higher prevalence of low birth weight was observed in the group of women with detectable levels of organochlorine pesticides relative to the group of women with undetectable levels of organochlorine pesticides. | Not accounted for | Serious |
| Van Tung et al. (2016) | Vietnam | Cross-sectional | 120 | Lactating women | Residential (living in areas where chemical herbicides were stored and spilled and aircrafts that sprayed Agent Orange were washed) | Breast milk and saliva samples | Prenatally and postnatally | Dioxin (defined as only PCDDs/PCDFs, not including PCBs) | Birth weight, low birth weight, weight and height at 8–9 and 12–14 weeks | The prevalence of low birth weight was higher among women exposed to dioxin than unexposed women. Dioxin isomers were significantly negatively correlated with birth weight but not with weight or height at 8–9 or 12–14 weeks | Not accounted for | Serious |
| Wang et al. (2012a) | China | Cross-sectional | 503 | Pregnant women | Occupational, personal use at home | Self-reported | Prenatally during pregnancy | Not reported | Birth weight, low birth weight | No significant associations with prenatal pesticide exposure. | Household location, maternal race, education, age, child sex, gestational age, age of menarche | Not serious |
| Wang et al. (2012b) | China | Cross-sectional | 187 | Pregnant women | Multiple sources | Self-reported; urinary sample | Prenatally | DMP, DMTP, DEP, DETP, DEDTP | Birth weight, birth length | No significant associations with prenatal pesticide exposure. | Gestational age, maternal height, pregnancy weight gain, family income | Not serious |
| Xu et al. (2017) | China | Cross-sectional | 106 | Pregnant women | Residential (living in area with high agricultural pollution) | Cord serum | Prenatally at birth | p,p’-DDE, o,p’-DDD, p, p’-DDD, o,p’-DDT, p, p’-DDT | Birth weight, birth length | Higher prenatal concentrations of p, p’-DDD and p,p’-DDT were associated with higher birth weight in adjusted models. No significant associations with birth length | Unadjusted: maternal BMI, age, education Adjusted: maternal age, education, BMI, infant sex, abortion times, parity, weight gain, drinking water | Not serious |
| Yang et al. (2020) | China | Cross-sectional | 102 | Pregnant women | Non-occupational | Blood sample | Prenatally | 9 organophosphates (propetamphos, phosalone, diazinon, methacrifos, pyrazophos, mecarbam, parathion-methyl, phthalimide, isazofos), 7 organochlorines (alachlor, α-HCH, β-HCH, γ-HCH, δ-HCH, o,p’-DDT p,p’-DDD), 5 carbamates (fenobucarb, pirimicarb, propham, propoxur, isoprocarb), and 16 others (diclobutrazol, dicamba, DDA, atrazine, tetramethrin, chlorothalonil, ethofumesate, furalaxyl, 2-phenyl-phenol, metalaxyl, chlozolinate, diphenamid, triclosan, flutolanil, dicloran, simazine) | Birth weight | Higher prenatal concentrations of β-HCH were associated with significantly lower birth weight | Pre-pregnancy BMI, maternal education, age, smoking, weight gain, drinking, child sex, gestation length, smoking, family income | Not serious |
| Yang et al. (2021) | China | Prospective cohort | 1039 | Pregnant women | Multiple sources | Cord serum | Prenatally at birth | α-HCH, β-HCH, γ-HCH, p,p′-DDT, p,p′-DDD, p, p′-DDE | Body mass index Z-score, overweight at birth, 6, 12, and 24 months of age, growth velocity (difference in weight z-score), birth length | Higher prenatal concentrations of β-HCH were associated with significantly higher BMIZ at 12 and 24 months and significantly higher growth velocity from 0 to 12 months. Higher prenatal concentrations of γ-HCH were associated with significantly higher BMIZ at 6 months and higher growth velocity from 0 to 6 months. Higher prenatal concentrations of p, p′-DDE were associated with significantly lower BMIZ at 6 months. Higher prenatal concentrations of p, p′-DDT were associated with higher BMIZ at 12 months. Higher prenatal concentrations of sum DDT were associated with lower BMIZ at 6 months. Higher prenatal concentrations of total HCH were associated with significantly higher growth velocity from 0 to 12 months. No significant associations with overweight or birth length. | Infant gender, maternal age, education, height, smoking, pre-pregnancy BMI, gestational weight gain, parity, duration of breastfeeding | Not serious |
| Zhang et al. (2018) | China | Prospective cohort | 1100 | Pregnant women | Not specified | Urine sample | Prenatally | Carbofuranphenol | Birth weight; birth length | No significant associations with prenatal carbofuranphenol levels. No differences between boys and girls. | Gestational duration, maternal age, pre-pregnancy BMI, gestational weight gain, education, parity, pregnancy smoking family income | Not serious |
Abbreviations: 2,4-D, 2,4-dichlorophenoxyacetic acid; 4-F-3-PBA, 3-PBA, 3-phenoxybenzoic acid; BMI, body mass index; BMIZ, body mass index Z-score; DAP, dialkylphosphate; DCCA, 3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid; DCP, dichlorophenol; DDD, dichlorodiphenyldichloroethane; DDE, dichlorodiphenyldichloroethylene; DDT, dichlorodiphenyltrichloroethane; DEDTP, diethydithiophosphate DEP, diethylphosphate; DETP, diethylthiophosphate; DMDTP, dimethydithiophosphate; DMP, methylphosphate; DMTP, dimethylthiophosphate; HCB, hexachlorobenzene; HCH, hexachlorocyclohexane; IMPY, 2-isopropyl-4-methyl-6-hydroxypyrimidine; LAZ, length-for-age Z-score; LBW, low birth weight; MDA, malathion dicarboxylic acid; PCB, polychlorinated biphenyl; PCDD, polychlorinated dibenzodioxin; PCDF, polychlorinated dibenzofuran; PCP, pentachlorophenol; PON1, Paraoxonase 1; PTB, pre-term birth; SGA, small-for-gestational age; TCP, trichlorophenol; TCPY, 3,5,6-trichloro-2-pyridinol; WAZ, weight-for-age Z-score; WHZ, weight-for-height Z-score.