Postnatal Exposure to Current Use Pesticides and Neurodevelopmental Outcomes in Children and Adolescents: A Systematic Review.

Background

Evidence on the neurodevelopmental impacts of postnatal exposure to current-use pesticides (CUPs) remains fragmented. This systematic review synthesises the international epidemiological evidence linking chronic postnatal CUP exposure with neurocognitive (NC), neurobehavioural (NB), and neurological (N_) outcomes in children and adolescents.

Methods

Following PRISMA 2020 (PROSPERO-CRD42021258519), we searched PubMed, Scopus, Web of Science, Cochrane, and EBSCOhost for epidemiological studies published between January 2010 and July 2025 assessing postnatal CUP exposure and NC, NB, or N_ outcomes in individuals aged 0-21 years. Data extraction captured exposure metrics, outcome domains, study design, and methodological quality. Findings were narratively synthesised using age- and domain-organised tables and direction-of-association plots.

Results

Sixty-six epidemiological studies met the inclusion criteria, spanning diverse settings but with limited representation from low-income low- and middle-income countries (LMICs; n = 9), including only one study from Sub-Saharan Africa (SSA). Study designs were predominantly cross-sectional (n=35) or longitudinal (n=23), and exposure assessment relied largely on biomonitoring (n=52). Across neurodevelopmental domains, 118 unique exposure-outcome findings were identified (NC n=41; NB n=47; N_ n=30). Statistically significant adverse associations comprised 53.7% of NC (22/41), 57.4% of NB (27/47), and 53.3% of N_ findings (16/30). Null findings remained substantial (NC 39.0%, NB 27.7%, N_ 36.7%), while non-significant adverse associations were less frequent (5.0-13.0%). Positive associations were rare (≤2.5%).

Conclusions

The evidence suggests potential associations between postnatal exposure to CUPs and adverse NC, NB, and N_ outcomes in children, although certainty is limited by methodological constraints. Future research should prioritise longitudinal designs, incorporate mixture modelling, and employ culturally and developmentally valid neurodevelopmental measures, particularly in underrepresented low-income LMICs and SSA settings.