The relationship between cadmium exposure and preeclampsia: a systematic review and meta-analysis

Chu Li; Jiamin Luo; Yunping Yang; Qianqian Wang; Yanmei Zheng; Zixing Zhong

doi:10.3389/fmed.2023.1259680

The relationship between cadmium exposure and preeclampsia: a systematic review and meta-analysis

Front Med (Lausanne). 2023 Dec 1:10:1259680. doi: 10.3389/fmed.2023.1259680. eCollection 2023.

Authors

Chu Li^{1

2}, Jiamin Luo³, Yunping Yang^{1

2}, Qianqian Wang¹, Yanmei Zheng¹, Zixing Zhong¹

Affiliations

¹ Department of Obstetrics, Center for Reproductive Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Zhejiang, China.
² The Second Clinical College of Zhejiang Chinese Medical University, Hangzhou, China.
³ Department of Ultrasound Medicine, Center for Reproductive Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Zhejiang, China.

Abstract

Background: Cadmium (Cd) is a heavy metal associated with several human disorders. Preeclampsia is a major cause of maternal mortality worldwide. The association between maternal Cd exposure and preeclampsia remains elusive.

Methods: To better understand this relationship, we conducted a systematic review and meta-analysis of eligible studies from five databases (PubMed, Embase, Web of Science, Scopus, and CNKI) from their inception to September 10, 2022. The quality of these studies was evaluated using the Newcastle-Ottawa quality assessment scale (NOS). We use random-effects models to calculate overall standardized mean differences (SMDs) and 95% confidence intervals (CIs). Sensitivity analyses were performed to assess the robustness of our results. We also evaluated publication bias using Egger's and Begg's tests. Additionally, we conducted meta-regression and sub-group analyses to identify potential sources of heterogeneity between studies.

Results: Our analysis included a total of 17 studies with 10,373 participants. We found a significant association between maternal cadmium exposure and the risk of preeclampsia (SMD 0.27, 95% CI 0.09-0.44, p < 0.01). No significant publication bias was detected in Begg's or Egger's tests. Meta-regression suggested that geographical location, year of publication, cadmium samples, sample size, and measurement methods did not contribute to heterogeneity between studies.

Conclusion: Our findings suggest that maternal blood cadmium levels are associated with an increased risk of preeclampsia. In contrast, the pregnant women's urine or placental levels of cadmium may not suggest preeclamptic risk during pregnancy. Further high-quality clinical studies and animal experiments are needed to understand this association better.

Systematic review registration: PROSPERO, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=361291, identifier: CRD42022361291.

Keywords: Cadmium; blood pressure; heavy metal; meta-analysis; preeclampsia; systematic review.

Publication types

Systematic Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was co-supported by the Zhejiang Provincial Project for Medical and Health Science [2022503241], and Zhejiang Provincial Project for Education [Y202249319].