School of Public Health, Zhengzhou University, Zhengzhou 450001, China; School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
Sci Total Environ. 2020 Jun 1;719:137349. doi: 10.1016/j.scitotenv.2020.137349. Epub 2020 Feb 15.
Gestational diabetes mellitus (GDM) is a serious complication of pregnancy that could cause adverse health effects on both mothers and fetuses, and its prevalence has been increasing worldwide. Experimental and epidemiological studies suggest that air pollution may be an important risk factor of GDM, but conclusions are inconsistent. To provide a comprehensive overview of ambient air pollution on GDM, we summarized existing evidence concerning biological linkages between maternal exposure to air pollutants and GDM based on mechanism studies. We also performed a quantitative meta-analysis based on human epidemiological studies by searching English databases (Pubmed, Web of Science and Embase) and Chinese databases (Wanfang, CNKI). As a result, the limited mechanism studies indicated that β-cell dysfunction, neurohormonal disturbance, inflammation, oxidative stress, imbalance of gut microbiome and insulin resistance may be involved in air pollution-GDM relationship, but few studies were performed to explore the direct biological linkage. Additionally, a total of 13 epidemiological studies were included in the meta-analysis, and the air pollutants considered included PM, PM, SO, NO and O. Most studies were retrospective and mainly conducted in developed regions. The results of meta-analysis indicated that maternal first trimester exposure to SO increased the risk of GDM (standardized odds ratio (OR) = 1.392, 95% confidence intervals (CI): 1.010, 1.773), while pre-pregnancy O exposure was inversely associated with GDM risk (standardized OR = 0.981, 95% CI: 0.977, 0.985). No significant effects were observed for PM, PM and NO. In conclusion, additional mechanism studies on the molecular level are needed to provide persuasive rationale underlying the air pollution-GDM relationship. Moreover, other important risk factors of GDM, including maternal lifestyle and road traffic noise exposure that may modify the air pollution-GDM relationship should be considered in future epidemiological studies. More prospective cohort studies are also warranted in developing countries with high levels of air pollution.
妊娠期糖尿病（GDM）是一种严重的妊娠并发症，可能对母婴健康造成不良影响，其全球患病率呈上升趋势。实验和流行病学研究表明，空气污染可能是 GDM 的一个重要危险因素，但结论并不一致。为了全面概述环境空气污染与 GDM 的关系，我们根据机制研究综述了母亲暴露于空气污染物与 GDM 之间的生物学联系的现有证据。我们还通过检索英文数据库（Pubmed、Web of Science 和 Embase）和中文数据库（万方、知网）对人类流行病学研究进行了定量荟萃分析。结果表明，有限的机制研究表明，β细胞功能障碍、神经激素紊乱、炎症、氧化应激、肠道微生物群失衡和胰岛素抵抗可能与空气污染-GDM 关系有关，但很少有研究探索直接的生物学联系。此外，荟萃分析共纳入 13 项流行病学研究，所考虑的空气污染物包括 PM、PM、SO、NO 和 O。大多数研究为回顾性研究，主要在发达地区进行。荟萃分析结果表明，母亲孕早期暴露于 SO 会增加 GDM 的发病风险（标准化优势比（OR）=1.392，95%置信区间（CI）：1.010，1.773），而孕前 O 暴露与 GDM 风险呈负相关（标准化 OR=0.981，95% CI：0.977，0.985）。PM、PM 和 NO 与 GDM 风险无显著相关性。综上所述，需要在分子水平上进行更多的机制研究，为空气污染-GDM 关系提供有说服力的依据。此外，在未来的流行病学研究中应考虑其他重要的 GDM 危险因素，包括可能改变空气污染-GDM 关系的母亲生活方式和道路交通噪声暴露。在空气污染水平较高的发展中国家，还需要进行更多的前瞻性队列研究。
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