The escalating global reliance on agricultural pesticides poses a profound, ubiquitous environmental health challenge, particularly for vulnerable populations in farming communities (Zhou et al., 2025). Modern agricultural practices depend heavily on chemical interventions to ensure crop yields and maintain global food security amidst a growing population (Iqbal et al., 2025). This widespread application results in pervasive environmental contamination across soil, water, and air systems worldwide (Pathak et al., 2022). Human populations residing in or near agricultural zones experience continuous, low-level exposure to complex chemical mixtures (González, 2026). The sheer magnitude of this exposure necessitates a comprehensive, multidisciplinary understanding of its global public health implications and demands immediate attention from the scientific community.

Pregnant women and their developing fetuses represent a highly susceptible demographic to the toxicological impacts of agrochemical exposure (Felisbino et al., 2024). Physiological adaptations during pregnancy alter maternal metabolism and increase respiratory rates, potentially amplifying the absorption of environmental toxicants (Ventura-Miranda et al., 2022). The placental barrier, while inherently protective, remains permeable to numerous lipophilic pesticide compounds, allowing direct fetal exposure during critical windows of organogenesis (Colopi et al., 2023). Emerging clinical observations consistently link these exposures to a spectrum of adverse outcomes, including neurodevelopmental delays, metabolic disruptions, and endocrine alterations (Botnaru et al., 2025). Protecting this specific demographic requires targeted, rigorous scrutiny of the risks posed by agricultural chemicals to ensure that maternal and fetal well-being remains a paramount public health priority.

Recent advancements in environmental epidemiology and biomonitoring have significantly refined our understanding of prenatal pesticide toxicity (Dhananjayan et al., 2022). Contemporary research has successfully transitioned from relying on subjective, self-reported occupational histories to utilizing highly objective biomarkers. Advanced analytical techniques, such as liquid chromatography-tandem mass spectrometry, now enable the precise quantification of pesticide metabolites in maternal biological samples (Birolli et al., 2024). The integration of geographic information systems allows researchers to accurately map ambient exposure risks based on residential proximity to agricultural applications (Thompson et al., 2022). These methodological improvements provide a much more accurate and granular assessment of chemical exposure pathways, ultimately strengthening the validity of epidemiological associations.

Despite these methodological advancements, critical inconsistencies remain regarding the precise health outcomes associated with varying exposure windows and chemical formulations. Existing literature frequently presents conflicting data concerning the impact of specific organophosphate concentrations on birth weight and gestational age (De Joode et al., 2024). Many studies fail to adequately control for individual-level confounding variables, such as maternal nutrition and socioeconomic status, particularly in ecological study designs. There is a distinct lack of synthesis on how these diverse toxicological findings can be translated directly into actionable clinical nursing practices (Rueda-Ruzafa et al., 2023). This fragmentation actively hinders the development of unified public health guidelines for rural populations, leaving healthcare providers without clear directives for patient care.

This systematic review introduces a novel synthesis by specifically evaluating recent, high-quality empirical evidence through the lens of agro-nursing and maternal-fetal health. Previous broad environmental reviews failed to apply rigorous Joanna Briggs Institute critical appraisal tools, whereas this investigation ensures only methodologically sound studies inform the conclusions. The review focuses exclusively on the most recent literature published in the past year, capturing the latest breakthroughs in toxicogenomic and spatial analyses. This targeted approach isolates the most relevant and reliable data available for contemporary healthcare decision-making. The integration of clinical nursing perspectives elevates the practical utility of the synthesized epidemiological data, bridging the gap between environmental science and bedside nursing care (Nurhadijah et al., 2025).

The primary objective of this study is to systematically evaluate the association between prenatal pesticide exposure and adverse maternal and child health outcomes. This investigation utilizes the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework to ensure transparent and reproducible literature selection. The research aims to identify specific chemical classes and exposure periods that pose the highest risk to pregnant women and their offspring. By categorizing findings across neurodevelopmental, metabolic, and oncological domains, the study provides a structured overview of the current toxicological landscape (Reed et al., 2023). This systematic evaluation serves as a foundational resource for evidence-based clinical interventions, ultimately guiding the development of specialized agro-nursing protocols.

