Jiang Jing, Zuo Xuan, An Songlin, Yang Jing, Wu Linfei, Zeng Rong, Hu Qiongdan, Fan Lu, Wang Haiyu, Yang Chuanwu, Liang Yihan, Zhou Yuanzhong, Pan Hong, Xie Yan
School of Public Health, Zunyi Medical University, Zunyi, China.
Key Laboratory of Maternal & Child Health and Exposure Science of Guizhou Higher Education Institutes, Zunyi, China.
PLoS One. 2025 Jun 2;20(6):e0320603. doi: 10.1371/journal.pone.0320603. eCollection 2025.
Several observational studies have explored the link between arsenic (As) exposure and intrauterine growth restriction (IUGR). However, epidemiological findings have been inconsistent, with a wide range of reported heterogeneity. This study aims to systematically evaluate the association between As exposure and IUGR (SGA(Small for gestational age), PTB(Preterm birth), LBW(Preterm birth)) through a meta-analysis. We searched six databases-China National Knowledge Infrastructure, Wan Fang, VIP Database, PubMed, Web of Science, and Science Direct-for studies on As exposure and IUGR up to May 2024. After screening and data extraction, a comprehensive bias risk assessment was conducted using the Newcastle-Ottawa Scale (NOS), AHRQ (the assessment tool of the Agency for Healthcare Research and Quality), and NTP/OHAT (the assessment tool of the National Toxicology Program/Office of Health Assessment and Translation). Meta-analysis was conducted using random-effects models (I2 > 50%) or fixed-effects models (I2 < 50%) to estimate effect sizes. Subgroup analysis and meta-regression analysis were performed to identify the sources of heterogeneity. Publication bias was assessed using the Egger test, Begg test, and funnel plot. Eleven studies, including 2,183,652 participants from the Americas, Europe, Asia, and Africa, were analyzed. Results showed a significant association between As exposure and SGA (OR: 1.06, 95% CI: 1.00, 1.13), particularly in Asia (OR: 1.28, 95% CI: 1.10, 1.49). Maternal exposure to higher As levels (10-100 μg/L) was also significantly associated with SGA (OR: 1.25, 95% CI: 1.04, 1.50). Although PTB (OR: 1.03, 95% CI: 0.99, 1.07) and LBW (OR: 1.03, 95% CI: 0.97, 1.09) did not show overall significant associations, subgroup analyses revealed increased risks under specific conditions. As exposure at 1-10 μg/L significantly increased PTB risk (OR: 1.13, 95% CI: 1.06, 1.21), while exposure at 0-1 μg/L significantly increased LBW risk (OR: 1.13, 95% CI: 1.06, 1.21). This study supports a link between As exposure and increased IUGR risk, particularly SGA. Stricter public health policies are needed to reduce arsenic exposure during pregnancy. However, due to heterogeneity and potential publication bias, results should be interpreted with caution.
多项观察性研究探讨了砷（As）暴露与宫内生长受限（IUGR）之间的联系。然而，流行病学研究结果并不一致，报道的异质性范围很广。本研究旨在通过荟萃分析系统评估砷暴露与IUGR（小于胎龄儿（SGA）、早产（PTB）、低出生体重（LBW））之间的关联。我们检索了六个数据库——中国知网、万方、维普数据库、PubMed、Web of Science和Science Direct——以查找截至2024年5月关于砷暴露与IUGR的研究。在筛选和数据提取后，使用纽卡斯尔-渥太华量表（NOS）、美国医疗保健研究与质量局评估工具（AHRQ）以及美国国家毒理学计划/健康评估与转化办公室评估工具（NTP/OHAT）进行了全面的偏倚风险评估。使用随机效应模型（I2>50%）或固定效应模型（I2<50%）进行荟萃分析以估计效应大小。进行亚组分析和荟萃回归分析以确定异质性来源。使用Egger检验、Begg检验和漏斗图评估发表偏倚。分析了11项研究，包括来自美洲、欧洲、亚洲和非洲的2183652名参与者。结果显示砷暴露与小于胎龄儿之间存在显著关联（比值比：1.06，95%置信区间：1.00，1.13），特别是在亚洲（比值比：1.28，95%置信区间：1.10，1.49）。母亲暴露于较高水平的砷（10 - 100μg/L）也与小于胎龄儿显著相关（比值比：1.25，95%置信区间：1.04，1.50）。虽然早产（比值比：1.03，95%置信区间：0.99，1.07）和低出生体重（比值比：1.03，95%置信区间：0.97，1.09）总体上未显示出显著关联，但亚组分析揭示了在特定条件下风险增加。1 - 10μg/L的砷暴露显著增加早产风险（比值比：1.13，95%置信区间：1.06，1.21），而0 - 1μg/L的暴露显著增加低出生体重风险（比值比：1.13，95%置信区间：1.06，1.21）。本研究支持砷暴露与宫内生长受限风险增加之间的联系，特别是小于胎龄儿。需要更严格的公共卫生政策来减少孕期砷暴露。然而，由于异质性和潜在的发表偏倚，结果应谨慎解释。
