孕前暴露于空气污染与妊娠期糖尿病风险的关联：抗炎饮食的作用。
Association between exposure to air pollution during preconception and risk of gestational diabetes mellitus: The role of anti-inflammatory diet.
机构信息
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 Aristogenic, Anhui Medical University, Hefei, China.
Department of Data Science/ Data Science and Big Data Technology, Shanghai University of International Business and Economics, Shanghai, China.
出版信息
Environ Res. 2023 Oct 15;235:116561. doi: 10.1016/j.envres.2023.116561. Epub 2023 Jul 19.
BACKGROUND
Regarding the association between the sensitive time-windows of air pollution (AP) exposure and gestational diabetes mellitus (GDM), epidemiological findings are inconsistent. The dietary inflammatory potential has been implicated in the development of GDM, but it is unclear whether an anti-inflammatory diet during pregnancy reduces the association between AP and GDM.
OBJECTIVE
We aimed to characterize the sensitive time-windows of AP to GDM risk. Further, to verify whether a maternal anti-inflammatory diet can reduce the risk of AP-induced GDM, by inhibiting inflammation.
METHODS
A total of 8495 pregnant women were included between 2015 and 2021 in the Maternal & Infants Health in Hefei study. Weekly mean AP exposure to fine particles (PM and PM), SO2, and NO was estimated from the data of Hefei City Ecology and Environment Bureau. High-sensitivity C-reactive protein (hs-CRP) concentrations were measured to evaluate systemic inflammation. The empirical dietary inflammatory pattern (EDIP) score based on a validated food frequency questionnaire was used to assess the dietary inflammatory potential of pregnant women. Logistic regression models with distributed lags were used to identify the sensitive time-window for the effect of AP on GDM. Mediation analysis estimated the mediated effect of hs-CRP, linking AP with GDM. Stratified analysis was used to investigate the potential effect of anti-inflammatory diet on GDM risk.
RESULTS
The increased risks of GDM were found to be positively associated with exposure to PM (OR = 1.11, 95% CI:1.07-1.15), PM (OR = 1.12, 95% CI:1.09-1.16), and SO (OR = 1.42, 95% CI:1.25-1.60) by distributed lag models, and the critical exposure windows were 21st to 28th weeks of preconception. The proportion of association between PM PM and SO with GDM mediated by hs-CRP was 25.9%, 21.1%, and 19.4%, respectively, according to mediation analysis. In the stratified analyses by EDIP, the association between AP and GDM was not statistically significant among women those with anti-inflammatory diets.
CONCLUSIONS
Exposure to AP, especially in 21st to 28th week of preconception, is associated with risk of GDM, which is partly mediated by hs-CRP. Adherence to the anti-inflammatory dietary pattern may reduce the risk of AP-induced GDM.
背景
关于空气污染（AP）暴露的敏感时间窗与妊娠糖尿病（GDM）之间的关系，流行病学研究结果并不一致。饮食炎症潜能与 GDM 的发生有关，但尚不清楚孕期抗炎饮食是否能通过抑制炎症来降低 AP 与 GDM 之间的关联。
目的
本研究旨在描述 AP 对 GDM 风险的敏感时间窗。进一步验证，通过抑制炎症，母体抗炎饮食是否可以降低 AP 引起的 GDM 风险。
方法
2015 年至 2021 年，共纳入 8495 名孕妇参加合肥市母婴健康研究。根据合肥市生态环境局的数据，每周平均 PM 和 PM、SO2 和 NO 浓度来估计 AP 暴露水平。采用高敏 C 反应蛋白（hs-CRP）浓度评估全身炎症。根据验证后的食物频率问卷，采用经验性饮食炎症模式（EDIP）评分来评估孕妇的饮食炎症潜能。使用分布滞后模型识别 AP 对 GDM 影响的敏感时间窗。中介分析估计 hs-CRP 介导的 AP 与 GDM 之间的关联。分层分析用于探讨抗炎饮食对 GDM 风险的潜在影响。
结果
分布滞后模型显示，GDM 的患病风险与 PM（OR=1.11，95%CI：1.07-1.15）、PM（OR=1.12，95%CI：1.09-1.16）和 SO（OR=1.42，95%CI：1.25-1.60）暴露呈正相关，关键暴露窗口为受孕前 21 周到 28 周。PM PM 和 SO 与 GDM 之间的关联通过 hs-CRP 介导的比例分别为 25.9%、21.1%和 19.4%。根据分层分析，在 EDIP 分层中，在摄入抗炎饮食的女性中，AP 与 GDM 之间的关联无统计学意义。
结论
AP 暴露，尤其是受孕前 21 周到 28 周，与 GDM 风险相关，这部分是通过 hs-CRP 介导的。遵循抗炎饮食模式可能会降低 AP 引起的 GDM 风险。
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