AbstractAn evolving body of evidence supports that cadmi-um, a non-essential heavy metal, may be associated with multiple adverse women’s reproductive health outcomes. Our objective was to conduct a systematic review of epidemi-ologic studies that evaluated cadmium exposure and the fol-lowing reproductive health outcomes: puberty/menarche, fer-tility, time to pregnancy, pregnancy loss, preeclampsia, endo-metriosis, uterine leiomyoma, and menopause. Twenty-two
studies were identified based upon our search criteria. Available evidence was inadequate to draw meaningful con-clusions for most of the reproductive outcomes studied. The strongest evidence was for a possible association between cadmium and preeclampsia, which was limited to cross-sectional studies. Some evidence, although conflicting, was also observed for fertility related outcomes. This lack of evidence underscores the need for additional research on cadmium and women’s reproductive health outcomes. KeywordsCadmium.Fertility. Endometriosis. Leiomyoma. Menarche.Menopause. Metal.Pregnancy loss .Preeclampsia. Reproduction. Reproductive health. Women.Epidemiologic evidence