title: Pregnancy outcome and ultraviolet radiation; A systematic review.
abstract: Season and vitamin D are indirect and direct correlates of ultraviolet (UV) radiation and are associated with pregnancy outcomes. Further to producing vitamin D, UV has positive effects on cardiovascular and immune health that may support a role for UV directly benefitting pregnancy.
  
  
  
  To investigate the effects of UV exposure on pregnancy; specifically fetal growth, preterm birth and hypertensive complications.
  
  
  
  We conducted a systematic review of Medline, EMBASE, DoPHER, Global Health, ProQuest Public Health, AustHealth Informit, SCOPUS and Google Scholar to identify 537 citations, 8 of which are included in this review. This review was registered on PROSPERO and a. narrative synthesis is presented following PRISMA guidance.
  
  
  
  All studies were observational and assessed at high risk of bias. Higher first trimester UV was associated with and improved fetal growth and increased hypertension in pregnancy. Interpretation is limited by study design and quality. Meta-analysis was precluded by the variety of outcomes and methods.
  
  
  
  The low number of studies and risk of bias limit the validity of any conclusions. Environmental health methodological issues are discussed with consideration given to design and analytical improvements to further address this reproductive environmental health question.
  
  
  
  The evidence for UV having benefits for pregnancy hypertension and fetal growth is limited by the methodological approaches utilized. Future epidemiological efforts should focus on improving the methods of modeling and linking widely available environmental data to reproductive health outcomes.
authors.affiliation: School of Women's and Infants Health, University of Western Australia, 35 Crawley Ave, Crawley, Perth, Western Australia, Australia; Edinburgh Tommy's Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, United Kingdom. Electronic address: lauren.megaw@ed.ac.uk.
authors.forename: Lauren
authors.initials: L
authors.lastname: Megaw
authors.affiliation: School of Geosciences, University of Edinburgh, Drummond St, Edinburgh, Midlothian, United Kingdom. Electronic address: Tom.clemens@ed.ac.uk.
authors.forename: Tom
authors.initials: T
authors.lastname: Clemens
authors.affiliation: School of Geosciences, University of Edinburgh, Drummond St, Edinburgh, Midlothian, United Kingdom. Electronic address: Chris.dibben@ed.ac.uk.
authors.forename: Chris
authors.initials: C
authors.lastname: Dibben
authors.affiliation: MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, United Kingdom. Electronic address: Richard.weller@ed.ac.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Weller
authors.affiliation: School of Women's and Infants Health, University of Western Australia, 35 Crawley Ave, Crawley, Perth, Western Australia, Australia; Edinburgh Tommy's Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, United Kingdom. Electronic address: Sarah.stock@ed.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Stock
mesh_terms: D000818:Animals; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D014466:Ultraviolet Rays
keywords: Environmental epidemiology; Pregnancy; Solar ultraviolet radiation; Systematic review