Pesticide Exposure and Reproductive Health Outcomes in Agricultural Workers: Exposure Patterns, Semen Quality, Pregnancy Outcomes, and Determinants of Adverse Reproductive Events

Pesticide exposure has been associated with adverse reproductive outcomes in multiple international studies, though evidence in South Asian agricultural contexts remains limited despite the substantial population of agricultural workers and high pesticide use intensity. We undertook a combined cross-sectional and longitudinal cohort study of 348 agricultural workers and their reproductive partners across high-pesticide-use districts. Primary exposure category was organophosphates (40.8%), followed by pyrethroids (22.4%), organochlorines (10.9%), carbamates (9.2%), herbicides (8.0%), and mixed/multiple categories (6.3%). Semen quality analysis in 268 working-age male workers showed substantial gradient by exposure intensity: mean sperm concentration 58, 42, and 28 million/mL across low, moderate, and high exposure categories. Pregnancy outcomes among 152 followed pregnancies showed substantial gradient: live-birth rate 72%, 62%, and 48% across exposure categories, miscarriage rate 18%, 26%, and 34%. Strongest predictors of adverse reproductive outcomes included pesticide application without PPE, high exposure intensity, organophosphate primary exposure, mixing/loading concentrates, female partner direct exposure, and duration of exposure ≥10 years. PPE use, integrated pest management, and safety training were strongly protective.