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

Given China's recent introduction of the "three-child policy" in response to population ageing, safeguarding perinatal health has become an urgent priority. Previous epidemiological research seldom explored the risk factors of maternal cardiovascular and haematological diseases, or its impact on adverse pregnancy outcomes (APO). To fill the literature gap, here we conducted systematic epidemiological analyses on 121,090 pregnant women and their neonates from the ZEBRA Chinese prospective maternity cohort. We find that incremental exposure in PM_2.5, O₃, and green space modify the risks of APO, including congenital heart disease, by 11.2%, 7.8%, and -5.5%, respectively. Maternal cardiovascular and haematological complications during pregnancy significantly aggravate the risk of APO by 66.2%, 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 findings support the Sustainable Development Goals (e.g. SDG3) by providing first-hand epidemiological evidence and clinical guidance for protecting maternal and neonatal health.