Environmental exposure to metal(loid)s and hypertensive disorders of pregnancy: A systematic review

Environ Res. 2024 Sep 15:257:119391. doi: 10.1016/j.envres.2024.119391. Epub 2024 Jun 8.


Background: Environmental exposure to metal(loid)s has been associated with adverse effects on human health, but the systemic repercussion of these elements on the development of hypertensive disorders of pregnancy (HDP) is still poorly understood.

Objective: To summarize evidence published about the influence of environmental exposure to aluminum, arsenic, barium, cadmium, lead, strontium and mercury on the development of HDP.

Methods: We conducted a systematic literature review according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search strategy was validated by the Peer Review of Electronic Search Strategies. We searched for articles published up to February 2023 in seven databases without language restriction. Two researchers conducted the steps for selection, data extraction and evaluation of the methodological quality of the instruments for epidemiological studies of the Joanna Briggs Institute. Any disagreements were resolved by a third researcher.

Results: We obtained 5076 records, of which 37 articles met the inclusion criteria moderate to high methodological quality. Single exposure to metal(loid)s was predominant, and the leading biological matrix analyzed to detect the concentrations from exposure was maternal blood. Lead was the metal investigated the most, and had the largest number of studies showing positive association with HDP. In relation to the other metal(loid)s, higher levels were found in women with HDP in comparison with healthy women, but the finding of a cause-effect relationship was inconsistent.

Conclusions: Although we found evidence of harmful effects of the metal(loid)s studied on human health, the results were inconclusive with regard to HDP. Longitudinal studies that consider prospective investigation, adjustment of confounding factors and the interference of other contaminants in the exacerbation of oxidative stress in women from the preconception phase to the puerperal period should be encouraged.

Keywords: Environmental exposure; Heavy metals; Hypertension; Metals; Preeclampsia; Pregnancy-induced; Trace elements.

Publication types

  • Systematic Review
  • Review

MeSH terms

  • Environmental Exposure* / adverse effects
  • Environmental Pollutants / analysis
  • Environmental Pollutants / toxicity
  • Female
  • Humans
  • Hypertension, Pregnancy-Induced* / chemically induced
  • Hypertension, Pregnancy-Induced* / epidemiology
  • Metals / analysis
  • Metals / toxicity
  • Pregnancy


  • Environmental Pollutants
  • Metals