母体孕期砷暴露与后代先天性心脏病关系的Meta分析

Relationship between maternal arsenic exposure during pregnancy and congenital heart disease in offspring:A meta-analysis

目的系统评价母体孕期砷暴露与后代先天性心脏病(CHD)的关系。方法通过PubMed、Web of Science、Embase、中国知网、万方数据知识服务平台、维普网等数据库进行文献检索,将国内外发表的母体孕期砷暴露与后代CHD关系的流行病学文献纳入研究,检索时间从数据库建库至2022年11月2日。采用Stata MP15软件进行二分类变量的Meta分析,用I 2统计量和Q检验进行异质性检验,根据检验结果选择固定效应模型或随机效应模型。以OR值(95%CI)作为效应评价指标,并根据CHD亚型[圆锥动脉干畸形(CTD)、房室间隔缺损(AVSD)、全肺静脉回流异常(TAPVR)、左室流出道阻塞(LVOTO)、右室流出道梗阻(RVOTO)、房间隔缺损(ASD)/室间隔缺损(VSD)、动脉导管未闭(PDA)]进行亚组分析。结果最终纳入9篇文献,包括2篇中文文献、7篇英文文献。其中,以CHD为结局的有8篇,以ASD/VSD为结局的有5篇,以CTD为结局的有4篇,以LVOTO为结局的有3篇,以PDA为结局的有2篇,以RVOTO为结局的有1篇。对以CHD为结局的8篇文献进行分析,经异质性检验,I 2=88.5%且P<0.001,存在显著异质性,采用随机效应模型进行Meta分析,合并OR值(95%CI)为1.51(1.40~1.62)。CHD亚组分析结果显示,ASD/VSD、CTD、LVOTO、PDA、RVOTO的合并OR值(95%CI)分别为1.68(1.53~1.84)、1.64(1.29~2.09)、2.89(1.82~4.61)、1.78(1.53~2.08)、0.81(0.64~1.03)。结论母体孕期砷暴露与后代CHD的发生相关,其中ASD/VSD、CTD、LVOTO、PDA为后代CHD的常见病变。

Objective To systematically evaluate the correlation between maternal arsenic exposure during pregnancy and congenital heart disease(CHD)in offspring.Methods Literature search was performed through databases such as PubMed,Web of Science,Embase,China National Knowledge Infrastructure,Wanfang Data Knowledge Service Platform,and VIP.com to include epidemiological literature on association between maternal arsenic exposure during pregnancy and offspring CHD published domestically and internationally.The search was conducted from database establishment until November 2,2022.Stata MP15 software was used for meta-analysis of binary variables,and I 2 statistics and Q test were used for heterogeneity test,fixed effect model or random effect model was selected based on the test results.Using OR value(95%CI)as the effect evaluation indicator,subgroup analysis was conducted based on CHD subtypes[conotruncal defects(CTD),atrioventricular septal defect(AVSD),total anomalous pulmonary venous return(TAPVR),left ventricular outflow tract obstruction(LVOTO),right ventricular outflow tract obstruction(RVOTO),atrial septal defect(ASD)/ventricular septal defect(VSD),and patent ductus arteriosus(PDA)].Results Nine articles were finally included,including two Chinese and seven English articles.Among them,8 articles had CHD as the outcome,5 articles had ASD/VSD as the outcome,4 articles had CTD as the outcome,3 articles had LVOTO as the outcome,2 articles had PDA as the outcome,and 1 article had RVOTO as the outcome.An analysis was conducted on 8 articles with CHD as the outcome.After heterogeneity testing,I 2=88.5%and P<0.001,indicating significant heterogeneity.A random effect model was used for meta-analysis,and the combined OR value(95%CI)was 1.51(1.40-1.62).The results of CHD subgroup analysis showed that the combined OR values(95%CI)for ASD/VSD,CTD,LVOTO,PDA,and RVOTO were 1.68(1.53-1.84),1.64(1.29-2.09),2.89(1.82-4.61),1.78(1.53-2.08),and 0.81(0.64-1.03),respectively.Conclusion Maternal arsenic exposure during pregnancy is associated with development of offspring CHD,including ASD/VSD,CTD,LVOTO,and PDA as the common lesions in offspring CHD.