Cadmium Exposure and Preeclampsia: A Systematic Review of Environmental Risk in Pregnancy
Bibliographic record
Abstract
Objective: To systematically evaluate current scientific evidence on the association between cadmium (Cd) exposure and the risk of preeclampsia in pregnant women, and to explore underlying mechanisms and population-specific patterns.Methods: This systematic review was conducted according to PRISMA guidelines. Comprehensive literature searches were performed across PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar without time restriction, focusing on the past 15 years. Inclusion criteria encompassed original human studies measuring cadmium exposure—biological, dietary, or environmental—and reporting preeclampsia as an outcome. Risk of bias was assessed using the Newcastle-Ottawa Scale.Results: Twenty-five eligible studies were included, spanning case-control, cohort, and cross-sectional designs across diverse geographic regions. Most studies found a positive association between cadmium exposure and increased preeclampsia risk, though methodological heterogeneity exists. Proposed mechanisms include cadmium-induced oxidative stress, endothelial dysfunction, placental insufficiency, and hormonal dysregulation. Evidence also highlights differences in risk based on diet, region, and environmental regulation. However, inconsistencies in exposure metrics and population stratification remain.Conclusion: The cumulative evidence suggests cadmium is a plausible environmental risk factor for preeclampsia. Future research must standardize exposure assessments and address population-specific modifiers. This review provides critical groundwork for hypothesis-driven studies and policy frameworks addressing toxic metal exposure in maternal health.Paparan Kadmium dan Preeklampsia: Tinjauan Sistematis terhadap Risiko Lingkungan pada KehamilanAbstrakTujuan: Penelitian ini bertujuan untuk melakukan tinjauan sistematis terhadap bukti ilmiah terkini mengenai hubungan antara paparan kadmium (Cd) dan risiko preeklampsia pada ibu hamil, serta mengeksplorasi mekanisme biologis yang mendasari dan pola risiko spesifik populasi.Metode: Tinjauan sistematis ini disusun berdasarkan pedoman PRISMA. Pencarian literatur dilakukan secara menyeluruh melalui basis data PubMed, Scopus, Web of Science, ScienceDirect, dan Google Scholar tanpa batasan waktu, dengan fokus pada publikasi 15 tahun terakhir. Kriteria inklusi meliputi penelitian asli pada manusia yang mengukur paparan kadmium—baik secara biologis, dietetik, maupun lingkungan—dan melaporkan preeklampsia sebagai luaran. Risiko bias dinilai menggunakan Newcastle-Ottawa Scale.Hasil: Sebanyak 25 studi memenuhi kriteria dan dianalisis, mencakup desain studi kasus-kontrol, kohort, dan potong lintang dari berbagai wilayah geografis. Mayoritas studi menunjukkan adanya hubungan positif antara paparan kadmium dan peningkatan risiko preeklampsia, meskipun terdapat heterogenitas metodologis. Mekanisme yang diusulkan meliputi stres oksidatif akibat kadmium, disfungsi endotel, insufisiensi plasenta, dan disregulasi hormonal. Bukti juga menunjukkan perbedaan risiko berdasarkan pola diet, lokasi geografis, dan tingkat pengawasan lingkungan. Namun, masih terdapat ketidakkonsistenan dalam metrik paparan dan stratifikasi populasi.Kesimpulan: Bukti kumulatif mendukung bahwa kadmium merupakan faktor risiko lingkungan yang potensial terhadap preeklampsia. Penelitian selanjutnya perlu menstandarkan metode pengukuran paparan dan mempertimbangkan faktor-faktor spesifik populasi. Tinjauan ini memberikan landasan penting bagi studi berbasis hipotesis dan penyusunan kebijakan terkait paparan logam toksik dalam kesehatan maternal.Kata kunci: Komplikasi kehamilan; paparan kadmium; preeklampsia; stres oksidatif; toksikologi lingkungan
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.030 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.006 |
| Bibliometrics | 0.010 | 0.012 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".