背景:越来越多的证据表明,暴露于PM2.5及其成分与妊娠期糖尿病(GDM)的风险增加有关,但是关于PM2.5成分暴露与GDM风险之间关系的研究仍然有限。
方法:本回顾性队列研究共招募广州地区17,855名孕妇,并使用随时间变化的平均浓度方法来估计怀孕期间个体对PM2.5及其成分的暴露。采用Logistic回归分析PM2.5及其成分暴露与GDM风险的关系,用Logistic回归结合有限三次样条曲线估计PM2.5及其成分暴露与GDM风险之间的预期拐点。进行了分层分析和相互作用测试。
结果:调整混杂因素后,暴露于PM2.5及其成分(NO3-,NH4+,和OM)与妊娠期GDM的风险呈正相关,特别是当暴露于NO3-和NH4+发生在孕早期到中期,每个四分位间距会使GDM的风险增加20.2%(95%CI:1.118-1.293)和18.2%(95%CI.1.107-1.263),分别。PM2.5、SO42-、NO3-,NH4+,OM,整个妊娠期的BC浓度和GDM风险分别为18.96、5.80、3.22、2.67、4.77和0.97µg/m3。在头三个月,暴露于SO42-,OM,观察BC和GDM的风险。
结论:本研究表明,PM2.5及其成分暴露与GDM风险呈正相关。具体来说,暴露于NO3-,NH4+,OM与GDM风险增加尤其相关。本研究有助于更好地了解暴露于PM2.5及其成分对GDM风险的影响。
BACKGROUND: There is increasing evidence that exposure to PM2.5 and its constituents is associated with an increased risk of gestational diabetes mellitus (GDM), but studies on the relationship between exposure to PM2.5 constituents and the risk of GDM are still limited.
METHODS: A total of 17,855 pregnant women in Guangzhou were recruited for this retrospective cohort
study, and the time-varying average concentration method was used to estimate individual exposure to PM2.5 and its constituents during pregnancy. Logistic regression was used to assess the relationship between exposure to PM2.5 and its constituents and the risk of GDM, and the expected inflection point between exposure to PM2.5 and its constituents and the risk of GDM was estimated using logistic regression combined with restricted cubic spline curves. Stratified analyses and interaction tests were performed.
RESULTS: After adjustment for confounders, exposure to PM2.5 and its constituents (NO3-, NH4+, and OM) was positively associated with the risk of GDM during pregnancy, especially when exposure to NO3- and NH4+ occurred in the first to second trimester, with each interquartile range increase the risk of GDM by 20.2% (95% CI: 1.118-1.293) and 18.2% (95% CI. 1.107-1.263), respectively. The lowest inflection points between PM2.5, SO42-, NO3-, NH4+, OM, and BC concentrations and GDM risk throughout the gestation period were 18.96, 5.80, 3.22, 2.67, 4.77 and 0.97 µg/m3, respectively. In the first trimester, an age interaction effect between exposure to SO42-, OM, and BC and the risk of GDM was observed.
CONCLUSIONS: This
study demonstrates a positive association between exposure to PM2.5 and its constituents and the risk of GDM. Specifically, exposure to NO3-, NH4+, and OM was particularly associated with an increased risk of GDM. The present
study contributes to a better understanding of the effects of exposure to PM2.5 and its constituents on the risk of GDM.