Abstract：
BACKGROUND: 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.
OBJECTIVE: To investigate the effects of prenatal PAHs &PAEs exposure on the risk of GDM and hyperglycemia in pregnant women.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
OBJECTIVE: To investigate the effects of prenatal PAHs &PAEs exposure on the risk of GDM and hyperglycemia in pregnant women.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：多环芳烃和邻苯二甲酸酯（PAHs和PAEs），被称为内分泌干扰化学物质(EDC)，广泛存在于日常生活和工业生产中。先前的研究表明，PAHs和PAEs可能会改变子宫内的稳态，并对胎儿发育产生不利影响。然而,关于PAHs和PAEs与妊娠期糖尿病（GDM）之间关联的流行病学证据仍然有限。
目的：探讨孕妇产前PAHs和PAEs暴露对GDM和高血糖风险的影响。
方法：研究人群为2019年12月至2021年12月进行的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。通过气相色谱串联质谱法测定尿PAHs和PAEs浓度。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)，应用贝叶斯核机回归(BKMR)来探索和验证PAHs和PAEs对血糖稳态的个体和总体影响。在所有统计模型中调整了潜在的混杂因素。
结果：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）的ln-单位增量（调整后的风险比（aRR）=1.13;1.02-1.26）与GDM风险增加相关。混合暴露模型显示出类似的结果。我们还发现，在qgcomp模型中，MBZP（邻苯二甲酸单苄基酯）（aRR=1.19；1.02-1.39）与GDM风险呈正相关。虽然没有一个模型证明2-OHNAP（2-羟基萘）和9-OHFLU（9-羟基芴）增加GDM的风险，2-OHNAP和9-OHFLU暴露显著增加血糖水平。BKMR模型进一步证实PAHs和PAEs的总体效应与妊娠期高血糖和GDM风险显著相关。
结论：我们的研究表明，环境暴露于PAHs和PAEs与妊娠期葡萄糖水平和发生GDM的风险呈正相关。特别是,2-OHNAP,9-OHFLU,4-OHPHE和MBZP可作为预防GDM发展的重要监测标志物。
目的：探讨孕妇产前PAHs和PAEs暴露对GDM和高血糖风险的影响。
方法：研究人群为2019年12月至2021年12月进行的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。通过气相色谱串联质谱法测定尿PAHs和PAEs浓度。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)，应用贝叶斯核机回归(BKMR)来探索和验证PAHs和PAEs对血糖稳态的个体和总体影响。在所有统计模型中调整了潜在的混杂因素。
结果：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）的ln-单位增量（调整后的风险比（aRR）=1.13;1.02-1.26）与GDM风险增加相关。混合暴露模型显示出类似的结果。我们还发现，在qgcomp模型中，MBZP（邻苯二甲酸单苄基酯）（aRR=1.19；1.02-1.39）与GDM风险呈正相关。虽然没有一个模型证明2-OHNAP（2-羟基萘）和9-OHFLU（9-羟基芴）增加GDM的风险，2-OHNAP和9-OHFLU暴露显著增加血糖水平。BKMR模型进一步证实PAHs和PAEs的总体效应与妊娠期高血糖和GDM风险显著相关。
结论：我们的研究表明，环境暴露于PAHs和PAEs与妊娠期葡萄糖水平和发生GDM的风险呈正相关。特别是,2-OHNAP,9-OHFLU,4-OHPHE和MBZP可作为预防GDM发展的重要监测标志物。
