Associations of gestational diabetes mellitus with residential air pollution exposure in a large Southern California pregnancy cohort

Heejoo Jo; Sandrah P. Eckel; Jiu Chiuan Chen; Myles Cockburn; Mayra P. Martinez; Ting Chow; Fred Lurmann; William E. Funk; Rob McConnell; Anny H. Xiang

doi:10.1016/j.envint.2019.104933

Associations of gestational diabetes mellitus with residential air pollution exposure in a large Southern California pregnancy cohort

Heejoo Jo, Sandrah P. Eckel, Jiu Chiuan Chen, Myles Cockburn, Mayra P. Martinez, Ting Chow, Fred Lurmann, William E. Funk, Rob McConnell, Anny H. Xiang^*

^*Corresponding author for this work

Preventive Medicine

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: Studies of effects of air pollution on gestational diabetes mellitus (GDM) have not been consistent, and there has been little investigation of effects of exposure preceding pregnancy. In previous studies, the temporal relationship between exposure and GDM onset has been difficult to establish. Methods: Data were obtained for 239,574 pregnancies between 1999 and 2009 in a population-based health care system with comprehensive electronic medical records. Concentrations of ambient nitrogen dioxide (NO₂), particulate matter (PM) ≤2.5 μm in aerodynamic diameter (PM_2.5) and ≤10 μm (PM₁₀), and ozone (O₃) during preconception and the first trimester of pregnancy at the residential birth address were estimated from regulatory air monitoring stations. Odds ratios (ORs) of GDM diagnosed in the second and third trimesters in association with pollutant exposure were estimated using generalized estimating equation models adjusted for birth year, medical center service areas, maternal age, race/ethnicity, education, census-tract household income, and parity. Results: In single-pollutant models, preconception NO₂ was associated with increased risk of GDM (OR = 1.10 per 10.4 ppb, 95% confidence interval [CI]: 1.07, 1.13). First trimester NO₂ was weakly associated with GDM, and this was not statistically significant (OR = 1.02 per 10.4 ppb, 95% CI: 0.99, 1.05). Preconception NO₂ associations were robust in multi-pollutant models adjusted for first trimester NO₂ with another co-pollutant from both exposure windows. In single-pollutant models, preconception PM_2.5 and PM₁₀ associations were associated with increased risk of GDM (OR = 1.04 per 6.5 μg/m³, 95% CI: 1.01, 1.06; OR = 1.03 per 16.1 μg/m³, 95% CI: 1.00, 1.06, respectively), but these effect estimates were not robust to adjustment for other pollutants. In single-pollutant models, preconception and first trimester O₃ were associated with reduced risk of GDM (OR = 0.94 per 15.7 ppb, 95% CI: 0.92, 0.95; OR = 0.95 per 15.7 ppb, 95% CI: 0.94, 0.97), associations that were robust to adjustment for co-pollutants. Conclusions: Maternal exposure to NO₂ during the preconception trimester may increase risk of GDM.

Original language	English (US)
Article number	104933
Journal	Environment international
Volume	130
DOIs	https://doi.org/10.1016/j.envint.2019.104933
State	Published - Sep 2019

Funding

This research was supported by Kaiser Permanente Southern California Direct Community Benefit Funds; National Institute of Environmental Health Sciences (#5F31ES027340 [Jo], #R56ES028121 [Xiang]; P01ES022845, and U.S. Environmental Protection Agency RD-83544101 [McConnell]; and #5P30ES007048 [Southern California Environmental Health Sciences Center]); and University of Southern California Provost Scholarship Award (Jo). The authors thank the patients of Kaiser Permanente for helping us improve care through the use of information collected through our electronic health record systems. This research was supported by Kaiser Permanente Southern California Direct Community Benefit Funds; National Institute of Environmental Health Sciences (# 5F31ES027340 [Jo], # R56ES028121 [Xiang]; P01ES022845 , and U.S. Environmental Protection Agency RD-83544101 [McConnell]; and # 5P30ES007048 [ Southern California Environmental Health Sciences Center ]); and University of Southern California Provost Scholarship Award (Jo).

