Institute of Population Research/China Center on Population Health and Development, Peking University, Beijing 100871, China.
Institute of Population Research/China Center on Population Health and Development, Peking University, Beijing 100871, China.
Environ Int. 2023 Aug;178:108043. doi: 10.1016/j.envint.2023.108043. Epub 2023 Jun 16.
Maternal pesticide exposure might be associated with adverse pregnancy outcomes through triggering inflammation and oxidative stress and disrupting endocrine functions. Yet the association between prenatal pesticide exposure and risk of preterm birth remains inconclusive.
To conduct a systematic review and meta-analysis of human observational studies using the Office of Health Assessment and Translation (OHAT) framework to explore the association of per ten-fold increase of pesticide concentrations in maternal biological samples during pregnancy with risk of preterm birth and length of gestational age at birth.
Five English (PubMed, Embase, Cochrane Library, Web of Science and Scopus) and 3 Chinese databases (China national knowledge infrastructure (CNKI), Wanfang Data, and Chinese Biomedical Literature Database (CBM)) were searched till Jan 18th, 2023.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: To be included, pesticide exposure should be measured in maternal biological samples during pregnancy and in log-transformed forms. The primary outcome was preterm birth and the secondary outcome was gestational age at birth.
STUDY APPRAISAL, SYNTHESIS METHODS AND CONFIDENCE ASSESSMENT: Quality of studies was evaluated using OHAT Risk of Bias Tool. Evidence was quantitatively synthesized with Correlated and Hierarchical Effects (CHE) model. The confidence rating in the body of evidence was done using OHAT.
A total of 21 studies reported by 18 papers were included, with 7 studies for preterm birth and 19 for gestational age at birth. The meta-analysis found a ten-fold increase of pesticide concentrations was potentially associated with risk of preterm birth (pooled OR = 1.28; 95%CI: 0.93, 1.78) and shortened gestational age at birth (β = -0.10; 95%CI: -0.21, 0.01). Sampling biospecimens in different trimesters was identified as a potential modifier in the association between pesticide exposure and length of gestational age (F = 2.77, P < 0.05). For studies that collected samples at any time during pregnancy, pesticide exposure was found to be associated with shortened length of gestational age (β = -0.43; 95%CI: -0.81, -0.06). The confidence rating in the body of evidence was "moderate" and "very low" for preterm birth and gestational age at birth, respectively.
Our result suggested moderate evidence of an association between pesticide exposure and higher risk of preterm birth. Yet more studies are still needed with larger sample size and careful considerations of confounders and accuracy of outcome measurements. Attention is also required on other pesticide compounds in addition to organochlorine and organophosphorus pesticides, and on windows of susceptibility.
母体农药暴露可能通过引发炎症和氧化应激以及破坏内分泌功能而导致不良妊娠结局。然而，产前农药暴露与早产风险之间的关联仍不明确。
使用健康评估和翻译办公室 (OHAT) 框架对人类观察性研究进行系统评价和荟萃分析，以探讨妊娠期间母体生物样本中农药浓度每增加十倍与早产风险和出生时妊娠年龄的关系。
2023 年 1 月 18 日之前，在五个英文数据库（PubMed、Embase、Cochrane 图书馆、Web of Science 和 Scopus）和三个中文数据库（中国知网 (CNKI)、万方数据和中国生物医学文献数据库 (CBM)）中进行了检索。
研究入选标准、参与者和干预措施：纳入标准为应在妊娠期间的母体生物样本中测量农药暴露，并以对数形式表示。主要结局是早产，次要结局是出生时的妊娠年龄。
研究评估、综合方法和置信度评估：使用 OHAT 风险偏倚工具评估研究质量。使用相关和分层效应 (CHE) 模型对证据进行定量综合。使用 OHAT 对证据进行置信度评级。
共有 18 篇论文报道了 21 项研究，其中 7 项研究早产，19 项研究出生时的妊娠年龄。荟萃分析发现，农药浓度增加十倍可能与早产风险相关（合并 OR=1.28；95%CI：0.93，1.78），并缩短出生时的妊娠年龄（β=-0.10；95%CI：-0.21，0.01）。研究发现，在与妊娠年龄的关系中，在不同孕期采集生物样本被认为是农药暴露的一个潜在调节因素（F=2.77，P<0.05）。对于在妊娠期间任何时间采集样本的研究，发现农药暴露与缩短妊娠年龄有关（β=-0.43；95%CI：-0.81，-0.06）。对早产和出生时的妊娠年龄，证据的置信度评级分别为“中度”和“非常低”。
我们的结果表明，农药暴露与更高的早产风险之间存在中度关联的证据。然而，仍需要更多的研究，这些研究需要更大的样本量，并仔细考虑混杂因素和结局测量的准确性。还需要关注除有机氯和有机磷农药以外的其他农药化合物，以及易感窗口期。
