Endocrine Disruption and Reproductive Health in Latin America and the Caribbean: A Systematic Review of Microplastics

Microplastics pollution is a widespread environmental issue in Latin America and the Caribbean (LAC), where factors such as urbanization, insufficient waste management, and coastal vulnerability may increase exposure risks. Microplastics can act as carriers for endocrine-disrupting chemicals (EDCs), but a comprehensive synthesis of region-specific evidence linking this contamination to reproductive health outcomes has been lacking. This systematic review examines the evidence regarding the impact of microplastics pollution on reproductive health across species in LAC, identifies contamination hotspots and exposure pathways, and highlights gaps in policy and research. Following PRISMA 2020 guidelines, we analyzed 30 peer-reviewed studies (2014-2024) from 12 LAC nations. Due to significant heterogeneity in study designs, populations, and outcomes, a narrative synthesis was conducted to integrate evidence from environmental monitoring, animal toxicology, and human biomonitoring studies. Risk of bias was assessed using design-specific tools. The evidence indicates widespread microplastics contamination in LAC, with notable hotspots in coastal Colombia (4.54 particles/m2), Argentine riverine systems (30 780 particles/m2), and Mexican groundwater (18.3 particles/L). Overall, 82% of assessed sites were classified as "Dirty" to "Extremely Dirty." Animal studies reported that microplastics exposure was associated with reproductive toxicity, including reduced sperm concentration and motility, ovarian fibrosis, and polycystic ovary syndrome (PCOS)-like phenotypes. Human biomarker studies found elevated urinary bisphenol A (BPA) levels in pregnant women from Caribbean countries, correlating with altered gonadotropin ratios. Dietary intake, particularly from seafood and beverages, was identified as a primary exposure pathway, while inhalable particles in urban air posed additional risks. No LAC country has established enforceable microplastics thresholds for drinking water or standardized biomonitoring protocols. This systematic review suggests that microplastics pollution is prevalent in LAC environments and is associated with adverse reproductive outcomes in animal models. Preliminary human data indicate potential exposure-related endocrine effects, though causal inference is limited by the absence of direct microplastic exposure measurements and reliance on cross-sectional EDC biomarker studies. The findings underscore the need for expanded biomonitoring, harmonized research methodologies, and region-specific policy development to better understand and address potential public health implications.