Prenatal air pollution exposure in relation to the telomere-mitochondrial axis of aging at birth: A systematic review
Open accessAbstract
Telomere length (TL) and mitochondrial DNA (mtDNA) are central markers of vital biological mechanisms, including cellular aging. Prenatal air pollution exposure may impact molecular markers of aging leading to adverse health effects. To perform a systematic review on human population-based studies investigating the association between prenatal air pollution exposure and TL or mtDNA content at birth. Searches were undertaken on PubMed and Web of Science until July 2023. The framework of the review was based on the PRISMA-P guidelines. Nineteen studies studied prenatal air pollution and TL or mtDNA content at birth. Studies investigating TL or mtDNA content measured at any other time or did not evaluate prenatal air pollution were excluded. Twelve studies (including 4381 participants with study sample range: 97 to 743 participants) investigated newborn TL and eight studies (including 3081 participants with study sample range: 120 to 743 participants) investigated mtDNA content at birth. Seven studies focused on particulate matter (PM2.5) exposure and newborn TL of which all, except two, showed an inverse association in at least one of the gestational trimesters. Of the eight studies on mtDNA content, four focused on PM2.5 air pollution with two of them reporting an inverse association. For PM2.5 exposure, observations on trimester-specific effects were inconsistent. Current literature showing associations with other prenatal air pollutants (including nitrogen oxides, sulfur dioxide, carbon monoxide and ozone) is inconsistent. This review provides initial evidence that prenatal PM2.5 exposure impacts the telomere-mitochondrial axis of aging at birth. The current evidence did not reveal harmonious observations for trimester-specific associations nor showed consistent effects of other air pollutants. Future studies should elucidate the specific contribution of prenatal exposure to pollutants other than PM in relation to TL and mtDNA content at birth, and the potential later life health consequences.
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Maternal stress, smoking, air pollution and heavy-metal exposure during pregnancy are associated with shorter or altered newborn telomere length, although effect direction and magnitude vary by exposure window, tissue and assay.
“Maternal stress, smoking, air pollution and heavy-metal exposure during pregnancy have been associated with shorter or altered newborn TL, although effect direction and magnitude vary by exposure window, tissue and assay [122,123,124,125,126].”
From Placental Pathophysiology and Developmental Programming of Adult Cardiometabolic Risk: A Narrative Review of Pregnancy Exposures (2026) · cites this paper as [123]
The placenta regulates fetal exposure to inflammatory and oxidative mediators and is frequently sampled in these studies.
“The placenta regulates fetal exposure to inflammatory and oxidative mediators and is frequently sampled in these studies [123,131].”
From Placental Pathophysiology and Developmental Programming of Adult Cardiometabolic Risk: A Narrative Review of Pregnancy Exposures (2026) · cites this paper as [123]
Prenatal air-pollution studies have examined telomere length together with mtDNA content or related indices and reported exposure-associated differences at birth.
“Prenatal air-pollution studies have examined TL together with mtDNA content or related indices and reported exposure-associated differences at birth [123].”
From Placental Pathophysiology and Developmental Programming of Adult Cardiometabolic Risk: A Narrative Review of Pregnancy Exposures (2026) · cites this paper as [123]
These associations show that prenatal exposures can coincide with early differences in telomere biology; they do not establish that neonatal telomere length mediates adult disease.
“These associations show that prenatal exposures can coincide with early differences in telomere biology; they do not establish that neonatal TL mediates adult disease.”
From Placental Pathophysiology and Developmental Programming of Adult Cardiometabolic Risk: A Narrative Review of Pregnancy Exposures (2026) · cites this paper as [123]
Pregnancy exposures are socially patterned and often cluster with postnatal environmental and familial factors.
“At the same time, pregnancy exposures are socially patterned and often cluster with postnatal environmental and familial factors [60,123].”
From Placental Pathophysiology and Developmental Programming of Adult Cardiometabolic Risk: A Narrative Review of Pregnancy Exposures (2026) · cites this paper as [123]
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Panteris, E., Kakatsaki, I., Koukou, Z., Kolvatzis, C., Papanikolaou, S., & Hatzidaki, E. (2026) · Pathophysiology · doi:10.3390/pathophysiology33030067
- Authors
- Mishra, S., Stukken, C. V. D., Drury, S., Nawrot, T. S., & Martens, D. S.
- Affiliations
- Hasselt University (BE)
- Boston Children's Hospital (US)
- Corresponding author
- Martens, Dries S.
- Venue
- Environmental Research
- Publisher
- Elsevier BV
- Published
- 2024-03
- Volume
- 244
- Pages
- 117990
- ISSN
- 0013-9351 (ISSN-L)
- PMC
- PMC10922941
- OpenAlex
- W4390084274
- Cited by
- 7
- References
- 5
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1
- FWCI
- 0.19
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Environmental Research (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Document Server@UHasselt (UHasselt) (submittedVersion, cc-by-nc-nd)
- Lirias (KU Leuven) (submittedVersion, cc-by-nc-nd)
- Funders
- Horizon 2020 Framework Programme
- Horizon 2020 (956780)
- European Commission
- Fonds Wetenschappelijk Onderzoek (FWO12X9623N)
- National Institutes of Health (U24AG066528)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Health, Environment, Cognitive Aging
- Social Sciences › Sociology and Political Science › Environmental Justice and Health Disparities
- Keywords
- prenatal air pollution exposure, telomere length, mitochondrial DNA content, cellular aging, neonates, particulate matter PM2.5, pregnancy trimesters, nitrogen oxides, sulfur dioxide, carbon monoxide, ozone, aging biomarkers
- MeSH terms
- Systematic Reviews as Topic, Aging, Air Pollutants, Air Pollution, DNA, Mitochondrial, Environmental Exposure, Female, Humans, Infant, Newborn, Mitochondria, Pregnancy, Prenatal Exposure Delayed Effects, Meta-Analysis as Topic, Telomere, Maternal Exposure, Particulate Matter
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