Griffith University - School of Applied Psychology, Brisbane, Australia.
RMIT University - Centre for Environmental Sustainability and Remediation (EnSuRe), School of Science, Bundoora, Victoria, Australia.
Environ Res. 2018 Jan;160:12-19. doi: 10.1016/j.envres.2017.09.014. Epub 2017 Sep 21.
Multiple cross-sectional studies suggest that there is an association between blood lead and preeclampsia.
We performed a systematic review and meta-analysis to summarize information on the association between preeclampsia and lead poisoning.
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.
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.
Blood lead concentrations in pregnant women are a major risk factor for preeclampsia, with an increase of 1μg/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 5μg/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.
多项横断面研究表明，血铅与子痫前期之间存在关联。
我们进行了系统综述和荟萃分析，以总结子痫前期与铅中毒之间关联的信息。
通过检索 Medline、Web of Science、Scopus、Pubmed、Science Direct 和 ProQuest（论文和学位论文），共确定了 2089 篇报告，其中 46 篇在查看摘要后被下载，11 项研究被评估为符合选择标准。使用 ROBINS-I 模板（Sterne 等人，2016 年）进行评估，所有研究均显示存在中度偏倚风险。
我们发现血铅浓度与子痫前期显著且显著相关（k = 12；N = 6069；Cohen's d = 1.26；优势比 = 9.81；优势比 LCL = 8.01；优势比 UCL = 12.02；p = 0.005）。消除一项研究后，进行了一项同质性荟萃分析，得出了更强的估计值，尽管其余研究来自八个不同的国家，且存在相反的偏倚风险。
孕妇血铅浓度是子痫前期的一个主要危险因素，每增加 1μg/dL，子痫前期的可能性增加 1.6%，这似乎是迄今为止报道的子痫前期最强的危险因素。有历史铅暴露的孕妇应常规检测血铅浓度，尤其是在中期之后。血铅浓度高于 5μg/dL 的女性应积极监测子痫前期，并建议进行预防性钙补充。应建议所有孕妇积极避免铅暴露。
