Abstract：
BACKGROUND: Prenatal exposure to metal mixtures is associated with adverse pregnancy and birth outcomes like low birth weight, preterm birth, and small for gestational age. However, prior studies have used individual metal analysis, lacking real-life exposure scenarios.
OBJECTIVE: This systematic review aims to evaluate the strength and consistency of the association between metal mixtures and pregnancy and birth outcomes, identify research gaps, and inform future studies and policies in this area.
METHODS: The review adhered to the updated Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) checklist, along with the guidelines for conducting systematic reviews and meta-analyses of observational studies of etiology (COSMOS-E). Our data collection involved searching the PubMed, MEDLINE, and SCOPUS databases. We utilized inclusion criteria to identify relevant studies. These chosen studies underwent thorough screening and data extraction procedures. Methodological quality evaluations were conducted using the NOS framework for cohort and case-control studies, and the AXIS tool for cross-sectional studies.
RESULTS: The review included 34 epidemiological studies, half of which focused on birth weight, and the others investigated neonate size, preterm birth, small for gestational age, miscarriage, and placental characteristics. The findings revealed significant associations between metal mixtures (including mercury (Hg), nickel (Ni), arsenic (As), cadmium (Cd), manganese (Mn), cobalt (Co), lead (Pb), zinc (Zn), barium (Ba), cesium (Cs), copper (Cu), selenium (Se), and chromium (Cr)) and adverse pregnancy and birth outcomes, demonstrating diverse effects and potential interactions.
CONCLUSIONS: In conclusion, this review consistently establishes connections between metal exposure during pregnancy and adverse consequences for birth weight, gestational age, and other vital birth-related metrics. This review further demonstrates the need to apply mixture methods with caution but also shows that they can be superior to traditional approaches. Further research is warranted to deeper understand the underlying mechanisms and to develop effective strategies for mitigating the potential risks associated with metal mixture exposure during pregnancy.
OBJECTIVE: This systematic review aims to evaluate the strength and consistency of the association between metal mixtures and pregnancy and birth outcomes, identify research gaps, and inform future studies and policies in this area.
METHODS: The review adhered to the updated Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) checklist, along with the guidelines for conducting systematic reviews and meta-analyses of observational studies of etiology (COSMOS-E). Our data collection involved searching the PubMed, MEDLINE, and SCOPUS databases. We utilized inclusion criteria to identify relevant studies. These chosen studies underwent thorough screening and data extraction procedures. Methodological quality evaluations were conducted using the NOS framework for cohort and case-control studies, and the AXIS tool for cross-sectional studies.
RESULTS: The review included 34 epidemiological studies, half of which focused on birth weight, and the others investigated neonate size, preterm birth, small for gestational age, miscarriage, and placental characteristics. The findings revealed significant associations between metal mixtures (including mercury (Hg), nickel (Ni), arsenic (As), cadmium (Cd), manganese (Mn), cobalt (Co), lead (Pb), zinc (Zn), barium (Ba), cesium (Cs), copper (Cu), selenium (Se), and chromium (Cr)) and adverse pregnancy and birth outcomes, demonstrating diverse effects and potential interactions.
CONCLUSIONS: In conclusion, this review consistently establishes connections between metal exposure during pregnancy and adverse consequences for birth weight, gestational age, and other vital birth-related metrics. This review further demonstrates the need to apply mixture methods with caution but also shows that they can be superior to traditional approaches. Further research is warranted to deeper understand the underlying mechanisms and to develop effective strategies for mitigating the potential risks associated with metal mixture exposure during pregnancy.
摘要：
背景：产前接触金属混合物与不良妊娠和低出生体重等出生结局有关，早产,而且小于胎龄。然而,先前的研究使用了单个金属分析，缺乏现实生活中的曝光场景。
目的：本系统综述旨在评估金属混合物与妊娠和分娩结局之间关联的强度和一致性，确定研究差距，并为该领域未来的研究和政策提供信息。
方法：审查遵循更新的系统审查和荟萃分析（PRISMA）清单的首选报告项目，以及进行病因学观察性研究的系统评价和荟萃分析的指南（COSMOS-E）。我们的数据收集涉及搜索PubMed，MEDLINE,和SCOPUS数据库。我们利用纳入标准来确定相关研究。这些选择的研究进行了彻底的筛选和数据提取程序。方法学质量评价使用NOS框架进行队列和病例对照研究，以及用于横断面研究的AXIS工具。
结果：该综述包括34项流行病学研究，其中一半集中在出生体重上，其他人调查了新生儿的大小，早产,小于胎龄，流产,和胎盘特征。研究结果表明，金属混合物(包括汞(Hg)，镍(Ni),砷（As），镉(Cd),锰(Mn),钴(Co),铅(Pb),锌(Zn),钡(Ba),铯（Cs），铜(Cu),硒(Se),和铬（Cr））以及不良妊娠和分娩结局，展示不同的影响和潜在的相互作用。
结论：结论：这篇综述一致地确立了怀孕期间金属暴露与出生体重不良后果之间的联系，胎龄,和其他重要的出生相关指标。这篇综述进一步证明了谨慎应用混合方法的必要性，但也表明它们可以优于传统方法。有必要进行进一步的研究，以更深入地了解潜在的机制，并制定有效的策略来减轻怀孕期间与金属混合物接触相关的潜在风险。
目的：本系统综述旨在评估金属混合物与妊娠和分娩结局之间关联的强度和一致性，确定研究差距，并为该领域未来的研究和政策提供信息。
方法：审查遵循更新的系统审查和荟萃分析（PRISMA）清单的首选报告项目，以及进行病因学观察性研究的系统评价和荟萃分析的指南（COSMOS-E）。我们的数据收集涉及搜索PubMed，MEDLINE,和SCOPUS数据库。我们利用纳入标准来确定相关研究。这些选择的研究进行了彻底的筛选和数据提取程序。方法学质量评价使用NOS框架进行队列和病例对照研究，以及用于横断面研究的AXIS工具。
结果：该综述包括34项流行病学研究，其中一半集中在出生体重上，其他人调查了新生儿的大小，早产,小于胎龄，流产,和胎盘特征。研究结果表明，金属混合物(包括汞(Hg)，镍(Ni),砷（As），镉(Cd),锰(Mn),钴(Co),铅(Pb),锌(Zn),钡(Ba),铯（Cs），铜(Cu),硒(Se),和铬（Cr））以及不良妊娠和分娩结局，展示不同的影响和潜在的相互作用。
结论：结论：这篇综述一致地确立了怀孕期间金属暴露与出生体重不良后果之间的联系，胎龄,和其他重要的出生相关指标。这篇综述进一步证明了谨慎应用混合方法的必要性，但也表明它们可以优于传统方法。有必要进行进一步的研究，以更深入地了解潜在的机制，并制定有效的策略来减轻怀孕期间与金属混合物接触相关的潜在风险。