Keywords

Air pollution
Gestational diabetes mellitus
Preconception
Pregnancy

ASJC Scopus subject areas

General Environmental Science

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.envint.2019.104933

Cite this

@article{0a8d0f38a0424910acf0749621e4c7c3,

title = "Associations of gestational diabetes mellitus with residential air pollution exposure in a large Southern California pregnancy cohort",

abstract = "Background: Studies of effects of air pollution on gestational diabetes mellitus (GDM) have not been consistent, and there has been little investigation of effects of exposure preceding pregnancy. In previous studies, the temporal relationship between exposure and GDM onset has been difficult to establish. Methods: Data were obtained for 239,574 pregnancies between 1999 and 2009 in a population-based health care system with comprehensive electronic medical records. Concentrations of ambient nitrogen dioxide (NO2), particulate matter (PM) ≤2.5 μm in aerodynamic diameter (PM2.5) and ≤10 μm (PM10), and ozone (O3) during preconception and the first trimester of pregnancy at the residential birth address were estimated from regulatory air monitoring stations. Odds ratios (ORs) of GDM diagnosed in the second and third trimesters in association with pollutant exposure were estimated using generalized estimating equation models adjusted for birth year, medical center service areas, maternal age, race/ethnicity, education, census-tract household income, and parity. Results: In single-pollutant models, preconception NO2 was associated with increased risk of GDM (OR = 1.10 per 10.4 ppb, 95% confidence interval [CI]: 1.07, 1.13). First trimester NO2 was weakly associated with GDM, and this was not statistically significant (OR = 1.02 per 10.4 ppb, 95% CI: 0.99, 1.05). Preconception NO2 associations were robust in multi-pollutant models adjusted for first trimester NO2 with another co-pollutant from both exposure windows. In single-pollutant models, preconception PM2.5 and PM10 associations were associated with increased risk of GDM (OR = 1.04 per 6.5 μg/m3, 95% CI: 1.01, 1.06; OR = 1.03 per 16.1 μg/m3, 95% CI: 1.00, 1.06, respectively), but these effect estimates were not robust to adjustment for other pollutants. In single-pollutant models, preconception and first trimester O3 were associated with reduced risk of GDM (OR = 0.94 per 15.7 ppb, 95% CI: 0.92, 0.95; OR = 0.95 per 15.7 ppb, 95% CI: 0.94, 0.97), associations that were robust to adjustment for co-pollutants. Conclusions: Maternal exposure to NO2 during the preconception trimester may increase risk of GDM.",

keywords = "Air pollution, Gestational diabetes mellitus, Preconception, Pregnancy",

author = "Heejoo Jo and Eckel, {Sandrah P.} and Chen, {Jiu Chiuan} and Myles Cockburn and Martinez, {Mayra P.} and Ting Chow and Fred Lurmann and Funk, {William E.} and Rob McConnell and Xiang, {Anny H.}",

note = "Publisher Copyright: {\textcopyright} 2019",

year = "2019",

month = sep,

doi = "10.1016/j.envint.2019.104933",

language = "English (US)",

volume = "130",

journal = "Environment international",

issn = "0160-4120",

publisher = "Elsevier Limited",

}

TY - JOUR

T1 - Associations of gestational diabetes mellitus with residential air pollution exposure in a large Southern California pregnancy cohort

AU - Jo, Heejoo

AU - Eckel, Sandrah P.

AU - Chen, Jiu Chiuan

AU - Cockburn, Myles

AU - Martinez, Mayra P.

AU - Chow, Ting

AU - Lurmann, Fred

AU - Funk, William E.

AU - McConnell, Rob

AU - Xiang, Anny H.