Translating these synthesized findings into clinical practice is urgently needed to equip agro-nurses with evidence-based protocols for mitigating prenatal risks. Healthcare providers in rural settings currently lack standardized frameworks for assessing and counseling patients regarding environmental chemical exposures. Immediate implementation of comprehensive environmental health screenings during prenatal intake can significantly reduce the fetal burden of agricultural toxicants. Empowering the nursing workforce with advanced environmental health competencies will directly safeguard vulnerable agricultural populations (Steel & Hyland, 2025). This research provides the critical evidence base necessary to drive immediate policy advocacy and optimize perinatal care trajectories globally, preventing long-term developmental and metabolic consequences in future generations.

The systematic review search identified 14,161 records across three databases, with Scopus contributing the largest number at 7,972, followed by ProQuest with 5,444 and PubMed with 745. A substantial number of records (12,658) were removed because they were published before 2025, leaving 1,503 records for screening. The screening process excluded 723 records that were not research articles, resulting in 780 reports sought for retrieval. Access restrictions led to the exclusion of 208 records, leaving 572 reports for eligibility assessment. The application of inclusion and exclusion criteria resulted in the exclusion of 562 reports. The final review included 10 studies, with Scopus contributing 5, PubMed 4, and ProQuest 1. The rigorous screening process demonstrates a significant reduction from initial identification to final inclusion, reflecting strict adherence to the predefined selection criteria and the temporal restriction to recent publications.

The study-selection process is illustrated in Figure 1.

The characteristics and findings of the included studies are summarized in Table 1, and their JBI critical appraisal is presented in Table 2.

The Joanna Briggs Institute (JBI) critical appraisal revealed a predominantly high methodological quality across the ten included studies. Eight investigations achieved a high overall quality rating by satisfying all evaluated criteria. The study designs comprised seven cohort studies and one statewide case-control study. Specifically, Van Deventer et al., 2025; Guesdon et al., 2025; Parra et al., 2026; Xu et al., 2026; Yin et al., 2026; Baba et al., 2025; López-Flores et al., 2025; and Iversen et al., 2025 demonstrated rigorous research frameworks. These high-quality studies provided clear inclusion criteria, utilized valid and reliable exposure measurements, adequately identified and controlled for confounding factors, and applied appropriate statistical analyses. The robust methodologies in these cohorts and the case-control design significantly strengthen the reliability of their findings regarding prenatal pesticide exposure.

Two studies received a moderate overall quality rating due to specific methodological limitations identified during the appraisal process. Mwakalasya et al. (2025) employed an analytical cross-sectional design in which the exposure measurement was marked as unclear. This ambiguity in exposure assessment introduces potential recall bias and limits the precision of the observed associations between maternal pesticide exposure and child neurodevelopment. Andrade-Rivas et al. (2026 utilized an ecological and spatial analysis approach that lacked clarity regarding the control of confounding factors. Spatial and ecological study designs inherently face challenges in accounting for individual-level confounders, which may lead to ecological fallacy or unmeasured-variable bias. Despite these moderate ratings, both studies still met the criteria for inclusion, setting, outcome measurement, and statistical analysis, providing valuable complementary evidence to the systematic review.

The systematic review identified ten recent studies investigating the impact of prenatal pesticide exposure on various maternal and child health outcomes. Neurodevelopmental and oncological effects were prominent areas of research. Mwakalasya et al. (2025) established a link between self-reported maternal pesticide exposure during pregnancy and adverse neurodevelopmental outcomes in children aged four to six years. Xu et al. (2026) corroborated these findings by demonstrating that prenatal exposure to specific organochlorine pesticides leads to poorer early childhood neurodevelopment, with girls exhibiting heightened vulnerability. Endocrine disruption was also evident in pediatric outcomes. Iversen et al. (2025) observed that prenatal exposure to chlorpyrifos and 2,4-D affects reproductive hormones in infant girls during minipuberty. Regarding oncological risks, Van Deventer et al. (2025) reported that ambient prenatal pesticide exposure increases the risk of childhood neuroblastoma.

Metabolic and endocrine disruptions in mothers constituted another major focus of the included literature. Guesdon et al. (2025) identified five specific pesticides associated with gestational diabetes mellitus through agricultural or dietary exposure pathways. Parra et al. (2026) expanded on this metabolic risk by finding that preconception exposure to pyrethroids and third-trimester exposure to organophosphates elevate the risk of gestational diabetes mellitus. Maternal thyroid function and overall metabolic profiles were also affected by chemical exposures. Yin et al. (2026) demonstrated that early-pregnancy co-exposure to organophosphate flame retardants and pesticides disrupts maternal thyroid homeostasis and elevates the risk of autoimmunity. López-Flores et al. (2025) revealed that organophosphate exposure induces significant metabolic disruptions in pregnant women, potentially compromising fetal development.

