Abstract
Cardiovascular disease (CVD) is the leading cause of pregnancy-related deaths, with rates continuing to rise. While older maternal age and preexisting conditions such as obesity, diabetes and hypertension contribute to this trend, they do not fully account for it, suggesting a critical role for environmental factors. A major environmental concern is inorganic arsenic (iAs), which contaminates the food and water supply of over 140 million people worldwide. Exposure to iAs has been linked to a number of chronic diseases including cancer, neurodegenerative disorders and heart disease. During pregnancy, gestational iAs exposure poses a substantial threat to maternal and fetal health. It is linked with a higher risk of maternal hypertension, preeclampsia, and structural heart changes during and after pregnancy. Concurrently, it drives fetal complications including pre-term delivery, congenital heart defects and low birth weight. Furthermore, these early-life exposures predispose offspring to lifelong CVD. Herein, we summarize current evidence regarding the adverse impacts of prenatal iAs exposure on the cardiovascular health of mothers and their offspring. We underscore the need to elucidate the underlying biological mechanisms to inform targeted preventive strategies, therapeutics, and public health policies aimed at combating the rising global maternal mortality.