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Cadmium exposure and the risk of GDM: evidence emerging from the systematic review and meta-analysis

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Abstract

Gestational diabetes mellitus (GDM) has become a global concern for its severe adverse effects on both mother and fetus. Recent epidemiological studies reported inconsistent results of the association between cadmium (Cd) exposure and GDM. Therefore, a systematic review and meta- analysis were performed. PubMed, Web of Science, Scopus, Embase, and SpringerLink were searched up to July 2021. Observational studies containing the adjusted relative risks between Cd exposure and GDM were included in the quantitative synthesis. The retrieval comprised 218 articles out of which 11 met our criteria and 9 were included in the meta-analysis, representing a total of 32,392 subjects (2881 GDM). In total, Cd exposure might increase the risk of GDM in some extent (OR = 1.21, 95% CI [0.89, 1.64]), even without statistical significance in high heterogeneity (Q = 28.45, p < 0.05, I2 = 71.9%). Filtering two outliers indicated by Galbraith plot yielded a similar risk (OR = 1.19, 95% CI [1.02, 1.39]) with statistical significance. However, the heterogeneity among studies was obviously reduced (Q = 11.75, p = 0.068, I2 = 48.9%). Additionally, biological specimen, study design, and diagnostic criteria contributed to the high heterogeneity according to the subgroup analysis. Since some important results do not deny that Cd exposure increases the risk of GDM, high-quality multi-centered large cohort studies are required in the future.

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Data availability

All concerned data are posted on the manuscript and its supporting information files. Moreover, registration form of this meta-analysis (CRD42021249057) can be viewed on PROSPERO database: https://www.crd.york.ac.uk/PROSPERO.

Abbreviations

GDM:

Gestational diabetes mellitus

BMI:

Body mass index

Cd:

Cadmium

EDC:

Endocrine Disrupting Chemicals

PRISMA:

Preferred Reporting Item for Systematic Reviews and Meta- analysis

PECOS:

Population Exposure Comparison Outcome Study design

MeSH:

Medical Subject Headings

RR:

Risk ratio

OR:

Odds ratio

HR:

Hazard ratio

PR:

Prevalence ratio

CI:

Confidence interval

NOS:

Newcastle–Ottawa scale

AHRQ:

Agency for Healthcare Research and Quality

DCT-1:

Divalent Cation Transporter-1

B-Cd:

Cadmium in blood

U-Cd:

Cadmium in urine

Cas-3:

Caspase 3

ROS:

Reactive oxygen species

TBARS:

2-Thiobarbituric acid reactive substances

Nrf2:

Nuclear factor E2-related factor 2

JNK:

C-Jun NH(2)-terminal kinases

IL-6:

Interleukin 6

TNF-α:

Tumor necrosis factor alpha

FFA:

Free fatty acid

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Acknowledgements

The authors would like to appreciate the library of Huazhong University of Science and Technology for providing approaches to various online databases.

Funding

This work was funded by National Key Research and Development Program of China (Grant numbers: 2018YFC1004300, 2018YFC1004304).

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Authors and Affiliations

  1. Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Minqi Zhou, Lianqi Peng, Jingming Wang, Rong Cao, Zixuan Ou & Yiwei Fang

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  1. Minqi Zhou
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Contributions

M.Q.Z put forward the study design. M.Q.Z and L.Q.P conducted literature search, quality appraisal and data extraction. M.Q.Z performed the procedure of data analyses. M.Q.Z and L.Q.P contributed to work of writing the draft of the manuscript. J.M.W, R.C, and Z.X.O helped to answer crucial questions and provided significant suggestions for language correction. Y.W.F guaranteed the whole procedure and gave guides when confuses arose. All authors agree with the last version of manuscript.

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Correspondence to Yiwei Fang.

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Zhou, M., Peng, L., Wang, J. et al. Cadmium exposure and the risk of GDM: evidence emerging from the systematic review and meta-analysis. Environ Sci Pollut Res 29, 77253–77274 (2022). https://doi.org/10.1007/s11356-022-21171-4

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