Pregnancy and birth outcomes presented mixed findings across the analyzed cohorts. Baba et al. (2025) reported no robust association between higher concentrations of organophosphate pesticides and adverse pregnancy outcomes such as gestational age at birth or birth weight. In contrast to this null finding, Andrade-Rivas et al. (2026) used spatial analysis to show that mothers residing in areas with high pesticide application rates face a significantly increased risk of delivering low-birth-weight babies. These diverse results underscore the complex nature of pesticide toxicity, varying by chemical class, exposure timing, and geographic context.

The synthesized evidence underscores the critical role of agro-nursing in mitigating the adverse maternal and child health outcomes associated with prenatal pesticide exposure. This systematic review identified ten recent studies demonstrating profound impacts across multiple physiological domains. Neurodevelopmental risks were prominently featured, with research linking maternal exposure to adverse cognitive outcomes in early childhood. Metabolic disruptions, particularly the increased incidence of gestational diabetes mellitus, emerged as a significant concern for pregnant women in agricultural settings. Endocrine alterations and potential oncological risks further compounded the vulnerability of this specific demographic. Birth outcomes presented a complex picture, varying significantly by chemical class and exposure assessment methodology. Agro-nurses must recognize this multifaceted threat to provide comprehensive, evidence-based prenatal care in rural and farming communities (Kurniyawan et al., 2026).

Neurodevelopmental and oncological vulnerabilities represent the most severe consequences of agricultural chemical exposure during pregnancy, demanding proactive nursing surveillance. Mwakalasya et al. (2025) established a clear association between self-reported maternal pesticide exposure during pregnancy and adverse neurodevelopmental outcomes in children aged four to six years. Xu et al. (2026) corroborated these developmental concerns by demonstrating that prenatal exposure to specific organochlorine pesticides leads to poorer early childhood neurodevelopment, with girls exhibiting heightened vulnerability. The oncological risks are equally alarming. Van Deventer et al. (2025) highlighted that ambient prenatal pesticide exposure increases the likelihood of childhood neuroblastoma through residential proximity to agricultural applications. These findings necessitate that agro-nursing assessments rigorously evaluate both occupational and residential environmental histories to identify at-risk pregnancies early.

Metabolic and endocrine disruptions constitute a pervasive yet frequently overlooked consequence of prenatal pesticide exposure in agricultural communities. Guesdon et al. (2025) identified five specific pesticides associated with gestational diabetes mellitus through agricultural or dietary exposure pathways in a nationwide cohort. Parra et al. (2026) expanded on this metabolic risk by finding that preconception exposure to pyrethroids and third-trimester exposure to organophosphates elevate the risk of gestational diabetes mellitus. Maternal thyroid function and overall metabolic profiles were also affected by chemical exposures. Yin et al. (2026) demonstrated that early-pregnancy co-exposure to organophosphate flame retardants and pesticides disrupts maternal thyroid homeostasis and elevates the risk of autoimmunity. Iversen et al. (2025) observed that prenatal exposure to chlorpyrifos and 2,4-D affects reproductive hormones in infant girls during minipuberty. Agro-nursing clinical protocols must expand beyond traditional occupational hazard screenings to actively monitor these subtle biochemical shifts.

The impact of organophosphate exposure on maternal metabolic profiles and subsequent birth outcomes presents a complex clinical picture requiring nuanced nursing interpretation. Baba et al. (2025) reported no robust association between higher concentrations of organophosphate pesticides, measured by urinary dialkyl phosphate metabolites, and adverse pregnancy outcomes such as gestational age at birth or birth weight. In contrast to this null finding, López-Flores et al. (2025) reported that organophosphate exposure induces significant metabolic disruptions in pregnant women, potentially compromising fetal development. Andrade-Rivas et al. (2026) used spatial analysis to show that mothers residing in areas with high pesticide application rates face a significantly increased risk of delivering low-birth-weight babies. This discrepancy highlights the need for agro-nurses to consider both individual biomarkers and community-level environmental data when counseling expectant mothers.

