以妊娠期接触大麻和出生缺陷为例,进一步了解 Meta 分析。

IF 4.5 2区 医学 Q1 PSYCHIATRY Journal of Clinical Psychiatry Pub Date : 2024-11-20 DOI:10.4088/JCP.24f15673
Chittaranjan Andrade
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引用次数: 0

摘要

在美国,约有 5%-10%的孕妇接触过大麻,据报道,在怀孕的头三个月,大麻的使用率最高。最近的两项荟萃分析对与产前接触大麻有关的出生缺陷风险进行了估计;规模较大、时间较近的荟萃分析汇集了来自 18 项队列研究和 18 项病例对照研究的数据,样本总量超过 1,900 万。荟萃分析发现,产前接触大麻与任何出生缺陷的风险增加有关,虽然风险增加的幅度较小,但在统计学上具有显著意义(汇总赔率比[ORs],1.25-1.33);心血管、胃肠道、神经系统、泌尿生殖系统和肌肉骨骼出生缺陷的赔率比也显著增加,但口腔出生缺陷的赔率比没有增加。在调整分析中,OR 值较小,也不太可能具有统计学意义。这些荟萃分析既有优点,也有不足。本文将对其优点和缺点进行详细解释,以便读者更好地理解如何批判性地评估荟萃分析的结果。优点之一是同时提供了未调整和调整后的集合估计值;前者可以让人们了解现实世界中普通患者的风险,后者可以让人们了解暴露对结果的独特贡献。另一个优点是提出了累积荟萃分析,表明从哪个日历年开始,科学文献中的某项发现在统计学上具有持续意义。在出生缺陷子类别的分析中,一个不足之处是在同一森林图中重复出现同一样本;这是有问题的,原因很多。另一个不足之处是将队列研究与病例对照研究得出的 ORs 进行了汇总;我们也解释了这一做法在概念和数字上存在问题的原因。
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Towards a Further Understanding of Meta-Analysis Using Gestational Exposure to Cannabis and Birth Defects as a Case in Point.

About 5%-10% of pregnancies in the US are exposed to cannabis with highest use reported during the first trimester. Two recent meta-analyses presented estimates of the risk of birth defects associated with prenatal exposure to cannabis; the larger and more recent meta-analysis pooled data from 18 cohort and 18 case-control studies with a total sample size of >19 million subjects. The meta-analyses found that prenatal exposure to cannabis was associated with a small but statistically significant increased risk of any birth defect (pooled odds ratios [ORs], 1.25-1.33); ORs were also significantly elevated for cardiovascular, gastrointestinal, nervous system, genitourinary, and musculoskeletal but not orofacial birth defects. The ORs were smaller and less likely to be statistically significant in adjusted analyses. These meta-analyses had strengths but also shortcomings. The strengths and shortcomings are explained in detail so that readers obtain a better understanding of how to critically assess findings in meta-analyses. One strength was the presentation of both unadjusted and adjusted pooled estimates; the former allow an understanding of risks in the average real world patient and the latter allow an understanding of the unique contribution of the exposure to the outcomes. Another strength was the presentation of cumulative meta-analyses which demonstrated from which calendar year onwards a finding became consistently statistically significant in the scientific literature. One shortcoming, in analyses of subcategories of birth defects, was the repeated representation of the same sample in the same forest plot; the many reasons why this is problematic are explained. Another shortcoming was the pooling of ORs obtained from cohort studies with those obtained from case control studies; conceptual and numerical reasons why this is problematic are also explained.

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来源期刊
Journal of Clinical Psychiatry
Journal of Clinical Psychiatry 医学-精神病学
CiteScore
7.40
自引率
1.90%
发文量
0
审稿时长
3-8 weeks
期刊介绍: For over 75 years, The Journal of Clinical Psychiatry has been a leading source of peer-reviewed articles offering the latest information on mental health topics to psychiatrists and other medical professionals.The Journal of Clinical Psychiatry is the leading psychiatric resource for clinical information and covers disorders including depression, bipolar disorder, schizophrenia, anxiety, addiction, posttraumatic stress disorder, and attention-deficit/hyperactivity disorder while exploring the newest advances in diagnosis and treatment.
期刊最新文献
Rates of Major Depressive Disorder and Bipolar Disorder in Black and White Postpartum Women. Towards a Further Understanding of Meta-Analysis Using Gestational Exposure to Cannabis and Birth Defects as a Case in Point. Clarification Regarding the Psychiatrist's Role: Psychiatric Care Versus Psychosocial Support-Reply to Akerson et al. Mental Health Assessment and Psychosocial Intervention Are Already Happening for Maternal-Fetal Interventions. Substance Use Disorder Treatment Programs for Transgender and Gender Diverse Patients.
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