Wang Meng, Jiang Xian Chen, Lai Shi Ming, Gan Zhi Juan, Wang Jin Na, Zhan Bing Dong
Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou City, China.
Department of NCDs Control and Prevention, Quzhou Center for Disease Control and Prevention, Quzhou City, China.
J Matern Fetal Neonatal Med. 2023 Dec;36(2):2279021. doi: 10.1080/14767058.2023.2279021. Epub 2023 Nov 9.
Multiple factors associated with neural tube defects (NTDs) risk have been identified, yet there is little evidence on the possible effects of maternal stressful life events. In this study, we aimed to investigate the association between stressful life events during the periconceptional period and risk of NTDs in offspring.
Relevant literature was searched in PubMed, Springer Link, ScienceDirect, and Cochrane Library up to July 2023. The pooled odds ratio (OR) and 95% confidence interval (CI) of NTDs risk with maternal stressful life events were estimated using a random effects model. Publication bias was assessed using Egger's regression asymmetry test and Begg's rank correlation test with Begg's funnel plot.
Analysis results showed that mothers who experienced stressful life events during the periconceptional period were at greater risk of having NTDs offspring (OR: 1.37, 95% CI: 1.08-1.73) than those who did not. In subgroup analysis, the pooled OR was 1.37 (1.13-1.67) and 1.73 (0.36-8.32) for with and without adjusting for folic acid supplementation in each included study, while was 1.37 (1.13-1.67) and 1.64 (0.39-6.88) for exposure time of three months preconception until three months post conception and one year preconception until three months post conception, respectively.
This study suggests that maternal stressful life events during the periconceptional period are significantly associated with higher NTDs risk in offspring. Tailored approaches for evaluating the risk and policy of NTDs among women of childbearing age should emphasize individual stressful experiences before and during early pregnancy.
已确定了多种与神经管缺陷（NTDs）风险相关的因素，但关于孕产妇应激性生活事件可能产生的影响，证据却很少。在本研究中，我们旨在调查受孕前后期间应激性生活事件与后代神经管缺陷风险之间的关联。
截至2023年7月，在PubMed、Springer Link、ScienceDirect和Cochrane图书馆中检索相关文献。使用随机效应模型估计孕产妇应激性生活事件导致神经管缺陷风险的合并优势比（OR）和95%置信区间（CI）。使用Egger回归不对称检验和Begg秩相关检验以及Begg漏斗图评估发表偏倚。
分析结果显示，在受孕前后期间经历应激性生活事件的母亲，其后代患神经管缺陷的风险（OR：1.37，95%CI：1.08 - 1.73）高于未经历此类事件的母亲。在亚组分析中，每项纳入研究中，调整叶酸补充剂与否时，合并OR分别为1.37（1.13 - 1.67）和1.73（0.36 - 8.32）；对于受孕前三个月至受孕后三个月以及受孕前一年至受孕后三个月的暴露时间，合并OR分别为1.37（1.13 - 1.67）和1.64（0.39 - 6.88）。
本研究表明，受孕前后期间孕产妇应激性生活事件与后代神经管缺陷风险显著相关。针对育龄妇女评估神经管缺陷风险和制定相关政策的定制方法，应强调怀孕早期之前及期间的个体应激经历。
