新兴的研究结果表明,空气中的颗粒物可能是妊娠期糖尿病(GDM)的危险因素。然而,不同类型颗粒物的浓度-反应关系和敏感时间窗口可能有所不同。在这个回顾性分析中,我们采用一种新的稳健方法来评估GDM患病率的关键时间窗,并区分三种GDM亚型对空气污染暴露的易感性.这项研究包括2018-2021年在重庆市妇幼保健院接受常规产前护理的16,303名孕妇,中国。总的来说,2482名女性(15.2%)被诊断为GDM。我们评估了个人每天平均暴露于空气污染的情况,根据志愿者的地址,包括PM2.5、PM10、O3、NO2、SO2和CO。我们使用机器学习模型生成的高精度网格空气污染数据来评估每个母体暴露水平的颗粒物。我们进一步分析了孕前的关联,早期,使用广义加性模型(GAM)和分布滞后非线性模型(DLNMs)分析特定孕周暴露与GDM风险之间的关联。我们观察到,在头三个月,PM10和PM2.5暴露的每IQR增加与GDM风险增加相关(PM10:OR=1.19,95CI:1.07~1.33;PM2.5:OR=1.32,95CI:1.15~1.50)和单独的负荷后高血糖(GDM-IPH)风险(PM10:OR=1.23,95CI:1.09~1.39;PM2.5:OR=1.38,CI:9561)。妊娠中期O3暴露与GDM的相关风险呈正相关,而孕前和孕早期暴露与GDM-IPH的风险呈负相关。妊娠中期暴露于SO2与GDM-IPH的风险呈负相关。然而,未观察到NO2和CO暴露与GDM及其亚组风险之间的关联.我们的结果表明,孕妇在妊娠早期暴露于颗粒物和在妊娠中期暴露于O3可能会增加GDM的风险。GDM-IPH是对空气颗粒物暴露敏感的GDM亚型。
Emerging research findings suggest that airborne particulate matter might be a risk factor for gestational diabetes mellitus (GDM). However, the concentration-response relationships and the susceptible time windows for different types of particulate matter may vary. In this retrospective analysis, we employ a novel robust approach to assess the crucial time windows regarding the prevalence of GDM and to distinguish the susceptibility of three GDM subtypes to air pollution exposure. This study included 16,303 pregnant women who received routine antenatal care in 2018-2021 at the Maternal and Child Health Hospital in Chongqing, China. In total, 2482 women (15.2%) were diagnosed with GDM. We assessed the individual daily average exposure to air pollution, including PM2.5, PM10, O3, NO2, SO2, and CO based on the volunteers\' addresses. We used high-accuracy gridded air pollution data generated by machine learning models to assess particulate matter per maternal exposure levels. We further analyzed the association of pre-pregnancy, early, and mid-pregnancy exposure to environmental pollutants using a generalized additive model (GAM) and distributed lag nonlinear models (DLNMs) to analyze the association between exposure at specific gestational weeks and the risk of GDM. We observed that, during the first trimester, per IQR increases for PM10 and PM2.5 exposure were associated with increased GDM risk (PM10: OR = 1.19, 95%CI: 1.07~1.33; PM2.5: OR = 1.32, 95%CI: 1.15~1.50) and isolated post-load hyperglycemia (GDM-IPH) risk (PM10: OR = 1.23, 95%CI: 1.09~1.39; PM2.5: OR = 1.38, 95%CI: 1.18~1.61). Second-trimester O3 exposure was positively correlated with the associated risk of GDM, while pre-pregnancy and first-trimester exposure was negatively associated with the risk of GDM-IPH. Exposure to SO2 in the second trimester was negatively associated with the risk of GDM-IPH. However, there were no observed associations between NO2 and CO exposure and the risk of GDM and its subgroups. Our results suggest that maternal exposure to particulate matter during early pregnancy and exposure to O3 in the second trimester might increase the risk of GDM, and GDM-IPH is the susceptible GDM subtype to airborne particulate matter exposure.