OBJECTIVES: Air pollutants are known neurotoxicants. In this updated systematic review, we evaluate new evidence since our 2019 systematic review on the effect of outdoor air pollution exposure on childhood and adolescent brain structure and function as measured by magnetic resonance imaging (MRI). METHODS: Using PubMed, Web of Science, and Scopus we conducted an updated literature search and systematic review of articles published through January 2025, using key terms for air pollution and functional and/or structural MRI. Two raters independently screened all articles using Covidence and implemented the risk of bias instrument for systematic reviews used to inform the World Health Organization Global Air Quality Guidelines. RESULTS: We identified 29 relevant papers, and 20 new studies met our inclusion criteria. Including six studies from our 2019 review, the 26 publications to date include study populations from the United States, Netherlands, Spain, and United Kingdom. Studies investigated exposure periods spanning pregnancy through early adolescence, and estimated air pollutant exposure levels via personal monitoring, geospatial residential estimates, or school courtyard monitors. Brain MRI occurred when children were on average 6-14.7 years old
however, one study assessed newborns. Several MRI modalities were leveraged, including structural morphology, diffusion tensor imaging, restriction spectrum imaging, arterial spin labeling, magnetic resonance spectroscopy, as well as resting-state and task-based functional MRI. Air pollutants were associated with widespread brain differences, although the magnitude and direction of findings are largely inconsistent, making it difficult to draw strong conclusions. CONCLUSION: Prenatal and childhood exposure to outdoor air pollution is associated with structural and functional brain variations. Compared to our initial 2019 review comprised of only cross-sectional studies, the current literature now includes longitudinal studies and more advanced neuroimaging methods. Further research is needed to clarify the effects of developmental timing, along with the downstream implications of outdoor air pollution exposure on children's cognitive and mental health.