The Association of Environmental Exposure in the Etiology of Esophageal Atresia in Children: A Systematic Review and Meta-analysis.

AIM: To elucidate the impact of environmental exposure on the etiology of esophageal atresia (EA), identify potential risk factors, and propose preventive measures.

METHOD: Protocol drafted under PRISMA guideline and registered on PROSPERO (CRD42023391247). A comprehensive search was conducted across three databases (EMBASE, Pubmed, CENTRAL) covering the period from January 2002 to September 2023. The search strategy consisted of a combination of terms related to EA, preconceptional exposure, fetal exposure, and environmental exposure. Statistical analysis was performed with CMA-V4 software.

RESULTS

A total of 391 abstracts were identified and 345 abstracts were screened. Full-text of the selected articles (n = 108) were assessed for eligibility, with 24 studies were included in the quantitative analysis. Maternal alcohol consumption during the periconceptional period [OR: 1.26 (95 % CI: 1.09-1.45), p = 0.002] and passive smoking [OR: 1.25 (95 % CI: 1.053-1.48), p = 0.011] were related with higher EA risk. EA risk was significantly higher in mothers with gestational diabetes [OR: 1.95 (95 % CI: 1.53-2.48), p < 0.001] and in those aged over 35 years old [OR: 1.48 (95 % CI: 1.22-1.79), p < 0.001]. There was not statistically significant association between environmental pollution and occurrence of EA [OR: 1.29 (95 % CI: 0.98-1.68), p = 0.068].

CONCLUSION

This systematic review revealed that environmental factors may contribute to the development of EA. Specifically, maternal alcohol consumption, passive smoking of mother, maternal diabetes, and older mother age seem to be associated with a significantly increased risk of EA. However, further studies are needed to explore the impact of other periconceptional exposures on the development of EA.