Bristol Dental School, Faculty of Health Sciences, 152331University of Bristol, Bristol, UK.
Population Health Sciences, 152331Bristol Medical School, University of Bristol, Bristol, UK.
Cleft Palate Craniofac J. 2022 Oct;59(10):1253-1263. doi: 10.1177/10556656211045553. Epub 2022 Jan 11.
To assess whether women who experience stressful life events during the periconceptional period are at higher risk of giving birth to a baby with an orofacial cleft (OFC).
Systematic review and meta-analysis of studies reporting the proportion of babies born with OFC to mothers exposed and unexposed to population-level or personal-level stressful life events during the periconceptional period. Six electronic databases were searched from inception to August 2020. Risk of bias was assessed using the Newcastle-Ottawa scale. Odds ratios (ORs) for the odds of OFC in babies of exposed mothers relative to unexposed controls were extracted and/or calculated. Random effects meta-analysis was undertaken, stratified by cleft subtype.
Of 12 eligible studies, 8 examined experience of personal events and 4 examined population-level events. Studies demonstrated low-moderate risk of bias and there was indication of publication bias. There was some evidence that personal stressful life events were associated with greater odds of cleft lip and/or palate (six studies, OR 1.63, 95% confidence interval (CI) 1.16, 2.30, = 0.001) and cleft palate only (six studies, OR 1.45, 95% CI 1.02, 2.06, = 0.04). Population-level events were associated with higher odds of OFC in studies that did not specify subtype (three studies, OR 1.64, 95% CI 1.19, 2.25, = 0.002), but subtype stratified analyses were underpowered. Heterogeneity was high.
Limited evidence indicated a weak positive association between maternal stressful life events during the periconceptional period and risk of OFC in the offspring, but further studies with greater consistency in research design are needed.
评估在受孕期间经历应激性生活事件的女性是否更有可能生育患有口腔面部裂（OFC）的婴儿。
对报告受孕期间暴露于人群水平或个体水平应激性生活事件的母亲所生的 OFC 婴儿比例的研究进行系统评价和荟萃分析。从成立到 2020 年 8 月，检索了六个电子数据库。使用纽卡斯尔-渥太华量表评估偏倚风险。提取并/或计算暴露母亲的 OFC 婴儿与未暴露对照的比值比（OR）。进行随机效应荟萃分析，并按裂隙亚型分层。
在 12 项合格研究中，8 项研究检查了个人事件的经历，4 项研究检查了人群水平的事件。研究表明存在低中度偏倚风险，并且存在发表偏倚的迹象。有一些证据表明个人应激性生活事件与唇裂和/或腭裂（6 项研究，OR 1.63，95%置信区间（CI）1.16，2.30，=0.001）和单纯腭裂（6 项研究，OR 1.45，95%CI 1.02，2.06，=0.04）的发生几率更高相关。在未明确说明亚型的研究中，人群水平的事件与 OFC 的发生几率更高相关（3 项研究，OR 1.64，95%CI 1.19，2.25，=0.002），但亚组分层分析的效力不足。异质性很高。
有限的证据表明，在受孕期间母亲经历应激性生活事件与后代发生 OFC 的风险之间存在微弱的正相关，但需要进一步研究设计更加一致的研究。
