Immunotoxic Effects in Children Resulting from Prenatal and Early Childhood Exposure to Pesticides: Protocol of a Systematic Review and Meta-Analysis

Background Pesticides, commonly employed in both agricultural and domestic environments, have been associated with disturbing the balance of the immune system during prenatal and early childhood phases of development. This disturbance has the potential to result in various outcomes such as autoimmunity, immunosuppression, inflammation, hypersensitivity, tissue damage, and overall alterations in immune modulation. The escalating concern regarding the immunotoxic effects of pesticides necessitates a systematic review and potential meta-analysis to consolidate empirical evidence and address the knowledge gaps. This systematic review aims to comprehensively assess the immunotoxic impact of pesticide exposure on children, considering alterations in immune system function induced by specific types of pesticides. Methods Through a meticulous search of the literature and synthesis of findings, the review will scrutinize prevalence, effect size, mechanisms, vulnerable periods, and the role of pre-existing conditions. The submitted protocol to PROSPERO aligns with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement, ensuring methodological rigor. A preliminary exploration involved a systematic search in electronic databases based on a pre-defined Population, Exposure, Comparator, and Outcome (PECO) statement. Data extraction sheets and risk of bias assessment tools were piloted on eight eligible articles to ensure reliability and efficiency. Subsequently, a rerun of the search will be executed, and two independent reviewers will employ the systematic review tool Covidence for article screening and data extraction, and Excel for risk of bias assessment. The results will be synthetized narratively in summary tables, and, if findings allow, meta-analysis including subgroup and sensitivity analysis will be conducted. Discussion By elucidating the intricate relationship between pesticide exposure and immunotoxicity during prenatal and early childhood, this review will provide insights into immune response that can contribute to public health awareness and guide interventions. PROSPERO Registration number: [CRD42024510916].