Ambient air pollution exposure during pregnancy and gestational diabetes mellitus in Shenyang, China: a prospective coho
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RESEARCH ARTICLE
Ambient air pollution exposure during pregnancy and gestational diabetes mellitus in Shenyang, China: a prospective cohort study Hehua Zhang 1 & Yuhong Zhao 2 Received: 14 July 2020 / Accepted: 5 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. Reports of the association between air pollution exposure and GDM have been inconsistent in previous studies. We conducted a cohort study to investigate the associations between air pollution exposure and GDM in the city of Shenyang in Northeast China for the first time. We studied interactions with different air pollutant exposures and conducted a stratified analysis according to folic acid intake, age, body mass index (BMI), primiparity, and sleep quality. We found significant associations between prenatal exposure to NOx and SO2 and the development of GDM during the second trimester: the largest effect on GDM was exposure to SO2 (odds ratio (OR): 1.77, 95% confidence interval (CI): 1.23–2.56) in the largest quartile compared with the lowest quartile. Significant interactions between age, BMI, parity, sleep quality, and air pollution exposures were observed; stratified analysis showed stronger associations between GDM and high air pollutant exposure in pregnant women with older age, larger BMI, poorer sleep quality, and more parity. We found that air pollution exposure during the second trimester was significantly associated with GDM in a prospective birth cohort study in Northeast China. SO2, oxynitride (NOX, NO2, NO), CO, and O3 all showed a linear trend effect on GDM. Interactions between prenatal air pollution exposure and other factors, such as age at pregnancy, BMI before pregnancy, primiparity, folic acid intake, and sleep quality, during the second trimester might exist. Keywords Prenatal air pollution exposure . Gestational diabetes mellitus . The second trimester . Sleep quality
Introduction Diabetes that appears for the first time during gestation in women with normal glucose metabolism before pregnancy is defined as gestational diabetes mellitus (GDM) (Wendland et al. 2012). The prevalence of GDM worldwide varies from 1 to 25% depending on race, ethnicity, economics, and other patient Responsible Editor: Lotfi Aleya Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11356-020-11143-x) contains supplementary material, which is available to authorized users. * Yuhong Zhao [email protected] Hehua Zhang [email protected] 1
Clinical Reserch Center, Shengjing Hospital of China Medical University, Huaxiang Road No. 39, Tiexi District, China
2
Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Sanhao Street, No. 36, Heping District, China
demographics (Moyer 2014). Recent research in China showed a large increase in GDM during the last 10 years compared with earlier studies (Liao et al. 2019). GDM is associated with perinatal complications and adv
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