Ambient air pollution exposure and gestational diabetes mellitus in Guangzhou, China: A prospective cohort study

Huanhuan Zhang; Haotian Dong; Meng Ren; Qianhong Liang; Xiaoting Shen; Qiang Wang; Le Yu; Hualiang Lin; Qiwei Luo; Weiyi Chen; Luke D Knibbs; Bin Jalaludin; Qiong Wang; Cunrui Huang

doi:10.1016/j.scitotenv.2019.134390

Ambient air pollution exposure and gestational diabetes mellitus in Guangzhou, China: A prospective cohort study

Sci Total Environ. 2020 Jan 10:699:134390. doi: 10.1016/j.scitotenv.2019.134390. Epub 2019 Sep 10.

Authors

Huanhuan Zhang¹, Haotian Dong², Meng Ren², Qianhong Liang³, Xiaoting Shen⁴, Qiang Wang⁵, Le Yu⁶, Hualiang Lin⁷, Qiwei Luo⁸, Weiyi Chen⁸, Luke D Knibbs⁹, Bin Jalaludin¹⁰, Qiong Wang¹¹, Cunrui Huang¹

Affiliations

¹ School of Public Health, Sun Yat-sen University, Guangzhou, China; Shanghai Typhoon Institute, China Meteorological Administration, Shanghai 200030, China; Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai 200030, China.
² School of Public Health, Sun Yat-sen University, Guangzhou, China.
³ Department of Ultrasound, Panyu Maternal and Child Care Service Center of Guangzhou.
⁴ Center for Reproductive Medicine, The first Affiliated Hospital of Sun Yat-sen University, China.
⁵ Department of Emergency, Guangzhou Women and Children's Medical Center, Guangzhou.
⁶ Department of Pediatrics in Traditional Chinese Medicine, Guangzhou Women and Children's Medical Center.
⁷ Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
⁸ Department of Obstetrics, Panyu Maternal and Child Care Service Center of Guangzhou, China.
⁹ School of Public Health, The University of Queensland, Herston, Australia.
¹⁰ School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
¹¹ School of Public Health, Sun Yat-sen University, Guangzhou, China. Electronic address: wangqiong@mail.sysu.edu.cn.

PMID: 31525546
DOI: 10.1016/j.scitotenv.2019.134390

Abstract

Background: Evidence concerning the effect of ambient air pollution exposure on gestational diabetes mellitus (GDM) is limited. No published studies have examined maternal weekly air pollution exposure and GDM, and the possible effect modification by folic acid supplementation has not been assessed.

Objectives: To evaluate the association between air pollution exposure and GDM at trimester and weekly levels, and to explore the potential effect modification by folic acid supplementation.

Methods: A total of 5421 pregnant women were recruited during 2011-2014 in Guangzhou, China. Daily PM_2.5, PM₁₀, SO₂ and NO₂ levels were collected from 10 monitoring stations. Individual's exposure during pregnancy was estimated using inverse-distance weighting approach. Binary logistic regression was used to examine the trimester-specific association between air pollution exposure and GDM. Distributed lag models (DLMs) were applied to estimate maternal weekly air pollution exposure and GDM. Stratified analyses by folic acid supplementation and interaction test were performed.

Results: The GDM incidence was 11.69%. An interquartile range (IQR) increase in first trimester SO₂ was associated with increased GDM risk in the single pollutant model, the adjusted odds ratio (aOR) and 95% confidence interval (CI) was 1.22 (1.02-1.47). In DLMs, an IQR increase in SO₂ during 4th to 10th gestational weeks was associated with increased GDM risk, with the strongest effect in the 7th gestational week. When stratified by maternal folic acid supplementation, first trimester exposure to SO₂ was associated with increased GDM risk among women taking folic acid supplements (aOR = 1.25, 95% CI: 1.03-1.53) and P value for interaction was 0.13. No significant effects were observed for PM_2.5, PM₁₀ and NO₂.

Conclusion: First trimester exposure to SO₂ was associated with increased GDM risk, especially during the 4th to 10th gestational weeks. The effect might be stronger among women taking folic acid supplements.

Keywords: Air pollution; Folic acid supplementation; Gestational diabetes mellitus; Pregnancy.

MeSH terms

Adult
Air Pollutants
Air Pollution / statistics & numerical data*
China / epidemiology
Diabetes, Gestational / epidemiology*
Environmental Exposure
Female
Humans
Maternal Exposure / statistics & numerical data*
Particulate Matter
Pregnancy

Substances

Air Pollutants
Particulate Matter