Genotoxicity of Prenatal and Early Childhood Exposure to Pesticides: A Protocol and Pilot Study of a Systematic Review and Meta-Analysis

1. Objectives To systematically review and meta-analyse the genotoxic impact of prenatal and early childhood pesticide exposure, investigating prevalence, specific pesticides, effect size, mechanisms, genetic susceptibility, and vulnerable periods. Study Design A protocol for systematic review and meta-analysis. A pilot study was also conducted to develop appropriate extraction and risk of bias tool. Methods Adhering to 2020 PRISMA guidelines, the review will explore genotoxic impact of prenatal and early childhood pesticide exposure in children up to 5 years. The protocol had been registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024510877). Searches was done across PubMed, EMBASE, Web of Science, and Scopus use keywords ‘prenatal or childhood’, ‘pesticides’, and ‘genotoxicity’. Manual reference screening supplements searches. Eligible observational studies (cross-sectional, case-control, cohort designs) in English will be included, while excluding case reports and in vitro studies, using Covidence screening tool. Two independent reviewers will use Newcastle-Ottawa Scale and novel tool for cross-sectional studies for screening, data extraction, and risk of bias assessment. Findings will be synthesized narratively, with potential meta-analysis of genotoxicity outcomes. GRADE approach will assess the evidence quality. Results A pilot test screened 1,405 studies, resulting in 21 eligible for full-text screening. Twelve were excluded. Data extraction and risk of bias assessment followed pre-defined protocols. Findings informed the refinement of study procedures. Conclusions The protocol outlines a comprehensive approach to systematically review the genotoxic impact of prenatal and early childhood pesticide exposure, aiming to provide necessary insights to a better understanding of this environmental risk.