Perinatal environmental exposures, maternal mental health and cognitive outcomes in very preterm infants born in urban London.

INTRODUCTION: Very preterm (VPT) infants face elevated neurodevelopmental risks. The impact of perinatal environmental exposures, where complex factors may affect maternal mental health and infant outcomes, remains poorly understood. This study examines how joint environmental exposures relate to postnatal maternal anxiety and neurodevelopmental outcomes in VPT infants. METHODS: We included 427 VPT infants born in Greater London (2010-2013). We derived residential environmental exposures: air pollutants, noise, and open space. Clustering analysis identified exposure profiles. At term-equivalent age (38-44 weeks), infants underwent T2-weighted MRI for brain volume and cortical feature analysis. Maternal anxiety, assessed at term; neurodevelopmental outcomes, evaluated at 18-24 months; and brain metrics were compared between exposure clusters, adjusting for socioeconomic status (SES). We further explored the role of SES in environmental exposure. RESULTS: Three exposure profiles emerged. Compared to Group 1 (reference; n = 358), Group 2 (n = 42), characterised by poor air quality and limited open space, had a higher risk of cognitive delay and greater socioeconomic disadvantage. Conversely, Group 3 (n = 27; low noise exposure) exhibited reduced maternal anxiety. SES contributed 20.91% of the environmental effect on cognitive delay. No significant differences in brain volumes or cortical features were observed between the three exposure profiles. CONCLUSION: Perinatal environmental exposures have distinct effects on maternal-infant outcomes. Neurotoxicant exposure and limited access to restorative environments may negatively impact early neurodevelopment, while noise reduction may support maternal mental health. These findings underscore the importance of environmental factors in shaping early development and highlight the need for further research into underlying biological mechanisms and long-term effects.