对儿童和青少年智力残疾的生物学、社会和环境决定因素的系统评价。
A systematic review of the biological, social, and environmental determinants of intellectual disability in children and adolescents.
作者信息
Leonard Helen, Montgomery Alicia, Wolff Brittany, Strumpher Elissa, Masi Anne, Woolfenden Susan, Williams Katrina, Eapen Valsamma, Finlay-Jones Amy, Whitehouse Andrew, Symons Martyn, Licari Melissa, Varcin Kandice, Alvares Gail, Evans Kiah, Downs Jenny, Glasson Emma
机构信息
Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia.
School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia.
出版信息
Front Psychiatry. 2022 Aug 25;13:926681. doi: 10.3389/fpsyt.2022.926681. eCollection 2022.
AIM
This systematic review aimed to identify the most important social, environmental, biological, and/or genetic risk factors for intellectual disability (ID).
METHODS
Eligible were published prospective or retrospective comparative studies investigating risk factors for ID in children 4-18 years. Exclusions were single group studies with no comparator without ID and a sample size <100. Electronic databases (Medline, Cochrane Library, EMBASE, PsycInfo, Campbell Collaboration, and CINAHL) were searched for eligible publications from 1980 to 2020. Joanna Briggs Institute critical appraisal instruments, appropriate for study type, were used to assess study quality and risk of bias. Descriptive characteristics and individual study results were presented followed by the synthesis for individual risk factors, also assessed using GRADE.
RESULTS
Fifty-eight individual eligible studies were grouped into six exposure topics: sociodemographic; antenatal and perinatal; maternal physical health; maternal mental health; environmental; genetic or biological studies. There were few eligible genetic studies. For half the topics, the certainty of evidence (GRADE) was moderate or high.
CONCLUSION
Multiple studies have examined individual potential determinants of ID, but few have investigated holistically to identify those populations most at risk. Our review would indicate that there are vulnerable groups where risk factors we identified, such as low socioeconomic status, minority ethnicity, teenage motherhood, maternal mental illness, and alcohol abuse, may cluster, highlighting a target for preventive strategies. At-risk populations need to be identified and monitored so that interventions can be implemented when appropriate, at preconception, during pregnancy, or after birth. This could reduce the likelihood of ID and provide optimal opportunities for vulnerable infants.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=120032], identifier [CRD42019120032].
目的
本系统评价旨在确定智力残疾（ID）最重要的社会、环境、生物和/或遗传风险因素。
方法
纳入已发表的前瞻性或回顾性比较研究，这些研究调查4至18岁儿童ID的风险因素。排除无ID对照组的单组研究以及样本量<100的研究。检索电子数据库（Medline、Cochrane图书馆、EMBASE、PsycInfo、坎贝尔协作组织和护理学与健康领域数据库），以查找1980年至2020年期间符合条件的出版物。使用适合研究类型的乔安娜·布里格斯研究所批判性评价工具来评估研究质量和偏倚风险。呈现描述性特征和个体研究结果，随后对个体风险因素进行综合分析，同样使用GRADE进行评估。
结果
58项符合条件的个体研究被分为六个暴露主题：社会人口统计学；产前和围产期；母亲身体健康；母亲心理健康；环境；遗传或生物学研究。符合条件的遗传研究较少。对于一半的主题，证据确定性（GRADE）为中等或高。
结论
多项研究已考察了ID的个体潜在决定因素，但很少有研究进行全面调查以确定风险最高的人群。我们的评价表明，存在一些弱势群体，我们所确定的风险因素，如低社会经济地位、少数族裔、少女母亲、母亲精神疾病和酒精滥用，可能在这些群体中聚集，这突出了预防策略的目标。需要识别和监测高危人群，以便在孕前、孕期或出生后适时实施干预措施。这可以降低ID的可能性，并为弱势婴儿提供最佳机会。
系统评价注册
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=120032]，标识符[CRD42019120032]。
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