产前暴露于环境空气污染物与先天性心脏缺陷：伞式综述。
Prenatal exposure to ambient air pollutants and congenital heart defects: An umbrella review.
机构信息
Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA.
Department of Molecular, Cell, and Developmental Biology, University of California, Los Angeles, Los Angeles, California, USA.
出版信息
Environ Int. 2023 Aug;178:108076. doi: 10.1016/j.envint.2023.108076. Epub 2023 Jun 30.
BACKGROUND
Prenatal exposure to ambient air pollutants has been linked to congenital heart defects (CHD), but findings of existing systematic reviews have been mixed.
OBJECTIVE
To assess the epidemiological evidence on associations between prenatal exposure to ambient air pollutants and CHD subtypes, based on a systematic overview of reviews ("umbrella review").
METHODS
We conducted a systematic search for reviews assessing associations between prenatal exposure to criteria air pollutants and CHD. The risk of bias was evaluated using the Risk of Bias in Systematic Reviews (ROBIS) tool. The certainty of the systematic review findings was graded using the Navigation Guide methodology.
RESULTS
We identified eleven systematic reviews, including eight with meta-analyses, assessing in total 35 primary studies of prenatal exposure to criteria air pollutants and various CHD subtypes. The certainty of the findings of four meta-analyses indicating an increased risk for coarctation of the aorta associated with nitrogen dioxide exposure was rated as moderate. The certainty of findings indicating positive, inverse, or null associations for other pollutant-subtype combinations was rated as very low to low, based on low precision and high statistical heterogeneity of summary odds ratios (SOR), substantial inconsistencies between review findings, and methodological limitations of the systematic reviews.
DISCUSSION
The inconsistent findings and high statistical heterogeneity of many SOR of the included systematic reviews may partly be traced to differences in methodological approaches, and the risk of bias across included reviews (e.g., inclusion criteria, systematic search strategies, synthesis methods) and primary studies (e.g., exposure assessment, diagnostic criteria). Adherence to appropriate systematic review guidelines for environmental health research, as well as rigorous evaluation of risk of bias in primary studies, are essential for future risk assessments and policy-making. Still, our findings suggest that prenatal exposure to ambient air pollutants may increase risks for at least some CHD subtypes.
背景
产前暴露于环境空气污染物与先天性心脏病（CHD）有关，但现有系统评价的结果存在差异。
目的
基于系统综述的综述（“伞式综述”），评估产前暴露于环境空气污染物与 CHD 亚型之间关联的流行病学证据。
方法
我们系统地搜索了评估产前暴露于标准空气污染物与 CHD 之间关联的综述。使用系统评价中的偏倚风险（ROBIS）工具评估偏倚风险。使用导航指南方法对系统综述结果的确定性进行分级。
结果
我们确定了 11 篇系统综述，其中 8 篇进行了荟萃分析，总共评估了 35 项关于产前暴露于标准空气污染物和各种 CHD 亚型的原始研究。四项荟萃分析表明，二氧化氮暴露与主动脉缩窄风险增加之间存在关联，其结果的确定性被评为中度。基于汇总优势比（SOR）的精度低和统计异质性高、综述结果之间存在实质性差异以及系统综述方法学局限性，指示其他污染物-亚型组合存在阳性、反向或无关联的四项荟萃分析结果的确定性被评为非常低至低。
讨论
纳入的系统综述中许多 SOR 的不一致发现和高统计异质性可能部分归因于方法学方法的差异，以及纳入的综述（例如，纳入标准、系统搜索策略、综合方法）和原始研究（例如，暴露评估、诊断标准）之间的偏倚风险。为了进行未来的风险评估和决策，遵守环境健康研究的适当系统综述指南以及对原始研究的偏倚风险进行严格评估至关重要。尽管如此，我们的研究结果表明，产前暴露于环境空气污染物可能会增加至少某些 CHD 亚型的风险。
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