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与大气污染相关的孕产妇健康结局:系统评价和荟萃分析的伞式综述。

Maternal health outcomes associated with ambient air pollution: An umbrella review of systematic reviews and meta-analyses.

机构信息

Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN 38152, United States.

Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, United States.

出版信息

Sci Total Environ. 2024 Mar 1;914:169792. doi: 10.1016/j.scitotenv.2023.169792. Epub 2024 Jan 9.

Abstract

A growing body of literature demonstrated an association between exposure to ambient air pollution and maternal health outcomes with mixed findings. The objective of this umbrella review was to systematically summarize the global evidence on the effects of air pollutants on maternal health outcomes. We adopted the Joanna Briggs Institute (JBI) methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting standards for this umbrella review. We conducted a comprehensive search across six major electronic databases and other sources to identify relevant systematic reviews and meta-analyses (SRMAs) published from the inception of these databases up to June 30, 2023. Out of 2399 records, 20 citations matched all pre-determined eligibility criteria that include SRMAs focusing on exposure to air pollution and its impact on maternal health, reported quantitative measures or summary effects, and published in peer-reviewed journals in the English language. The risk of bias of included SRMAs was evaluated based on the JBI critical appraisal checklist. All SRMAs reported significant positive associations between ambient air pollution and several maternal health outcomes. Specifically, particulate matter (PM), SO, and NO demonstrated positive associations with gestational diabetes mellitus (GDM). Moreover, PM and NO showed a consistent positive relationship with hypertensive disorder of pregnancy (HDP) and preeclampsia (PE). Although limited, available evidence highlighted a positive correlation between PM and gestational hypertension (GH) and spontaneous abortion (SAB). Only one meta-analysis reported the effects of air pollution on maternal postpartum depression (PPD) where only PM showed a significant positive relationship. Limited studies were identified from low- and middle-income countries (LMICs), suggesting evidence gap from the global south. This review necessitates further research on underrepresented regions and communities to strengthen evidence on this critical issue. Lastly, interdisciplinary policymaking and multilevel interventions are needed to alleviate ambient air pollution and associated maternal health disparities.

摘要

越来越多的文献表明,暴露于环境空气污染与母婴健康结局之间存在关联,但研究结果存在差异。本综述的目的是系统总结全球关于空气污染物对母婴健康结局影响的证据。我们采用了 Joanna Briggs 研究所(JBI)的方法和系统评价和荟萃分析的首选报告项目(PRISMA)报告标准进行这项综述。我们在六个主要电子数据库和其他来源进行了全面检索,以确定从这些数据库创建到 2023 年 6 月 30 日发表的相关系统评价和荟萃分析(SRMA)。在 2399 条记录中,有 20 条引文符合所有预先确定的纳入标准,包括关注空气污染暴露及其对母婴健康影响的 SRMA、报告定量措施或汇总效应的 SRMA,以及发表在同行评议期刊上的英文 SRMA。纳入的 SRMA 的偏倚风险是根据 JBI 批判性评价清单进行评估的。所有的 SRMA 都报告了环境空气污染与几种母婴健康结局之间存在显著的正相关关系。具体而言,颗粒物(PM)、SO 和 NO 与妊娠期糖尿病(GDM)呈正相关。此外,PM 和 NO 与妊娠高血压疾病(HDP)和子痫前期(PE)呈一致的正相关关系。尽管证据有限,但现有的证据强调了 PM 与妊娠高血压(GH)和自然流产(SAB)之间存在正相关关系。只有一项荟萃分析报告了空气污染对产妇产后抑郁(PPD)的影响,其中只有 PM 显示出显著的正相关关系。从低中等收入国家(LMICs)中确定的研究有限,这表明全球南方存在证据空白。本综述需要对代表性不足的地区和社区进行进一步研究,以加强对这一关键问题的证据。最后,需要采取跨学科的决策和多层次的干预措施,以减轻环境空气污染和相关的母婴健康差距。

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