Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana.
Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland.
J Expo Sci Environ Epidemiol. 2021 Mar;31(2):299-317. doi: 10.1038/s41370-021-00289-6. Epub 2021 Jan 29.
There are several inconsistencies in the epidemiological literature on the strength of the association between cadmium exposure and adverse pregnancy and birth outcomes, and the threshold dose of adverse effect.
We therefore conducted a systematic review and dose-response meta-analysis to evaluate the available evidence to influence clinical decision making and better tailor public health interventions.
PubMed and Scopus databases were searched up to January, 2019. Eighteen prospective studies satisfied the inclusion criteria. Random effects model was used to compute summary-effect estimates.
Cadmium exposure resulted in 42.11 g (95% confidence interval [CI]: -69.03, -15.18) reduction in birth weight, and 0.105 cm (95% CI: -0.181, -0.029) reduction in head circumference per 1 µg/l increment in blood/urine cadmium levels. Cadmium exposure also resulted in 21% (RR = 1.21; 95% CI: 1.02, 1.43), 32% (RR = 1.32; 95% CI: 1.05, 1.67) and 10% (RR = 1.10; 95% CI: 0.96, 1.27) increased risk of low birth weight (LBW), preterm birth (PTB), and small-for-gestational age (SGA), respectively. Risk for all outcomes decreased with decreasing exposure. In fixed effects dose-response meta-regression analyses, we found no evidence of association of cadmium exposure with LBW and SGA. For PTB, a 1 µg/l increment in cadmium exposure corresponded to 0.5% (OR = 1.005, 95% CI: 1.003, 1.007) increase in PTB risk.
Cadmium exposure was associated with risk of adverse birth outcomes. Regarding PTB, the formal dose-response meta-analyses suggests a causal association.
镉暴露与不良妊娠和出生结局之间关联的强度以及不良效应的阈值剂量在流行病学文献中存在多种不一致之处。
因此，我们进行了系统评价和剂量-反应荟萃分析，以评估现有证据，为临床决策提供参考，并更好地调整公共卫生干预措施。
检索了 PubMed 和 Scopus 数据库，截至 2019 年 1 月。有 18 项前瞻性研究符合纳入标准。采用随机效应模型计算汇总效应估计值。
镉暴露使出生体重降低了 42.11g（95%置信区间[CI]：-69.03，-15.18），使血/尿镉水平每增加 1μg/l，头围减少 0.105cm（95%CI：-0.181，-0.029）。镉暴露还使低出生体重（LBW）、早产（PTB）和小于胎龄儿（SGA）的风险分别增加了 21%（RR=1.21；95%CI：1.02，1.43）、32%（RR=1.32；95%CI：1.05，1.67）和 10%（RR=1.10；95%CI：0.96，1.27）。随着暴露的减少，风险也降低。在固定效应剂量-反应荟萃回归分析中，我们没有发现镉暴露与 LBW 和 SGA 之间存在关联的证据。对于 PTB，镉暴露每增加 1μg/l，PTB 的风险增加 0.5%（OR=1.005，95%CI：1.003，1.007）。
镉暴露与不良出生结局的风险相关。对于 PTB，正式的剂量-反应荟萃分析表明存在因果关系。
