1
|
Song S, Gao Z, Zhang X, Zhao X, Chang H, Zhang J, Yu Z, Huang C, Zhang H. Ambient fine particulate matter and pregnancy outcomes: An umbrella review. ENVIRONMENTAL RESEARCH 2023; 235:116652. [PMID: 37451569 DOI: 10.1016/j.envres.2023.116652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
The available evidence on the effects of ambient fine particulate matter (PM2.5) and pregnancy outcomes (birth outcomes and pregnancy complications) has increased substantially. The purpose of this umbrella review is to refine the evidence of the association between birth outcome (birth defects) and PM2.5; and summarize the credibility of existing research on the association between pregnancy complications and PM2.5. We searched PubMed, Web of Science, Embase, and Cochrane databases for relevant systematic reviews and meta-analyses up to March 16, 2022 in accordance with PRISMA guidelines. Two independent investigators conducted data extraction. AMSTAR 2 and GRADE assessment criteria were used to evaluate the methodological and evidence quality. We performed subgroup analyses by trimesters of pregnancy. The review protocol for this study has been registered in PROSPERO (CRD42022325550). This umbrella review identified a total of 41 systematic reviews, including 28 articles evaluating the influence of PM2.5 on birth outcomes and 13 on pregnancy complications. Positive associations between perinatal PM2.5 exposure and adverse birth outcomes were found, including low birth weight, preterm birth, stillbirth, small for gestational age, and birth defects. Pregnant women exposed to PM2.5 had a significantly higher risk of developing hypertensive disorder of pregnancy, gestational diabetes mellitus, gestational hypertension, and preeclampsia. The findings of subgroup analysis demonstrated that the effects of ambient PM2.5 exposure on pregnancy outcomes varied by trimesters. The findings of this extensive umbrella review provide convincing proof that exposure to ambient PM2.5 raises the risks of unfavorable birth outcomes and pregnancy complications. Some associations show considerable disparity between trimesters. These findings have implications for strengthen perinatal health care on air pollution and improving intergenerational equity.
Collapse
Affiliation(s)
- Shuaixing Song
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China; College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zhan Gao
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoan Zhang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Zhao
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Chang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junxi Zhang
- NHC Key Laboratory of Birth Defects Prevention & Henan Key Laboratory of Population Defects Prevention, Zhengzhou, China
| | - Zengli Yu
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Huanhuan Zhang
- College of Public Health, Zhengzhou University, Zhengzhou, China; NHC Key Laboratory of Birth Defects Prevention & Henan Key Laboratory of Population Defects Prevention, Zhengzhou, China.
| |
Collapse
|
2
|
Michel S, Atmakuri A, von Ehrenstein OS. Prenatal exposure to ambient air pollutants and congenital heart defects: An umbrella review. ENVIRONMENT INTERNATIONAL 2023; 178:108076. [PMID: 37454629 DOI: 10.1016/j.envint.2023.108076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Prenatal exposure to ambient air pollutants has been linked to congenital heart defects (CHD), but findings of existing systematic reviews have been mixed. OBJECTIVE To assess the epidemiological evidence on associations between prenatal exposure to ambient air pollutants and CHD subtypes, based on a systematic overview of reviews ("umbrella review"). METHODS We conducted a systematic search for reviews assessing associations between prenatal exposure to criteria air pollutants and CHD. The risk of bias was evaluated using the Risk of Bias in Systematic Reviews (ROBIS) tool. The certainty of the systematic review findings was graded using the Navigation Guide methodology. RESULTS We identified eleven systematic reviews, including eight with meta-analyses, assessing in total 35 primary studies of prenatal exposure to criteria air pollutants and various CHD subtypes. The certainty of the findings of four meta-analyses indicating an increased risk for coarctation of the aorta associated with nitrogen dioxide exposure was rated as moderate. The certainty of findings indicating positive, inverse, or null associations for other pollutant-subtype combinations was rated as very low to low, based on low precision and high statistical heterogeneity of summary odds ratios (SOR), substantial inconsistencies between review findings, and methodological limitations of the systematic reviews. DISCUSSION The inconsistent findings and high statistical heterogeneity of many SOR of the included systematic reviews may partly be traced to differences in methodological approaches, and the risk of bias across included reviews (e.g., inclusion criteria, systematic search strategies, synthesis methods) and primary studies (e.g., exposure assessment, diagnostic criteria). Adherence to appropriate systematic review guidelines for environmental health research, as well as rigorous evaluation of risk of bias in primary studies, are essential for future risk assessments and policy-making. Still, our findings suggest that prenatal exposure to ambient air pollutants may increase risks for at least some CHD subtypes.
