. 2021 Feb 2;30(2):245–252. doi: 10.1089/jwh.2020.8855

Table 1.

Examples of Environmental Stressors Linked to Maternal Health Outcomes and Potential Moderating Factors^a

Environmental stressors	Maternal outcomes
Air pollution	Hypertensive disorders of pregnancy^3,4
	Polycystic ovarian syndrome⁵
	Subfertility^6–9
	Miscarriage^10,11
	ART failure^12–17
Metals	Hypertensive disorders of pregnancy^18,19
	Uterine fibroids^20–23
	Subfertility^24–26
	Miscarriage^27,28
	Cardiometabolic health²⁹
PFAS^a	Breast development and lactation^30–32
	Breast cancer^33,34
	Cardiometabolic health³⁵
Persistent pesticides (DDT and DDE)	Lactation impairment³⁶
Persistent pesticides (DDT and DDE)	Breast cancer risk in mother and female offspring³⁷
Persistent pollutants (dioxin/PCBs)	Breast cancer risk in mother by 50 years of age³⁸
Persistent pollutants (dioxin/PCBs)	Mammary development and lactation³⁹
EDCs (e.g., phthalates, phenols)	Uterine fibroids^40–42
EDCs (e.g., phthalates, phenols)	Thyroid function, glucose metabolism and obesity, fertility, and carcinogenesis⁴³
Potential moderators
Race/ethnicity	Cardiometabolic health⁴⁴
Race/ethnicity	Uterine fibroids⁴⁵

^{^a}

Most exposures were associated with more adverse outcomes, but the strength and direction of effect varies. See cited references for details.

ART, assisted reproductive technology; DDE, dichlorodiphenyl dichloroethene; DDT, dichlorodiphenyltrichloroethane; EDC, endocrine-disrupting chemical; PCB, polychlorinated biphenyl; PFAS, perfluoroalkyl substance.