The findings of this systematic review align with and significantly expand upon the existing body of occupational and environmental health literature regarding agricultural chemical toxicity. Previous research established broad associations between farming occupations and adverse pregnancy outcomes, often relying on crude exposure metrics (Chen et al., 2023). The current synthesis refines this understanding by identifying specific chemical classes, including organophosphates, pyrethroids, and organochlorines, as primary drivers of pathology. The identification of precise exposure windows, such as preconception periods and specific trimesters, marks a critical evolution in environmental health science. Advanced analytical techniques like liquid chromatography-tandem mass spectrometry have replaced subjective self-reporting in high-quality studies, providing objective biomonitoring data. This progression from general occupational correlations to precise toxicogenomic and spatial analyses provides agro-nurses with highly specific targets for clinical intervention.

These synthesized findings mandate a paradigm shift in agro-nursing practice toward comprehensive environmental health screening and targeted patient education. Nurses in agricultural settings must routinely incorporate detailed occupational and environmental exposure histories into standard prenatal intake assessments. Patient education on proper use of personal protective equipment, thorough dietary washing practices, and the benefits of alternative farming methods is a primary nursing intervention. Community health nurses must also facilitate connections between pregnant agricultural workers and occupational health specialists. Developing culturally competent educational materials tailored to rural farming populations will enhance the efficacy of these preventive measures (Pumsopa et al., 2025). Proactive nursing interventions can reduce the fetal burden of environmental toxicants when implemented early in the prenatal care trajectory.

Translating these research findings into actionable health policies requires robust interdisciplinary collaboration led by advanced practice agro-nurses. Agro-nurses are uniquely positioned to advocate for stricter regulatory frameworks governing pesticide application near residential zones and schools. The spatial findings by Andrade-Rivas et al. (2026) provide empirical support for establishing larger, scientifically validated buffer zones around agricultural fields. Nursing leadership must drive the integration of environmental health competencies into standard nursing curricula to prepare the next generation of rural healthcare providers. Collaboration with agricultural extension services, toxicologists, and public health departments is essential for developing community-wide mitigation strategies. Policy advocacy remains a fundamental responsibility of the nursing profession in safeguarding vulnerable agricultural populations.

The interpretation of these findings must be tempered by several methodological limitations inherent in the included studies. Mwakalasya et al. (2025) relied on self-reported exposure, introducing significant recall bias and limiting the precision of the observed associations. Andrade-Rivas et al. (2026) used an ecological design, which is susceptible to ecological fallacy and cannot adequately control for individual-level confounders such as maternal nutrition or socioeconomic status. Variability in exposure measurement techniques, ranging from broad spatial databases to advanced mass spectrometry, creates heterogeneity that complicates direct meta-analytical comparisons. The cross-sectional design of some included studies also precludes establishing definitive causal relationships between pesticide exposure and adverse health outcomes. These methodological constraints highlight the ongoing need for rigorous, longitudinal research designs in environmental epidemiology.

The scope of this systematic review is further constrained by its strict inclusion criteria, which may have omitted relevant historical or non-English literature. Restricting the search to publications from the last year with active DOIs and open access ensures high contemporary relevance. This temporal restriction excludes foundational studies or valuable regional research published in local languages. The exclusion of conference abstracts missed emerging preliminary data on novel pesticide formulations currently entering the agricultural market. The focus on open-access articles may also introduce a publication bias, favoring studies with positive or statistically significant findings. Future research must prioritize large-scale, prospective longitudinal designs with objective biomonitoring to overcome these current evidentiary gaps and further solidify the evidence base for agro-nursing practice.

This systematic review establishes prenatal pesticide exposure as a critical determinant of adverse maternal and child health outcomes, necessitating immediate integration of environmental health competencies into agro-nursing practice. The synthesized evidence reveals profound neurodevelopmental, metabolic, and endocrine vulnerabilities linked to agricultural chemical exposure during pregnancy. Healthcare providers in rural settings must prioritize comprehensive environmental exposure histories and proactive patient education to mitigate these toxicological risks. Future epidemiological investigations should employ rigorous longitudinal designs with objective biomonitoring to clarify causal pathways and inform evidence-based public health policies. Empowering agro-nurses with advanced training in environmental health will ultimately safeguard vulnerable agricultural populations and optimize perinatal care trajectories globally.