Risk factors of unfavourable pregnancy outcomes include high levels of chemicals exposures, sociodemographic and clinical factors. Data are contradctory about the impact of environmental chemical pollutants exposures on pregnancy outcomes. Objectives: This study aimed to investigate risk factors of unfavourable pregnancy outcomes among pregnant women in Assiut city, Egypt and to define the impacts of high maternal blood lead level on the mother, fetus and infant. Subjects and methods: A

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... trol, hospital based study was carried out at the Obestetrics Emergency Room, in Aussiut University Hospital. The pregnants attended the Emergency Room for abortion or labor were recruited. The cases of unfavourable pregnancy outcomes represented the study group, 246 cases. An equal number of women with favourable pregnancy outcome was recruited as a control group. The required data were obtainned. Blood samples were collected from cases, controls, and their live borne infants and husbands to determine their blood lead and hemoglobin levels. Results: Mean blood lead level of women with unfavourable and favourable pregnancy outcomes were 29.46±6.72 and 28.61±6.53 μg/dL, respectively with a statistically insignificant difference. Gestational hypertension, pr-eclampsia/eclampsia, unfavourable pregnancy outcomes, and neonatal intensive care admission were more common among women with blood lead levls ≥30 μg/dL compared to women with <30 μg/dL, with statistically significant differences (P=0.006, 0.03, 0.000, 0.0001 and 0.000, and 0.000, respectively). One and 5-minutes Apgar scores, maternal and infant Hb were lower among women with blood lead levls ≥30 μg/dL with statisticaly significant differences (P=0.000 for each of them). Factors, significantly, put women at risk to develop unfavourable pregnancy outcomes were maternal age group 30-35 years (OR=6.13), interpregnancy space <2 years (OR=4.15), preveious unfavourable pregnancy outcomes (OR=3.08), primiparous (OR=2.58), and low socioeconomic level (OR=2.45). Also; living nearby hazardous environment (OR=3.2), hazardous maternal occupations (OR=2.81), and unusual exertion/heavy lifting (OR=2.53) were significant risk fators for unfavourable pregnancy outcomes. No regular antenatal care, no adequate diet intake and eating foods exposed to lead pollutants were significant risk factors (OR=2.77, 2.85, and 2.13, respectively). Maternal (OR=5.17) and paternal (OR=3.66) smoking, and traditional herbal medication use (OR=2.83) were sinificant risk factors. Lastly, hypertension (OR=5.71), stress (OR=4.56) and urinary tract infections (OR=3.19) were sinificant medical risk factors. Recommendations: Women at risk for unfavourable pregnancy outcomes should have frequent antenatal care for monitoring and evaluation their conditions. Environmental, nutritional, and behavioral interventions are indicated for all pregnant women in order to prevent undue exposures to the women, fetus, newborn and infant. Lastly, further studies in different areas in Egypt are needed to investigate this health problem.