Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China.
Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China.
Environ Res. 2020 Jun;185:109456. doi: 10.1016/j.envres.2020.109456. Epub 2020 Apr 3.
Mounting evidence has demonstrated that air pollution exposure is associated with the increased prevalence of gestational diabetes mellitus (GDM). However, the long-term exposure effect and the time window of the maximum effect of these air pollutants on GDM and glucose homeostasis during pregnancy are unclear.
We conducted this study on 5427 nondiabetic pregnant women who were admitted from three hospitals in Hefei City, China, between 2015 and 2018. The data regarding the average exposure to particulate matter (PM), sulfur dioxide (SO), and ozone (O) were estimated in a fixed monitoring station in Hefei. We used logistic regression and multiple linear regression to assess the effects of air pollutants on GDM and glucose homeostasis.
Of the 5427 participants, 1119 (20.6%) had GDM. We found prepregnancy exposure to air pollutants was associated with the risk of GDM in the single pollutant model [odds and 95% confidence interval (CI) of GDM for an interquartile range (IQR) increase was 1.24 (1.06-1.45) for PM, 1.42 (1.26-1.59) for PM, 1.21 (1.10-1.33) for SO and1.19 (1.08-1.31) for O]. The risk of GDM before pregnancy was higher with long-term exposure to high-concentration pollutants compared with the risk in pregnant women who were not exposed to high-concentration pollutants (χ = 41.52, p for trend <0.0001); the ORs and 95% CI values for the exposure times of 1, 2, and 3 months were 1.28 (0.96-1.72), 1.52 (1.06-2.19), and 1.69 (1.11-2.57), respectively. The results showed a positive effect of exposure to higher-concentration air pollutants 1 year before pregnancy on glucose homeostasis during pregnancy. The time windows of the maximum effect of PM, PM, SO, and O on GDM were different. The time windows of the maximum effect of PM, PM, and SO were 6 months, 5 months, and 1 month before the last menstrual period (LMP) and 3 months after the LMP, respectively. The time windows of the maximum effect of air pollution on glucose homeostasis indicators from the 2-h 75-g oral glucose tolerance test were similar to the abovementioned results.
Prepregnancy long-term air pollution exposure was associated with a higher risk of developing GDM by affecting glucose metabolism. The time window of the maximum effect of PM on GDM and glucose metabolism indicators was observed earlier than that of SO and O.
越来越多的证据表明，空气污染暴露与妊娠糖尿病（GDM）的患病率增加有关。然而，这些空气污染物对 GDM 和妊娠期间葡萄糖稳态的长期暴露效应以及最大效应的时间窗尚不清楚。
我们对 2015 年至 2018 年间在中国合肥市三家医院就诊的 5427 名非糖尿病孕妇进行了这项研究。在合肥市的一个固定监测站估计了 PM、SO 和 O 平均暴露量的数据。我们使用逻辑回归和多元线性回归来评估空气污染物对 GDM 和葡萄糖稳态的影响。
在 5427 名参与者中，有 1119 名（20.6%）患有 GDM。我们发现，在单污染物模型中，妊娠前接触空气污染物与 GDM 的风险相关[对于 PM、PM、SO 和 O，每增加一个四分位距（IQR），GDM 的优势比（OR）和 95%置信区间（CI）分别为 1.24（1.06-1.45）、1.42（1.26-1.59）、1.21（1.10-1.33）和 1.19（1.08-1.31）]。与未接触高浓度污染物的孕妇相比，长期接触高浓度污染物的孕妇患 GDM 的风险更高（χ²=41.52，p<0.0001）；暴露时间为 1、2 和 3 个月时的 OR 值和 95%CI 值分别为 1.28（0.96-1.72）、1.52（1.06-2.19）和 1.69（1.11-2.57）。结果表明，妊娠前接触更高浓度的空气污染物对妊娠期间的葡萄糖稳态有正向影响。PM、PM、SO 和 O 对 GDM 的最大效应的时间窗不同。PM、PM 和 SO 对 GDM 的最大效应时间窗分别为末次月经前 6 个月、5 个月和 1 个月，末次月经后 3 个月。2 小时 75g 口服葡萄糖耐量试验中空气污染对葡萄糖稳态指标的最大效应时间窗与上述结果相似。
妊娠前长期空气污染暴露与 GDM 发病风险增加有关，可能通过影响葡萄糖代谢。PM 对 GDM 和葡萄糖代谢指标的最大效应时间窗早于 SO 和 O。