Collapse
Affiliation(s)
- Sophie Michel
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA.
| | - Aishwarya Atmakuri
- Department of Molecular, Cell, and Developmental Biology, University of California, Los Angeles, Los Angeles, California, USA
| | - Ondine S von Ehrenstein
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA; Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| |
Collapse
|
3
|
Zhou X, Jiang Y, Fang J, Wang H, Xie D, Kuang H, Li T, Liu Q, He J. Incidence of cleft lip and palate, and epidemiology of perinatal deaths related to cleft lip and palate in Hunan Province, China, 2016-2020. Sci Rep 2023; 13:10304. [PMID: 37365256 DOI: 10.1038/s41598-023-37436-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 06/21/2023] [Indexed: 06/28/2023] Open
Abstract
This study aimed to analyze the epidemiological characteristics of cleft lip and/or palate (CL/P) and CL/P-related perinatal deaths, provide some information for intervention programs to reduce the incidence of CL/P and provide clues for future researchers. Data were obtained from the Birth Defects Surveillance System in Hunan Province, China, 2016-2020. Incidences of CL/P [number of cases per 1000 fetuses (births and deaths at 28 weeks of gestation and beyond)] with 95% confidence intervals (CI) were calculated by residence, gender, maternal age, year, and major types [cleft lip only (CL), cleft palate only (CP), and cleft lip with palate (CLP)]. Crude odds ratios (ORs) were calculated to examine the association of each maternal characteristic with CL/P. Pearson chi-square tests (χ2) were used to examine the association of each maternal characteristic with CL/P-related perinatal deaths. A total of 847,755 fetuses were registered, and 14,459 birth defects were identified, including 685 CL/P (accounted for 4.74% of all birth defects). CL, CP, and CLP accounted for 24.67% (169 cases), 36.79% (252 cases), and 38.54% (264 cases) of all CL/P, respectively. The incidence of CL/P was 0.81‰ (95%CI 0.75-0.87). The incidence of CL was 0.20‰ (95%CI 0.17-0.23) (169 cases), of CP was 0.30‰ (95%CI 0.26-0.33) (252 cases), and of CLP was 0.31‰ (95%CI 0.27-0.35) (264 cases). CL was more common in males than females (0.24‰ vs. 0.15‰, OR = 1.62, 95%CI 1.18-2.22). CP was more common in urban than rural (0.36‰ vs. 0.25‰, OR = 1.43, 95%CI 1.12-1.83), and less common in males than females (0.22‰ vs. 0.38‰, OR = 0.59, 95%CI 0.46-0.75). CLP was more common in males than females (0.35‰ vs. 0.26‰, OR = 1.36, 95%CI 1.06-1.74). Compared to mothers 25-29 years old, mothers < 20 years old were risk factors for CLP (OR = 3.62, 95%CI 2.07-6.33) and CL/P (OR = 1.80, 95%CI 1.13-2.86), and mothers ≥ 35 years old was a risk factor for CLP (OR = 1.43, 95%CI 1.01-2.02). CL/P-related perinatal deaths accounted for 24.96% (171/685) of all CL/P, of which 90.64% (155/171) were terminations of pregnancy. Rural residents, low income, low maternal age, and early prenatal diagnosis are risk factors for perinatal death. In conclusion, we found that CP was more common in urban areas and females, CL and CLP were more common in males, and CL/P was more common in mothers < 20 or ≥ 35 years old. In addition, most CL/P-related perinatal deaths were terminations of pregnancy. CL/P-related perinatal deaths were more common in rural areas, and the proportion of CL/P-related perinatal deaths decreased with the increase in maternal age, parity, and per-capita annual income. Several mechanisms have been proposed to explain these phenomena. Our study is the first systematic research on CL/P and CL/P-related perinatal deaths based on birth defects surveillance. It is significant for intervention programs to prevent CL/P and CL/P-related perinatal deaths. As well, more epidemiological characteristics of CL/P (such as the location of CL/P) and approaches to reduce CL/P-related perinatal deaths need to be studied in the future.
Collapse
Affiliation(s)
- Xu Zhou
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410000, Hunan Province, China.
| | - Yurong Jiang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410000, Hunan Province, China.
| | - Junqun Fang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410000, Hunan Province, China.
| | - Hua Wang
- The Hunan Children's Hospital, Changsha, 410000, Hunan Province, China.
- National Health Commission Key Laboratory of Birth Defects Research, Prevention and Treatment, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410000, Hunan Province, China.
| | - Donghua Xie
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410000, Hunan Province, China
| | - Haiyan Kuang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410000, Hunan Province, China
| | - Ting Li
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410000, Hunan Province, China
| | - Qin Liu
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410000, Hunan Province, China
| | - Jian He
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410000, Hunan Province, China
| |
Collapse
|
4
|
Gozar H, Bara Z, Dicu E, Derzsi Z. Current perspectives in hypospadias research: A scoping review of articles published in 2021 (Review). Exp Ther Med 2023; 25:211. [PMID: 37090085 PMCID: PMC10119991 DOI: 10.3892/etm.2023.11910] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/09/2023] [Indexed: 04/25/2023] Open
Abstract
Hundreds of papers are written about hypospadias every year referring to all aspects of the pathology, being one of the most common congenital malformations. The present study conducted a scoping review of articles published in 2021 to present the main issues and summarize current perspectives and achievements in the field. It searched for the keyword 'hypospadias' in the three most popular databases (PubMed, Scopus and Web of Science). After the analysis of the publications, they were categorized into different domains. The present review was performed respecting the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR) guidelines. A total of 284 articles were included. These were published in 142 different journals. The most accessed was the Journal of Paediatric Urology with 54 articles. The main identified domains were related to surgical techniques, postoperative care, complications, anesthesia, anatomical factors, genetics, environmental factors, endocrinology, associated malformations, questionnaires and recommendations, management, biological materials, animal models, retrospective studies of centers, social media, bibliometrics, small gestational age, neoplasm, or fertility. Promising modifications of existing surgical techniques were presented with improved outcomes for both the proximal and distal types of hypospadias. Relevant anatomical and etiological, and also genetic factors were clarified. Aspects of the peri- and postoperative management referring to the antibiotherapy, analgesia, dressing techniques, and the future use of novel bioengineering agents to prevent, reduce or treat the occurring complications were discussed.
