Chen Cynthia, Kaushal Neil, Scher David M, Doyle Shevaun M, Blanco John S, Dodwell Emily R
Hospital for Special Surgery, New York, NY.
J Pediatr Orthop. 2018 Sep;38(8):e462-e469. doi: 10.1097/BPO.0000000000001191.
Clubfoot is a common congenital anomaly with multiple potential risk factors. Identification of modifiable risk factors may minimize future incidence of clubfoot. The aim of this meta-analysis was to systematically review and analyze the best clinical evidence regarding risk factors associated with clubfoot.
Medline, Embase, and Cochrane databases were systematically searched from 1967 to May 11, 2016 for studies reporting risk factors for clubfoot. Randomized trials and observational studies were eligible for inclusion, and assessed in duplicate. Study quality was assessed with the Newcastle-Ottawa Scale or Cochrane risk of bias tool; low quality studies were excluded, all randomized trials were included. Two reviewers extracted data independently. This meta-analysis was conducted in accordance with PRISMA guidelines. Pooled effect estimates for the odds of clubfoot were calculated using random or fixed-effects models based on heterogeneity.
Forty-two studies (28 case-control, 10 cohort, 4 randomized trials) comprising 31,844 clubfoot cases and 6,604,013 controls were included. Risk factors associated with increased odds of clubfoot included maternal smoking [odds ratio (OR)=1.65; 95% confidence interval (CI), 1.54-1.78], paternal smoking (OR=1.72; 95% CI, 1.05-2.84), maternal body mass index >30 (OR=1.46; 95% CI, 1.29-1.65), family history (OR=7.80; 95% CI, 4.04-15.04), amniocentesis (OR=2.08; 95% CI, 1.34-3.21), selective serotonin reuptake inhibitor exposure (OR=1.78; 95% CI, 1.34-2.37) maternal single status (OR=1.17; 95% CI, 1.11-1.23), gestational diabetes (OR=1.40; 95% CI, 1.13-1.72), nulliparity (OR=1.32; 95% CI, 1.19-1.45), male sex (OR=1.68; 95% CI, 1.48-1.94), and aboriginal Australian race (OR=2.35; 95% CI, 1.63-3.38).
Smoking, maternal obesity, family history, amniocentesis, and some selective serotonin reuptake inhibitor exposures are the most clinically relevant exposures associated with increased odds of clubfoot, with family history representing the greatest risk. Recognition of modifiable risk factors may help in counseling patients, and minimizing clubfoot incidence.
Level II.
马蹄内翻足是一种常见的先天性畸形，存在多种潜在风险因素。识别可改变的风险因素可能会降低未来马蹄内翻足的发病率。本荟萃分析的目的是系统评价和分析与马蹄内翻足相关的风险因素的最佳临床证据。
系统检索1967年至2016年5月11日期间的Medline、Embase和Cochrane数据库，查找报告马蹄内翻足风险因素的研究。随机试验和观察性研究均符合纳入标准，并进行了重复评估。采用纽卡斯尔-渥太华量表或Cochrane偏倚风险工具评估研究质量；排除低质量研究，纳入所有随机试验。两名研究者独立提取数据。本荟萃分析按照PRISMA指南进行。根据异质性，使用随机或固定效应模型计算马蹄内翻足发生几率的合并效应估计值。
纳入42项研究（28项病例对照研究、10项队列研究、4项随机试验），共31844例马蹄内翻足病例和6604013例对照。与马蹄内翻足发生几率增加相关的风险因素包括母亲吸烟[比值比（OR）=1.65；95%置信区间（CI），1.54 - 1.78]、父亲吸烟（OR = 1.72；95% CI，1.05 - 2.84）、母亲体重指数>30（OR = 1.46；95% CI，1.29 - 1.65）、家族史（OR = 7.80；95% CI，4.04 - 15.04）、羊膜穿刺术（OR = 2.08；95% CI，1.34 - 3.21）、选择性5-羟色胺再摄取抑制剂暴露（OR = 1.78；95% CI，1.34 - 2.37）、母亲单身状态（OR = 1.17；95% CI，1.11 - 1.23）、妊娠期糖尿病（OR = 1.40；95% CI，1.13 - 1.72）、未生育（OR = 1.32；95% CI，1.19 - 1.45）、男性（OR = 1.68；95% CI，1.48 - 1.94）和澳大利亚原住民种族（OR = 2.35；95% CI，1.63 - 3.38）。
吸烟、母亲肥胖、家族史、羊膜穿刺术以及某些选择性5-羟色胺再摄取抑制剂暴露是与马蹄内翻足发生几率增加最相关的临床暴露因素，其中家族史风险最大。识别可改变的风险因素可能有助于为患者提供咨询，并降低马蹄内翻足的发病率。
二级。
