Association between Maternal Exposure to Arsenic during  Pregnancy and Risk of Preterm Birth: A Systematic Review and Meta-Analysis

Yanwen  Ding; Yuxin  Xu; Xiujuan  Tan; Mohammad  Alizadeh; Hamzeh Alizadeh

doi:10.18502/ijph.v53i4.15553

Yanwen Ding Outpatient Surgical Center, Zibo First Hospital, Zibo, 255200, China
Yuxin Xu Department of Endocrinology, Zibo First Hospital, Zibo, 255200, China
Xiujuan Tan Department of Intervention Chemotherapy, Zibo First Hospital, Zibo, 255200, China
Mohammad Alizadeh Department of Medical Surgical Nursing, Nasibeh Nursing & Midwifery School, Mazandaran University of Medical Sciences, Sari, Iran
Hamzeh Alizadeh Genetics Research Center, Department of Genetics and Breeding, the University of Guilan, Rasht, Iran

DOI: https://doi.org/10.18502/ijph.v53i4.15553

Keywords: Arsenic; Preterm birth; Pregnancy; Meta-analysis

Abstract

Background: Several observational studies have suggested that maternal exposure during pregnancy to arsenic is associated with the risk of preterm birth (PTB); however, available evidence is inconsistent. Therefore, we aimed to explore the relation of maternal exposure to arsenic to PTB risk.

Methods: A comprehensive systematic search was carried out from inception to April 2023 in PubMed and Scopus to retrieve all relevant studies. A pooled odds ratio (OR) with corresponding 95% confidence interval (CI) was employed using a random effects model to test the association.

Results: As a result, 14 eligible studies, with 12,619 participants, were included in the meta-analysis. Overall, the pooled OR of all analyzed studies indicated that higher maternal arsenic exposure is significantly related to the 1.12-fold increased odds of PTB (OR = 1.12, 95% CI = 1.04-1.21), with a remarkable heterogeneity across studies (P = <0.001, I²= 70.9%). This association was found in prospective cohort studies (OR = 1.15, 95% CI = 1.05-1.26), but not in non-cohort studies. In the stratified analysis, the majority of subgroups supported the association of arsenic with PTB.

Conclusion: Maternal exposure to arsenic during pregnancy is directly linked to the odds of PTB. Future studies are suggested to investigate the effectiveness of specific measures to decrease exposure to arsenic in high-risk communities, particularly in pregnant women.