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Residential proximity to agricultural pesticide exposures during preconception and pregnancy and associations with Apgar scores in the Az-PEAR study (2006–2020)

Journal of Exposure Science & Environmental Epidemiology (2026)Cite this article

Abstract

Background

Pesticide exposures disrupt biological functions in humans, raising concerns about potential effects on newborn health and development.

Objective

To analyze associations of preconception and prenatal exposures to carbamate, organophosphate, and pyrethroid pesticide classes and 25 individual active ingredients with newborn Apgar scores to evaluate the relationship between these exposures and neonatal health.

Methods

We used pesticide use registry and birth certificate data from 2006 to 2020, linked as part of the Arizona Pregnant Women’s Environmental and Reproductive Outcomes Study (Az-PEARS). Exposures were measured as binary variables and defined as living within 500 m of an agricultural pesticide application during preconception (T0, 90 days before conception) and each trimester (T1–T3). Five-minute Apgar scores (low: <8, high: ≥8) were analyzed using log-binomial regression and a meta-analytic approach to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI), adjusting for newborn and maternal demographics.

Results

Approximately half of the newborns were male, and the majority were born at ≥38 weeks of gestation. Mothers were predominantly 20–35 years old and non-Hispanic white. Exposure to several pesticide active ingredients at any point during preconception and/or pregnancy were associated with increased odds of low Apgar scores (aOR [95% CI]): the carbamates carbaryl (2.07 [1.45, 2.96]) and formetanate hydrochloride (3.50 [1.55, 7.89]); the organophosphates diazinon (1.67 [1.25, 2.22]) and tribufos (1.39 [1.02, 1.90]); and the pyrethroid cypermethrin (1.49 [1.03, 2.15]). Consistent effect estimates were seen across trimesters. Additional positive associations included ethephon, phorate, and beta-cyfluthrin during T0, methomyl during T1, and esfenvalerate and fenpropathrin during T2.

Significance

Prenatal exposure to certain carbamates, organophosphates, and pyrethroids had increased odds of low Apgar scores. We identified the preconception period as a possible sensitive exposure window for additional ingredients. These findings suggest that interventions aimed at mitigating maternal agricultural pesticide exposures may improve newborn health.

Impact

Few studies have investigated how ambient preconception and prenatal exposures to pesticide active ingredients affect neonatal health, despite the importance of studying sensitive windows of exposure. Using pesticide use registry and birth certificate data from the state of Arizona, we report that residential proximity to agricultural pesticide exposures of several pesticide active ingredients belonging to the carbamate, organophosphate, and pyrethroid classes during the preconception period and throughout pregnancy is associated with low Apgar scores. This research suggests that maternal pesticide exposures may adversely impact newborn health and emphasizes the importance of mitigating these exposures.

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Fig. 1: Flow diagram of complete case analysis in the Az-PEARS, 2006–2020 (N = 1,141,608).
Fig. 2

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by the National Institutes of Health (grant number R00ES028743).

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Authors and Affiliations

  1. Department of Community, Environment and Policy, University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA

    Audrey R. Yang, Paloma I. Beamer & Melissa A. Furlong

  2. Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Kimberly L. Parra

  3. Department of Epidemiology, University of California, Fielding School of Global Public Health, Los Angeles, CA, USA

    Kimberly C. Paul & Beate Ritz

  4. Department of Epidemiology and Biostatistics, University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA

    Edward J. Bedrick

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  1. Audrey R. Yang
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Contributions

ARY contributed to data analysis and manuscript writing. KLP contributed to manuscript writing and provided feedback. KCP contributed to manuscript writing and provided feedback. EJB contributed to manuscript writing and provided feedback. BR contributed to manuscript writing and provided feedback. PIB contributed to manuscript writing and provided feedback. MAF contributed to data extraction, data analysis, manuscript writing, and provided feedback.

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Correspondence to Audrey R. Yang.

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Study protocols and data procedures were approved by the University of Arizona’s Institutional Review Board (IRB #1806679925). We received a waiver for informed consent. All methods were performed in accordance with the relevant guidelines and regulations.

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Yang, A.R., Parra, K.L., Paul, K.C. et al. Residential proximity to agricultural pesticide exposures during preconception and pregnancy and associations with Apgar scores in the Az-PEAR study (2006–2020). J Expo Sci Environ Epidemiol (2026). https://doi.org/10.1038/s41370-026-00849-8

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