Environmental drivers of obstetric health and early childhood development

Environmental exposures are increasingly recognized as critical, yet underappreciated, determinants of reproductive, perinatal, and early childhood health. Developed through a structured consensus process and grounded in systematic evidence review, this FIGO committee opinion provides a comprehensive synthesis of the current evidence linking environmental toxicants—including air pollution, endocrine-disrupting chemicals, heavy metals, and climate-related stressors—to common obstetric outcomes such as preterm birth, hypertensive disorders of pregnancy, gestational diabetes, and impaired fetal growth, as well as to early childhood outcomes including neurodevelopmental delay, metabolic disease, and atopic conditions. This article also outlines common biological mechanisms, such as endocrine disruption, oxidative stress, epigenetic modification, and placental dysfunction, and provides clinicians with actionable guidance for integrating environmental health into reproductive care through screening, counseling, and advocacy. Special attention is paid to the role of social and structural inequities in amplifying exposure risks and health disparities. By linking environmental drivers to familiar clinical outcomes, this guidance empowers obstetricians and allied professionals to engage in preventive care that safeguards maternal and child health across the life course. FIGO calls on reproductive health professionals to embrace this leadership role—not only in clinical practice, but in shaping policies that protect current and future generations.