Combined effects of air pollutants on gestational diabetes mellitus: A prospective cohort study

Environ Res. 2022 Mar;204(Pt D):112393. doi: 10.1016/j.envres.2021.112393. Epub 2021 Nov 17.


Exposures to multiple air pollutants during pregnancy have been associated with the risk of gestational diabetes mellitus (GDM). However, their combined effects are unclear. We aimed to evaluate the combined associations of five air pollutants from pre-pregnancy to the 2nd trimester with GDM. This study included 20,113 participants from the Born in Guangzhou Cohort Study (BIGCS). The inverse distance-weighted models were used to estimate individual air pollutant exposure, namely ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), particulate matter less than 10 μm in diameter (PM10), and less than 2.5 μm in diameter (PM2.5). We estimated stage-specific associations of air pollutants with GDM using generalized estimating equation, and departures from additive joint effects were assessed using the relative excess risk (RERI) and the joint relative risk (JRR). Of the 20,113 participants, 3440 women (17.1%) were diagnosed with GDM. In the adjusted model, increased concentrations of O3 and SO2 3-6 months before pregnancy were associated with GDM occurrence, as well as O3 and PM10 in the 1st trimester, the adjusted relative risk (95% confident intervals) [RRs (95%CI)] ranged from 1.05 (1.00, 1.09) to 1.21 (1.04, 1.40). The largest JRR for GDM was the combination of SO2, NO2, and PM10 in the 1st trimester (JRR = 1.32, 95% CI: 1.10, 1.59). The JRR for O3 and SO2 was less than their additive joint effects [RERI = -0.25 (-0.47, -0.04), P for interaction = 0.048]. Associations of air pollutants with GDM differed somewhat by pre-pregnancy BMI and season. This study added new evidence to the current understanding of the combined effects of multiple air pollutants on GDM. Public health strategies were needed to reduce the adverse effects of air pollution exposure on pregnant women.

Keywords: Air pollution; Cohort study; Combined effect; Glucose metabolism; Maternal exposure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Air Pollutants* / analysis
  • Air Pollutants* / toxicity
  • Air Pollution* / adverse effects
  • Air Pollution* / analysis
  • Cohort Studies
  • Diabetes, Gestational* / chemically induced
  • Diabetes, Gestational* / epidemiology
  • Diabetes, Gestational* / etiology
  • Female
  • Humans
  • Nitrogen Dioxide / analysis
  • Nitrogen Dioxide / toxicity
  • Particulate Matter / analysis
  • Particulate Matter / toxicity
  • Pregnancy
  • Prospective Studies


  • Air Pollutants
  • Particulate Matter
  • Nitrogen Dioxide