Nicholas School of the Environment & Duke Global Health Institute, Duke University, Durham, North Carolina 27708, United States.
Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York 14642, United States.
Environ Sci Technol. 2024 Sep 10;58(36):15997-16005. doi: 10.1021/acs.est.4c05612. Epub 2024 Aug 27.
Epidemiologic evidence has emerged showing an association between exposure to air pollution and increased risks of gestational diabetes mellitus (GDM). This study examines the effect of low-level air pollution exposure on a subclinical biomarker of hyperglycemia (i.e., HbA1c) in pregnant people without diabetes before conception. We measured HbA1c in 577 samples repeatedly collected from 224 pregnant people in Rochester, NY, and estimated residential concentrations of PM and NO using high-resolution spatiotemporal models. We observed a U-shaped trajectory of HbA1c during pregnancy with average HbA1c levels of 5.13 (±0.52), 4.97 (±0.54), and 5.43 (±0.40)% in early-, mid-, and late pregnancy, respectively. After adjustment for the U-shaped trajectory and classic GDM risk factors, each interquartile range increase in 10 week NO concentration (8.0 ppb) was associated with 0.09% (95% CI: 0.02 to 0.16%) and 0.18% (95% CI: 0.08 to 0.28%) increases in HbA1c over the entire pregnancy and in late pregnancy, respectively. These associations remained robust among participants without GDM. Using separate distributed lag models, we identified a period between 8th and 14th gestational weeks as critical windows responsible for increased levels of HbA1c measured at 14th, 22nd, and 30th gestational weeks. Our results suggest that low-level air pollution contributes to hyperglycemia in medically low-risk pregnant people.
流行病学证据表明，暴露于空气污染与妊娠糖尿病（GDM）风险增加之间存在关联。本研究探讨了低水平空气污染暴露对妊娠前无糖尿病的孕妇亚临床高血糖生物标志物（即 HbA1c）的影响。我们在纽约罗切斯特的 224 名孕妇中重复测量了 577 个样本的 HbA1c，并使用高分辨率时空模型估计了 PM 和 NO 的住宅浓度。我们观察到孕妇怀孕期间 HbA1c 呈 U 形轨迹，早、中、晚期的平均 HbA1c 水平分别为 5.13（±0.52）、4.97（±0.54）和 5.43（±0.40）%。在调整 U 形轨迹和经典 GDM 危险因素后，10 周 NO 浓度（8.0 ppb）每增加一个四分位间距，整个孕期和晚期孕期 HbA1c 分别增加 0.09%（95%CI：0.02 至 0.16%）和 0.18%（95%CI：0.08 至 0.28%）。在没有 GDM 的参与者中，这些关联仍然稳健。使用单独的分布滞后模型，我们确定了第 8 至 14 个妊娠周之间的一个关键窗口期，负责增加第 14、22 和 30 个妊娠周测量的 HbA1c 水平。我们的结果表明，低水平空气污染导致医学低风险孕妇的高血糖。
