Table A2.
A summary of risk of bias assessment according to the risk of bias (ROB) tool from the National Toxicology Program (NTP)’s Office of Health Assessment and Translation (OHAT) handbook [55,93] on observational studies included in the meta-analysis. Note: ☺☺ = definitively low; ☺ = probably low; ☹ = probably high; ☹☹ = definitively high.
| Study | D1. Selection | D2. Confounding | D3. Attrition/Exclusion | D4. Detection | D5. Selective Reporting | D6. Other | |
|---|---|---|---|---|---|---|---|
| Did selection of study participants result in appropriate comparison groups? | Did the study design or analysis account for important confounding and modifying variables? | Were outcome data complete with respect to attrition or exclusion from analysis? | Can we be confident in the exposure characterization? | Can we be confident in the outcome assessment? | Were all measured outcomes reported? | Were there any other potential threats to internal validity? | |
| Pinheiro et al., 1976 [10] | ☺ | ☺ | ☺ | ☺☺ | ☺☺ | ☺ | ☺ |
| LeDuc et al., 1981 [11] | ☺ | ☺ | ☺ | ☺☺ | ☺☺ | ☺ | ☺ |
| Pinheiro et al., 1982 [61] | ☹ | ☺ | ☺☺ | ☺ | ☺☺ | ☺☺ | ☺☺ |
| Borborema et al., 1982 [12] | ☺ | ☺ | ☺☺ | ☺ | ☺☺ | ☺☺ | ☺☺ |
| Vasconcelos et al., 1989 [62] | ☺ | ☺ | ☺☺ | ☺ | ☺☺ | ☺☺ | ☺☺ |
| Rosa et al., 1996 [63] | ☹ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Watts et al., 1997 [64] | ☹ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Baisley et al., 1998 [14] | ☹ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| de Figueredo et al., 2004 [65] | ☹ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Tavares Neto et al., 2004 [66] | ☺ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| da Silva Azevedo et al., 2007 [40] | ☹ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Bernarders Terzian et al., 2009 [67] | ☹ | ☹ | ☺☺ | ☺ | ☺ | ☺ | ☹ |
| Cruz et al., 2009 [68] | ☹ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Manock et al., 2009 [23] | ☹ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Mourao et al., 2009 [69] | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | ☹ |
| Vasconcelos et al., 2009 [41] | ☺ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| AlvarezKFalconi et al., 2010 [70] | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ |
| Forshey et al., 2010 [25] | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ |
| Aguilar et al., 2011 [71] | ☺☺ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Bastos et al., 2012 [72] | ☺ | ☺ | ☹ | ☺ | ☺ | ☺ | ☺ |
| Bastos et al., 2014 [73] | ☹ | ☺ | ☺☺ | ☺ | ☹ | ☺ | ☺ |
| do Calmo Martins et al., 2014 [74] | ☹ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Cardoso et al., 2015 [75] | ☹ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ |
| Garcia et al., 2016 [76] | ☺☺ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Alva-Urcia et al., 2017 [77] | ☹ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ |
| SilvaKCaso et al., 2019 [35] | ☺ | ☺ | ☺ | ☺☺ | ☺☺ | ☺ | ☺ |
| do Nascimiento et al., 2020 [78] | ☺ | ☺ | ☺ | ☺☺ | ☺☺ | ☺ | ☺ |
| MartinsKLuna et al., 2020 [79] | ☹ | ☺ | ☺☺ | ☺ | ☺☺ | ☺☺ | ☺☺ |
| Rojas et al., 2020 [48] | ☺ | ☺ | ☺☺ | ☺ | ☺☺ | ☺☺ | ☺☺ |
| Salvador et al., 2020 [80] | ☺ | ☺ | ☺☺ | ☺ | ☺☺ | ☺☺ | ☺☺ |
| Elbadry et al., 2021 [24] | ☹ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Gaillet et al., 2021 [17] | ☹ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Saatkamp et al., 2021 [81] | ☹ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Salgado et al., 2021 [82] | ☹ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Carvalho et al., 2022 [83] | ☺ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Ciuoderis et al., 2022 [33] | ☹ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Dias et al., 2022 [84] | ☹ | ☹ | ☺☺ | ☺ | ☺ | ☺ | ☹ |
| Gil-Mora et al., 2022 [85] | ☹ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Gonçalves Maciel et al., 2022 [86] | ☹ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Watts et al., 2022 [16] | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | ☹ |
| De Lima et al., 2024 [87] | ☺ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Forato et al., 2024 [42] | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ |
| GrisalesKNieto et al., 2024 [20] | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ |
| Moreira et al., 2024 [88] | ☺☺ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Scachetti et al., 2024 [89] | ☺ | ☺☺ | ☺☺ | ☺ | ☺☺ | ☺ | ☺ |
| Silva et al., 2024 [90] | ☺☺ | ☺ | ☺☺ | ☺ | ☺ | ☺ | ☺ |
| Sanchez-Lerma et al., 2024 | ☹☹ | ☺ | ☺ | ☺ | ☺ | ☺ | ☺ |