Fitness costs of environmentally relevant concentrations of pharmaceuticals and personal care products in freshwater fauna: a systematic review and meta-analysis

Pharmaceuticals and personal care products (PPCPs) are now ubiquitous in freshwater ecosystems, entering water bodies through widespread use and incomplete removal during wastewater treatment. These compounds include psychoactive substances, antibiotics, anti-inflammatory drugs, hormones, chemotherapeutic drugs, fragrances, preservatives, UV filters, plasticizers and others. Although many studies report negative effects on survival and reproduction in non-target freshwater organisms, the overall magnitude and consistency of these impacts have remained unclear. We thus conducted the first systematic review and meta-analysis of PPCP effects at environmentally relevant concentrations across freshwater taxa. Our objectives were to quantify the overall effects of PPCP exposures on the fitness of freshwater fauna, and to test how the effects vary across taxa, and with developmental stage, sex, and experimental context. We synthesized data from 96 peer-reviewed experimental studies and open datasets spanning 28 species and 65 PPCP compounds. Our meta-analysis shows that exposure to environmental levels of PPCPs consistently reduced fitness components, with survival showing the strongest decline. Among compounds, pharmaceuticals—and particularly antibiotics—produced the largest effects. However, the responses were context dependent. Our synthesis also revealed a substantial gap in taxonomic and compound coverage. We found little statistical evidence of publication bias in our dataset and the results were robust to sensitivity analyses. This study provides the first quantitative, cross-taxon synthesis of PPCP impacts on freshwater animals. By integrating heterogeneous ecotoxicological evidence, our findings strengthen the basis for prioritizing high-risk compounds and improving environmental risk assessment and regulatory decision-making.