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Abstract：
Introduction: Three recent systematic reviews suggested a relationship between noise exposure and adverse birth outcomes. The aim of this review was to evaluate the evidence for the World Health Organization (WHO) noise guidelines and conduct an updated systematic review of environmental noise, specifically aircraft and road traffic noise and birth outcomes, such as preterm birth, low birth weight, being small for gestational age and congenital malformations. Materials and methods: We reviewed again all the papers on environmental noise and birth outcomes included in the previous three systematic reviews and conducted a systematic search on noise and birth outcomes to update previous reviews. Web of Science, PubMed and Embase electronic databases were searched for papers published between June 2014 (end date of previous systematic review) and December 2016 using a list of specific search terms. Studies were also screened in the reference list of relevant reviews/articles. Further inclusion and exclusion criteria for the studies provided by the WHO expert group were applied. Risk of bias was assessed according to criteria from the Newcastle-Ottawa quality assessment scale for case-control and cohort studies. Finally, we applied the GRADE principles to our systematic review in a reproducible and appropriate way for judgment about quality of evidence. Results: In total, 14 studies are included in this review, six studies on aircraft noise and birth outcomes, five studies (two with more or less the same population) on road traffic noise and birth outcomes and three related studies on total ambient noise that is likely to be mostly traffic noise that met the criteria. The number of studies on environmental noise and birth outcomes is small and the quality of evidence generally ranges from very low to low, particularly in case of the older studies. The quality is better for the more recent traffic noise and birth outcomes studies. As there were too few studies, we did not conduct meta-analyses. Discussion: This systematic review is supported by previous systematic reviews and meta-analyses that suggested that there may be some suggestive evidence for an association between environmental noise exposure and birth outcomes, although they pointed more generally to a stronger role of occupational noise exposure, which tends to be higher and last longer. Very strict criteria for inclusion and exclusion of studies, performance of quality assessment for risk of bias, and finally applying GRADE principles for judgment of quality of evidence are the strengths of this review.
We found evidence of very low quality for associations between aircraft noise and preterm birth, low birth weight and congenital anomalies, and low quality evidence for an association between road traffic noise and low birth weight, preterm birth and small for gestational age. Further high quality studies are required to establish such associations. Future studies are recommended to apply robust exposure assessment methods (e.g., modeled or measured noise levels at bedroom façade), disentangle associations for different sources of noise as well as daytime and nighttime noise, evaluate the impacts of noise evens (that stand out of the noise background), and control the analyses for confounding factors, such as socioeconomic status, lifestyle factors and other environmental factors, especially air pollution.
We found evidence of very low quality for associations between aircraft noise and preterm birth, low birth weight and congenital anomalies, and low quality evidence for an association between road traffic noise and low birth weight, preterm birth and small for gestational age. Further high quality studies are required to establish such associations. Future studies are recommended to apply robust exposure assessment methods (e.g., modeled or measured noise levels at bedroom façade), disentangle associations for different sources of noise as well as daytime and nighttime noise, evaluate the impacts of noise evens (that stand out of the noise background), and control the analyses for confounding factors, such as socioeconomic status, lifestyle factors and other environmental factors, especially air pollution.
摘要：
简介：最近的三项系统评价表明，噪声暴露与不良分娩结局之间存在关系。这项审查的目的是评估世界卫生组织（WHO）噪声准则的证据，并对环境噪声进行最新的系统审查，特别是飞机和道路交通噪音和出生结果，比如早产,低出生体重,小于胎龄和先天性畸形。材料和方法：我们再次回顾了前三个系统综述中有关环境噪声和出生结局的所有论文，并对噪声和出生结局进行了系统搜索，以更新以前的评论。WebofScience,使用特定搜索词列表搜索PubMed和Embase电子数据库，查找2014年6月（先前系统评价的结束日期）至2016年12月之间发表的论文。研究也在相关评论/文章的参考列表中进行了筛选。采用了世卫组织专家组提供的研究的进一步纳入和排除标准。根据病例对照和队列研究的纽卡斯尔-渥太华质量评估量表的标准评估偏倚风险。最后,我们以可重复且适当的方式将GRADE原则应用于我们的系统综述,以判断证据质量.结果：总的来说，本综述包括14项研究，六项关于飞机噪音和出生结果的研究，五项关于道路交通噪声和出生结果的研究(两项具有或多或少相同的人口)，以及三项关于总环境噪声的相关研究，这些噪声可能主要是符合标准的交通噪声。关于环境噪声和出生结局的研究数量很少，证据质量通常从非常低到低，特别是在较老的研究的情况下。对于最近的交通噪音和出生结果研究，质量更好。因为研究太少,我们没有进行荟萃分析.讨论：本系统评价得到了以前的系统评价和荟萃分析的支持，这些系统评价和荟萃分析表明，环境噪声暴露与出生结局之间可能存在一些暗示性证据。尽管他们更普遍地指出了职业噪声暴露的更强作用，往往更高，持续时间更长。纳入和排除研究的标准非常严格，对偏差风险的质量评估的执行情况，最后应用GRADE原则判断证据质量是本综述的优势所在。
我们发现有证据表明飞机噪音和早产之间的关联质量非常低，低出生体重和先天性异常，以及道路交通噪音和低出生体重之间关联的低质量证据，早产和小于胎龄。需要进一步的高质量研究来建立这种关联。建议未来的研究应用稳健的暴露评估方法(例如，建模或测量卧室立面的噪音水平)，区分不同噪声源以及白天和夜间噪声的关联，评估噪声均匀性的影响(从噪声背景中脱颖而出)，并控制对混杂因素的分析，比如社会经济地位，生活方式因素和其他环境因素，尤其是空气污染。
我们发现有证据表明飞机噪音和早产之间的关联质量非常低，低出生体重和先天性异常，以及道路交通噪音和低出生体重之间关联的低质量证据，早产和小于胎龄。需要进一步的高质量研究来建立这种关联。建议未来的研究应用稳健的暴露评估方法(例如，建模或测量卧室立面的噪音水平)，区分不同噪声源以及白天和夜间噪声的关联，评估噪声均匀性的影响(从噪声背景中脱颖而出)，并控制对混杂因素的分析，比如社会经济地位，生活方式因素和其他环境因素，尤其是空气污染。
