Maternal cardiovascular and haematological diseases alter the risk associations between environmental exposure and adverse pregnancy outcomes

Abstract China’s “three-child policy” in response to population ageing has cast safeguarding perinatal health an urgent priority, whereas previous research seldom explored the pregnancy-related cardiovascular and haematological diseases. Here we conducted comprehensive epidemiological analyses on 121,090 pregnant women and their 124,025 neonates from the ZEBRA Chinese prospective maternity cohort. We find that unit incremental exposure in PM2.5, O3, and green space can change the risks of maternal pregnancy-induced cardiovascular diseases (CVDs) by 7.3% (95% confidence interval 6.4–8.2%), 2.7% (2.2–3.3%), and –3.6% (1.8–5.2%), respectively. Maternal cardiovascular and haematological diseases significantly aggravate the risk of adverse pregnancy outcomes (APOs, including congenital heart disease) by 69.3% (61.5–77.5%), and also modify the environment-APO risk associations by amplifying the hazards of air pollution and weakening the protective effect of greenness accessibility. Our research supports several Sustainable Development Goals by providing first-hand epidemiological evidence and clinical guidance for maternal and neonatal health protection.