Department of Biological Sciences, Simon Fraser University, Burnaby, BC, Canada.
Centre for Cell Biology, Development and Disease, Simon Fraser University, Burnaby, BC, Canada.
Biol Sex Differ. 2023 Jul 11;14(1):47. doi: 10.1186/s13293-023-00532-9.
Premature birth and/or low birthweight have long-lasting effects on cognition. The purpose of the present systematic review is to examine whether the effects of prematurity and/or low birth weight on neurodevelopmental outcomes differ between males and females.
Web of Science, Scopus, and Ovid MEDLINE were searched for studies of humans born premature and/or of low birthweight, where neurodevelopmental phenotypes were measured at 1 year of age or older. Studies must have reported outcomes in such a way that it was possible to assess whether effects were greater in one sex than the other. Risk of bias was assessed using both the Newcastle-Ottawa scale and the National Institutes of Health Quality assessment tool for observational cohort and cross-sectional studies.
Seventy-five studies were included for descriptive synthesis, although only 24 presented data in a way that could be extracted for meta-analyses. Meta-analyses found that severe and moderate prematurity/low birthweight impaired cognitive function, and severe prematurity/low birthweight also increased internalizing problem scores. Moderate, but not severe, prematurity/low birthweight significantly increased externalizing problem scores. In no case did effects of prematurity/low birthweight differ between males and females. Heterogeneity among studies was generally high and significant, although age at assessment was not a significant moderator of effect. Descriptive synthesis did not identify an obvious excess or deficiency of male-biased or female-biased effects for any trait category. Individual study quality was generally good, and we found no evidence of publication bias.
We found no evidence that the sexes differ in their susceptibility to the effects of severe or moderate prematurity/low birthweight on cognitive function, internalizing traits or externalizing traits. Result heterogeneity tended to be high, but this reflects that one sex is not consistently more affected than the other. Frequently stated generalizations that one sex is more susceptible to prenatal adversity should be re-evaluated.
早产和/或低出生体重对认知有持久影响。本系统评价的目的是检验早产儿和/或低出生体重对神经发育结局的影响是否因性别而异。
在 Web of Science、Scopus 和 Ovid MEDLINE 上搜索人类早产和/或低出生体重的研究，其中神经发育表型在 1 岁或以上时进行测量。研究必须报告了这样的结果，即可以评估性别对结果的影响是否更大。使用纽卡斯尔-渥太华量表和美国国立卫生研究院对观察性队列和横断面研究的质量评估工具来评估偏倚风险。
有 75 项研究被纳入描述性综合分析，尽管只有 24 项研究以可以进行荟萃分析的方式提供了数据。荟萃分析发现，严重和中度早产/低出生体重会损害认知功能，严重早产/低出生体重也会增加内化问题评分。中度但不是严重的早产/低出生体重显著增加了外化问题评分。在任何情况下，早产/低出生体重的影响在男性和女性之间都没有差异。研究之间的异质性通常很高且显著，尽管评估时的年龄不是影响的显著调节因素。描述性综合分析并未发现任何特征类别存在明显的男性偏向或女性偏向效应的过剩或不足。个别研究质量普遍较好，且我们未发现发表偏倚的证据。
我们没有发现证据表明，在严重或中度早产/低出生体重对认知功能、内化特征或外化特征的影响方面，性别存在差异。结果的异质性往往较高，但这反映了一种性别并非始终比另一种性别受到更大的影响。经常提到的一种性别比另一种性别更容易受到产前逆境影响的一般性观点应重新评估。
