Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, PR China.
Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, PR China; National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, PR China; State Key Laboratory of Female Fertility Promotion, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, PR China; Key Laboratory of Assisted Reproduction, Ministry of Education, Peking University, Beijing, 100191, PR China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, PR China.
Int J Hyg Environ Health. 2024 Aug;261:114419. doi: 10.1016/j.ijheh.2024.114419. Epub 2024 Jul 4.
Polycyclic aromatic hydrocarbons and phthalate acid esters (PAHs & PAEs), known as endocrine disrupting chemicals (EDCs), widely exist in daily life and industrial production. Previous studies have suggested that PAHs & PAEs may modify the intrauterine homeostasis and have adverse effects on fetal development. However, epidemiological evidence on the associations between PAHs & PAEs and gestational diabetes mellitus (GDM) is still limited.
To investigate the effects of prenatal PAHs &PAEs exposure on the risk of GDM and hyperglycemia in pregnant women.
The study population was a total of 725 pregnant women from a prospective birth cohort study conducted from December 2019 to December 2021. Blood glucose levels were collected by the hospital information system. Urinary PAHs & PAEs concentrations were determined by gas chromatography tandem mass spectrometry. The Poisson regression in a generalized linear model (GLM), multiple linear regression, quantile-based g-computation method (qgcomp), and Bayesian kernel machine regression (BKMR) were applied to explore and verify the individual and overall effects of PAHs & PAEs on glucose homeostasis. Potential confounders were adjusted in all statistical models.
A total of 179 (24.69%) women were diagnosed with GDM. The Poisson regression suggested that a ln-unit increment of 4-OHPHE (4-hydroxyphenanthrene) (adjusted Risk Ratio (aRR) = 1.13; 1.02-1.26) was associated with the increased GDM risk. Mixed-exposure models showed similar results. We additionally found that MBZP (mono-benzyl phthalate) (aRR = 1.19; 1.02-1.39) was positively related to GDM risk in qgcomp model. Although neither model demonstrated that 2-OHNAP (2-hydroxynaphthalene) and 9-OHFLU (9-hydroxyfluorene) increased the risk of GDM, 2-OHNAP and 9-OHFLU exposure significantly increased blood glucose levels. BKMR model further confirmed that overall effects of PAHs & PAEs were significantly associated with the gestational hyperglycemia and GDM risk.
Our study presents that environmental exposure to PAHs & PAEs was positively associated with gestational glucose levels and the risks of developing GDM. In particular, 2-OHNAP, 9-OHFLU, 4-OHPHE and MBZP may serve as important surveillance markers to prevent the development of GDM.
多环芳烃和邻苯二甲酸酯（PAHs & PAEs），作为内分泌干扰物（EDCs），广泛存在于日常生活和工业生产中。先前的研究表明，PAHs & PAEs 可能会改变宫内稳态，并对胎儿发育产生不利影响。然而，关于 PAHs & PAEs 与妊娠糖尿病（GDM）之间关联的流行病学证据仍然有限。
探讨孕妇产前 PAHs & PAEs 暴露对 GDM 和高血糖的影响。
本研究人群为 2019 年 12 月至 2021 年 12 月期间进行的一项前瞻性出生队列研究中的 725 名孕妇。通过医院信息系统收集血糖水平。采用气相色谱串联质谱法测定尿中 PAHs & PAEs 浓度。应用广义线性模型（GLM）中的泊松回归、多元线性回归、基于分位数的 g 计算方法（qgcomp）和贝叶斯核机器回归（BKMR）来探讨和验证 PAHs & PAEs 对葡萄糖稳态的个体和总体影响。在所有统计模型中都调整了潜在的混杂因素。
共有 179 名（24.69%）女性被诊断为 GDM。泊松回归表明，4-OHPHE（4-羟基菲）ln-单位增加 1 个单位（调整后的风险比[aRR]为 1.13；1.02-1.26）与 GDM 风险增加相关。混合暴露模型得出了类似的结果。我们还发现，MBZP（单苄基邻苯二甲酸酯）（aRR 为 1.19；1.02-1.39）与 qgcomp 模型中的 GDM 风险呈正相关。虽然没有模型表明 2-OHNAP（2-羟基萘）和 9-OHFLU（9-羟基芴）增加 GDM 的风险，但 2-OHNAP 和 9-OHFLU 暴露确实显著增加了血糖水平。BKMR 模型进一步证实，PAHs & PAEs 的总体效应与妊娠高血糖和 GDM 风险显著相关。
本研究表明，环境暴露于 PAHs & PAEs 与妊娠期血糖水平升高和 GDM 发病风险呈正相关。特别是，2-OHNAP、9-OHFLU、4-OHPHE 和 MBZP 可能成为预防 GDM 发生的重要监测标志物。
