Blood lead and preeclampsia: A meta-analysis and review of implications
Blood lead and preeclampsia: A meta-analysis and review of implications
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DOI：
10.1016/j.envres.2017.09.014
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发表时间：
2018-01-01
影响因子：
8.3
通讯作者：
Mielke, Howard W.
中科院分区：
文献类型：
--
作者：
Poropat, Arthur E.;Laidlaw, Mark A. S.;Mielke, Howard W.
背景资料：多项横断面研究表明，血铅与先兆子痫之间存在关联。目的：我们进行了系统回顾和荟萃分析，总结先兆子痫与铅中毒之间的关联。方法：Medline、Web of Science、Scopus、Pubmed、Science Direct和ProQuest的数据库（学位论文和论文）确定了2089份报告，其中46份在审查摘要后被下载，11项研究被评估为符合选择标准。使用ROBINS-I模板的评估（Sterne等人，结果：我们发现血铅浓度与先兆子痫显著相关（k = 12; N = 6069; Cohen's d = 1.26;比值比= 9.81;比值比LCL = 8.01;比值比UCL = 12.02; p = 0.005）。排除一项研究产生了同质的荟萃分析和更强的估计，尽管其余的研究来自八个不同的国家，并有抵消偏倚的风险。结论：孕妇的血铅浓度是先兆子痫的主要危险因素，增加1 pg/dL与先兆子痫的可能性增加1.6%相关，这似乎是迄今为止报道的先兆子痫的最强风险因素。有铅暴露史的孕妇应定期检测血铅浓度，特别是在中期之后。浓度高于5 pg/dL的妇女应积极监测先兆子痫，并建议采取预防性补钙。应建议所有孕妇积极避免铅暴露。
Background: Multiple cross-sectional studies suggest that there is an association between blood lead and preeclampsia.Objectives: We performed a systematic review and meta-analysis to summarize information on the association between preeclampsia and lead poisoning.Methods: Searches of Medline, Web of Science, Scopus, Pubmed, Science Direct and ProQuest (dissertations and theses) identified 2089 reports, 46 of which were downloaded after reviewing the abstracts, and 11 studies were evaluated as meeting the selection criteria. Evaluation using the ROBINS-I template (Sterne, et al., 2016), indicated moderate risk of bias in all studies.Results: We found that blood lead concentrations were significantly and substantially associated with preeclampsia (k = 12; N = 6069; Cohen's d = 1.26; odds ratio = 9.81; odds ratio LCL = 8.01; odds ratio UCL = 12.02; p = 0.005). Eliminating one study produced a homogeneous meta-analysis and stronger estimates, despite the remaining studies coming from eight separate countries and having countervailing risks of bias.Conclusions: Blood lead concentrations in pregnant women are a major risk factor for preeclampsia, with an increase of 1 pg/dL associated with a 1.6% increase in likelihood of preeclampsia, which appears to be the strongest risk factor for preeclampsia yet reported. Pregnant women with historical lead exposure should routinely have blood lead concentrations tested, especially after mid-term. Women with concentrations higher than 5 pg/dL should be actively monitored for preeclampsia and be advised to take prophylactic calcium supplementation. All pregnant women should be advised to actively avoid lead exposure.