PY - 2019/9

Y1 - 2019/9

N2 - Background: Studies of effects of air pollution on gestational diabetes mellitus (GDM) have not been consistent, and there has been little investigation of effects of exposure preceding pregnancy. In previous studies, the temporal relationship between exposure and GDM onset has been difficult to establish. Methods: Data were obtained for 239,574 pregnancies between 1999 and 2009 in a population-based health care system with comprehensive electronic medical records. Concentrations of ambient nitrogen dioxide (NO2), particulate matter (PM) ≤2.5 μm in aerodynamic diameter (PM2.5) and ≤10 μm (PM10), and ozone (O3) during preconception and the first trimester of pregnancy at the residential birth address were estimated from regulatory air monitoring stations. Odds ratios (ORs) of GDM diagnosed in the second and third trimesters in association with pollutant exposure were estimated using generalized estimating equation models adjusted for birth year, medical center service areas, maternal age, race/ethnicity, education, census-tract household income, and parity. Results: In single-pollutant models, preconception NO2 was associated with increased risk of GDM (OR = 1.10 per 10.4 ppb, 95% confidence interval [CI]: 1.07, 1.13). First trimester NO2 was weakly associated with GDM, and this was not statistically significant (OR = 1.02 per 10.4 ppb, 95% CI: 0.99, 1.05). Preconception NO2 associations were robust in multi-pollutant models adjusted for first trimester NO2 with another co-pollutant from both exposure windows. In single-pollutant models, preconception PM2.5 and PM10 associations were associated with increased risk of GDM (OR = 1.04 per 6.5 μg/m3, 95% CI: 1.01, 1.06; OR = 1.03 per 16.1 μg/m3, 95% CI: 1.00, 1.06, respectively), but these effect estimates were not robust to adjustment for other pollutants. In single-pollutant models, preconception and first trimester O3 were associated with reduced risk of GDM (OR = 0.94 per 15.7 ppb, 95% CI: 0.92, 0.95; OR = 0.95 per 15.7 ppb, 95% CI: 0.94, 0.97), associations that were robust to adjustment for co-pollutants. Conclusions: Maternal exposure to NO2 during the preconception trimester may increase risk of GDM.

AB - Background: Studies of effects of air pollution on gestational diabetes mellitus (GDM) have not been consistent, and there has been little investigation of effects of exposure preceding pregnancy. In previous studies, the temporal relationship between exposure and GDM onset has been difficult to establish. Methods: Data were obtained for 239,574 pregnancies between 1999 and 2009 in a population-based health care system with comprehensive electronic medical records. Concentrations of ambient nitrogen dioxide (NO2), particulate matter (PM) ≤2.5 μm in aerodynamic diameter (PM2.5) and ≤10 μm (PM10), and ozone (O3) during preconception and the first trimester of pregnancy at the residential birth address were estimated from regulatory air monitoring stations. Odds ratios (ORs) of GDM diagnosed in the second and third trimesters in association with pollutant exposure were estimated using generalized estimating equation models adjusted for birth year, medical center service areas, maternal age, race/ethnicity, education, census-tract household income, and parity. Results: In single-pollutant models, preconception NO2 was associated with increased risk of GDM (OR = 1.10 per 10.4 ppb, 95% confidence interval [CI]: 1.07, 1.13). First trimester NO2 was weakly associated with GDM, and this was not statistically significant (OR = 1.02 per 10.4 ppb, 95% CI: 0.99, 1.05). Preconception NO2 associations were robust in multi-pollutant models adjusted for first trimester NO2 with another co-pollutant from both exposure windows. In single-pollutant models, preconception PM2.5 and PM10 associations were associated with increased risk of GDM (OR = 1.04 per 6.5 μg/m3, 95% CI: 1.01, 1.06; OR = 1.03 per 16.1 μg/m3, 95% CI: 1.00, 1.06, respectively), but these effect estimates were not robust to adjustment for other pollutants. In single-pollutant models, preconception and first trimester O3 were associated with reduced risk of GDM (OR = 0.94 per 15.7 ppb, 95% CI: 0.92, 0.95; OR = 0.95 per 15.7 ppb, 95% CI: 0.94, 0.97), associations that were robust to adjustment for co-pollutants. Conclusions: Maternal exposure to NO2 during the preconception trimester may increase risk of GDM.

KW - Air pollution

KW - Gestational diabetes mellitus

KW - Preconception

KW - Pregnancy

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Associations of gestational diabetes mellitus with residential air pollution exposure in a large Southern California pregnancy cohort

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UN SDGs

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