Air pollution is a major global public health threat, with disproportionate effects on pregnant women and children. Higher ventilation per body weight and ongoing organ development increase children’s susceptibility to pollutants such as particulate matter (PM), nitrogen oxides, and ozone. This narrative review synthesizes evidence on adverse health outcomes associated with outdoor air pollution and indoor environmental tobacco smoke (ETS) in children and women of reproductive age, and highlights implications for prevention.

Epidemiological studies and international reports indicate that prenatal and early-life exposure to ambient pollutants is associated with impaired fetal growth, low birth weight, preterm birth, and increased infant mortality. In Poland and other European settings, elevated levels of PM and benzo[a]pyrene correlate with higher rates of asthma exacerbations, respiratory infections, and healthcare utilization in children. Emerging data suggest cardiovascular effects, including elevated blood pressure and early vascular changes, as well as neurodevelopmental and mental health impacts (e.g., cognitive impairment and behavioral disorders). Evidence also links pollution exposure with metabolic outcomes, including obesity and type 1 diabetes, potentially mediated by oxidative stress, chronic inflammation, microbiome disruption, and epigenetic modifications (e.g., altered DNA methylation). ETS remains common (over 30% of children in Poland) and may both amplify health risks and confound associations attributed to outdoor pollution.

Air pollution contributes to multi-organ morbidity in maternal–child populations, spanning respiratory, cardiovascular, neurodevelopmental, metabolic, and oncologic domains. The available evidence supports immediate, actionable measures, including stricter emissions control, targeted protection during high-exposure periods, household interventions to eliminate ETS, and sustained health education. Further research should refine exposure assessment (including ETS) and evaluate the effectiveness of mitigation strategies.