Aflatoxin B1 exposure during pregnancy and neonatal outcomes: A systematic review

Evidence has suggested that exposure to aflatoxin B1 (AFB1) during pregnancy may be associated with adverse neonatal outcomes; however, available data are inconclusive. We conducted this systematic review to estimate the relation of AFB1 exposure during pregnancy to neonatal outcomes. Scopus and PubMed databases were systematically searched for relevant publications published before December 2022 evaluating the connection between AFB1 exposure in pregnant women and outcomes such as small for gestational age (SGA), birth length, low birth weight (LBW), birth weight, and preterm birth (PTB). This study comprised 7 studies with a combined sample size of 4,047 participants. After pooling all available effect sizes, it was determined that there was no significant correlation between increased AFB1 exposure during pregnancy and SGA, PTB, LBW, birth weight, and birth length. Significant heterogeneity was observed across studies for LBW (I2 = 68.6%, <i>p</i> = 0.02), birth weight (I2 = 96.8%, <i>p</i> ≤ 0.001), and birth length (I²= 93.1%, <i>p</i> ≤ 0.001). However, the sensitivity analysis suggested that exposure to AFB1 might be significantly linked to higher odds of LBW infants and inversely related to both birth weight and birth length. Exposure to AFB1 in pregnant women might be linked to adverse neonatal outcomes. Given the heterogeneity and the limited number of studies available, further high-quality, standardized research is essential to confirm or refute these findings with greater confidence.