Maternal risk factors for biliary atresia in neonates: a systematic review and meta-analysis

The risk factors for neonatal biliary atresia remain unclear. This study aimed to systematically analyze maternal risk factors associated with the development of neonatal biliary atresia (BA).

A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library to retrieve relevant literature published from database inception to December 31, 2025, focusing on maternal risk factors for neonatal biliary atresia. Stata (Version 18.0) was used for meta-analysis.

A total of 10 retrospective studies were included in the meta-analysis. The results identified several statistically significant risk factors for the development of biliary atresia (BA), including maternal urogenital tract infection (OR = 1.21, 95% CI: 1.02-1.43), maternal diabetes mellitus (OR = 1.55, 95% CI: 1.20-2.00), preterm birth (OR = 2.64, 95% CI: 1.66-4.22), and low birth weight (OR = 1.66, 95% CI: 1.28-2.16). Additionally, the incidence of BA was significantly lower in neonates of White/Caucasian ethnicity (OR = 0.67, 95% CI: 0.46-0.98). By contrast, maternal smoking history, neonatal sex, maternal age (with 35 years as the cutoff), mode of delivery, and fetal number (singleton/multiple pregnancy) did not show statistically significant associations in this meta-analysis.

The pathogenesis of neonatal biliary atresia is associated with multiple factors, including genetics, intrauterine infection, and maternal environmental exposures. Heightened vigilance for biliary atresia in neonates with high-risk characteristics is warranted to facilitate early diagnosis and treatment. However, due to the limited number of included studies, our findings require further validation through research with larger sample sizes.