Kinshella Mai-Lei Woo, Pickerill Kelly, Prasad Sarina, Campbell Olivia, Devji Jalila, Lopes Lívia Vieira, Balleny Rosa, Elawad Terteel, Craik Rachel, Volvert Marie-Laure, Mistry Hiten D, Blencowe Hannah, Filippi Véronique, von Dadelszen Peter, Magee Laura A, Vidler Marianne
Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Department of Women and Children's Health, School of Life Course and Population Sciences, Kings College London, London, UK.
BJOG. 2025 Feb 19. doi: 10.1111/1471-0528.18082.
Existing reviews of pre-eclampsia determinants have focused on clinical and genetic risk factors.
To evaluate social determinants for pre-eclampsia prevention.
Systematic searches were conducted from relevant electronic databases from inception of each database to 30th December 2024.
Reviews and large cohort studies (≥ 1000 participants), published between 2013 and 2024, reporting quantitative associations between social determinant exposures and pre-eclampsia outcomes.
Titles and abstracts, then relevant full-texts were reviewed by two reviewers, independently. Strength of association was evaluated as 'definite' (odds ratios [OR] or relative risk [RR] ≥ 3.00 or < 0.33), 'probable' (OR or RR 1.50-2.99 or 0.33-0.67), 'possible' (OR or RR 1.10-1.49 or 0.68-0.89), or 'unlikely' (OR or RR 0.90-1.09). Quality of the evidence was high, moderate, low, or very-low, using GRADE.
Twenty-seven publications found 24 associations of pre-eclampsia with socioeconomic status, social support/exclusion, healthcare access, and occupational and physical environmental factors. One association (polygamy) was definite (low-quality evidence). Probable associations included: work stress, lack of antenatal care and heat exposure in early pregnancy (high-quality evidence); prolonged occupational exposure to whole body vibrations or bending, distance to health facility, and UV-B radiation exposure (protective factor), all based on moderate-quality evidence; and neighbourhood deprivation, rotating work shifts, and Asian/Oceanian origins (protective factor), all based on low-quality evidence. There were 13 possible associations, which did not include education.
Our findings support recommendations to address climate change, strengthen occupational protection, and promote early antenatal attendance. Social determinants may be indicative of upstream factors (e.g., obesity) that increase likelihood of clinical risk factors for pre-eclampsia incidence and severity.
现有关于子痫前期决定因素的综述主要集中在临床和遗传风险因素上。
评估子痫前期预防的社会决定因素。
从各数据库建库起至2024年12月31日，对相关电子数据库进行系统检索。
2013年至2024年发表的综述和大型队列研究（≥1000名参与者），报告社会决定因素暴露与子痫前期结局之间的定量关联。
两名评审员独立审查标题和摘要，然后审查相关全文。关联强度评估为“确定”（比值比[OR]或相对风险[RR]≥3.00或<0.33）、“很可能”（OR或RR 1.50 - 2.99或0.33 - 0.67）、“可能”（OR或RR 1.10 - 1.49或0.68 - 0.89）或“不太可能”（OR或RR 0.90 - 1.09）。使用GRADE评估证据质量为高、中、低或极低。
27篇出版物发现子痫前期与社会经济地位、社会支持/排斥、医疗保健可及性以及职业和物理环境因素存在24种关联。一种关联（一夫多妻制）是确定的（低质量证据）。很可能的关联包括：工作压力、缺乏产前护理和孕早期受热暴露（高质量证据）；长期职业暴露于全身振动或弯腰、与医疗机构的距离以及UV - B辐射暴露（保护因素），均基于中等质量证据；以及社区贫困、轮班工作和亚洲/大洋洲血统（保护因素），均基于低质量证据。有13种可能的关联，其中不包括教育。
我们的研究结果支持应对气候变化、加强职业保护和促进早期产前检查的建议。社会决定因素可能表明上游因素（如肥胖），这些因素增加了子痫前期发病和严重程度的临床风险因素的可能性。