Collapse
Affiliation(s)
- Horea Gozar
- Clinic of Pediatric Surgery and Orthopedics, Târgu Mureș, County Emergency Clinical Hospital, Târgu Mureș 540136, Romania
- Department of Pediatric Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș 540142, Romania
| | - Zsolt Bara
- Clinic of Pediatric Surgery and Orthopedics, Târgu Mureș, County Emergency Clinical Hospital, Târgu Mureș 540136, Romania
| | - Emilia Dicu
- Clinic of Pediatric Surgery and Orthopedics, Târgu Mureș, County Emergency Clinical Hospital, Târgu Mureș 540136, Romania
| | - Zoltán Derzsi
- Clinic of Pediatric Surgery and Orthopedics, Târgu Mureș, County Emergency Clinical Hospital, Târgu Mureș 540136, Romania
- Department of Pediatric Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș 540142, Romania
| |
Collapse
|
5
|
Mahboubi K, MacDonald L, Ahrens B, Lane C, MacLellan D, Anderson P, Romao RLP. Geospatial analysis of hypospadias and cryptorchidism prevalence rates based on postal code in a Canadian province with stable population. J Pediatr Urol 2023; 19:91.e1-91.e6. [PMID: 36261304 DOI: 10.1016/j.jpurol.2022.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Hypospadias and cryptorchidism are hormone-mediated malformations that occur during male development. Prevalence rates of hypospadias and cryptorchidism are thought to be increasing worldwide. In-utero exposure to endocrine-disrupting chemicals (EDCs) may have a role in the occurrence of these malformations. Our group has reported significant clustering of hypospadias and cryptorchidism at the county level in areas of intense agricultural activity in the Canadian province of Nova Scotia (NS). Finer scale spatial analysis has shown clustering near urban centres. OBJECTIVES The objectives of the study were: 1) to perform a granular geospatial analysis of hypospadias and cryptorchidism prevalence, at the postal code level, of all babies born in NS over a 26-year period; and 2) to determine whether there is spatial correlation between these conditions and industries linked to toxic output. STUDY DESIGN Cases of hypospadias and cryptorchidism were identified based on ICD-10 codes from the Nova Scotia Atlee Perinatal Database with records of all live births in NS between 1988 and 2013. Data were geocoded and mapped based on the three first digits of the maternal postal code (Forward Sortation Area [FSA]). Regional prevalence of congenital anomalies was calculated for each of the 77 FSAs. To identify statistically significant high and low prevalence clusters for each anomaly, Local Morans I was used on the spatial data. Geospatial point data was created for industries linked to toxic output and correlation between clusters of malformations and proximity to these industries was assessed. RESULTS During the study period, there were 1045 cases of hypospadias and 993 cases of cryptorchidism. Both hypospadias and cryptorchidism demonstrated statistically significant areas of high prevalence clusters. There was no significant spatial correlation between the local clustering of the congenital malformations and proximity to toxic industries. DISCUSSION AND CONCLUSION Our study shows heterogeneity in the distribution of hypospadias and cryptorchidism, which is consistent with previously published works. In this follow-up, granular geospatial analysis of hypospadias and cryptorchidism prevalence in an area with stable population, we did not confirm the previous findings of high clustering in areas of intense agricultural activity. Furthermore, our analysis did not find high clustering of the congenital malformations in areas near toxic industries to support a clear environmental role in their development. Some of the limitations include underdiagnosis of hypospadias and cryptorchidism (as they both present with a clinical spectrum and are non-life threatening), and limited data currently available on the route of exposure to EDC industries in Nova Scotia.
Collapse
Affiliation(s)
- Kiana Mahboubi
- Division of Urology, Department of Surgery, IWK Health Centre, Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Landan MacDonald
- Division of Urology, Department of Surgery, IWK Health Centre, Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Beau Ahrens
- Interdisciplinary PhD Program, Faculty of Graduate Studies, Dalhousie University, Halifax, NS, Canada.
| | - Ciaran Lane
- Division of Urology, Department of Surgery, IWK Health Centre, Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Dawn MacLellan
- Division of Urology, Department of Surgery, IWK Health Centre, Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Peter Anderson
- Division of Urology, Department of Surgery, IWK Health Centre, Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Rodrigo L P Romao
- Division of Urology, Department of Surgery, IWK Health Centre, Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
| |
Collapse
|