TY - JOUR
T1 - Gestational diabetes mellitus, prenatal air pollution exposure, and autism spectrum disorder
AU - Jo, Heejoo
AU - Eckel, Sandrah P.
AU - Chen, Jiu Chiuan
AU - Cockburn, Myles
AU - Martinez, Mayra P.
AU - Chow, Ting
AU - Lurmann, Frederick W.
AU - Funk, William E.
AU - Xiang, Anny H.
AU - McConnell, Rob
N1 - Funding Information:
This research was supported by Kaiser Permanente Southern California Direct Community Benefit Funds ; National Institute of Environmental Health Sciences (# 5F31ES027340 [Jo]; # R01ES029963 [McConnell, Xiang]; # 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).
Publisher Copyright:
© 2019 The Authors
PY - 2019/12
Y1 - 2019/12
N2 - Background: Ambient air pollution and maternal diabetes may affect common biological pathways underlying adverse neurodevelopmental effects. However, joint effects of maternal diabetes and air pollution on autism spectrum disorder (ASD) have not been studied. Objective: We evaluated whether prenatal and early-life air pollution exposure interacts with maternal diabetes status to affect ASD risk. Methods: This retrospective cohort study included 246,420 singleton children born in Kaiser Permanente Southern California hospitals in 1999–2009. Children were followed from birth until age 5, during which 2471 ASD cases were diagnosed. Ozone (O3), particulate matter < 2.5 μm (PM2.5) and <10 μm in aerodynamic diameter, and nitrogen dioxide measured at regulatory air monitoring stations were interpolated to estimate exposures during preconception and each pregnancy trimester, and first year of life at each child's birth address. Hazard ratios (HRs) for ASD were estimated adjusting for birth year, KPSC service areas, and relevant maternal and child characteristics. For each exposure window, interactions were tested between pollutants and a 4-category maternal diabetes variable (none, GDM ≥ 24 and <24 weeks' gestation, and pre-existing type 2 diabetes). For an exposure window with statistically significant global interaction between pollutant and diabetes (p < 0.05), pollutant-associated HRs were estimated separately for each category of maternal diabetes. Results: There were associations of ASD with preconception, first and third trimesters, and first year of life PM2.5, but not with other pollutants. There were, however, interactions of maternal diabetes with first trimester and first year of life O3. Increased ASD risk was associated with first trimester O3 among mothers with GDM < 24 weeks' gestation [adjusted HR 1.50 per 15.7 ppb O3 (95% CI: 1.08–2.09)]. No O3 associations with ASD were observed in other categories of maternal diabetes. Conclusions: GDM onset early in pregnancy may increase children's susceptibility to prenatal O3-associated ASD risk. These novel findings merit further investigation.
AB - Background: Ambient air pollution and maternal diabetes may affect common biological pathways underlying adverse neurodevelopmental effects. However, joint effects of maternal diabetes and air pollution on autism spectrum disorder (ASD) have not been studied. Objective: We evaluated whether prenatal and early-life air pollution exposure interacts with maternal diabetes status to affect ASD risk. Methods: This retrospective cohort study included 246,420 singleton children born in Kaiser Permanente Southern California hospitals in 1999–2009. Children were followed from birth until age 5, during which 2471 ASD cases were diagnosed. Ozone (O3), particulate matter < 2.5 μm (PM2.5) and <10 μm in aerodynamic diameter, and nitrogen dioxide measured at regulatory air monitoring stations were interpolated to estimate exposures during preconception and each pregnancy trimester, and first year of life at each child's birth address. Hazard ratios (HRs) for ASD were estimated adjusting for birth year, KPSC service areas, and relevant maternal and child characteristics. For each exposure window, interactions were tested between pollutants and a 4-category maternal diabetes variable (none, GDM ≥ 24 and <24 weeks' gestation, and pre-existing type 2 diabetes). For an exposure window with statistically significant global interaction between pollutant and diabetes (p < 0.05), pollutant-associated HRs were estimated separately for each category of maternal diabetes. Results: There were associations of ASD with preconception, first and third trimesters, and first year of life PM2.5, but not with other pollutants. There were, however, interactions of maternal diabetes with first trimester and first year of life O3. Increased ASD risk was associated with first trimester O3 among mothers with GDM < 24 weeks' gestation [adjusted HR 1.50 per 15.7 ppb O3 (95% CI: 1.08–2.09)]. No O3 associations with ASD were observed in other categories of maternal diabetes. Conclusions: GDM onset early in pregnancy may increase children's susceptibility to prenatal O3-associated ASD risk. These novel findings merit further investigation.
KW - Air pollution
KW - Autism
KW - Gestational diabetes mellitus
KW - Pregnancy
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U2 - 10.1016/j.envint.2019.105110
DO - 10.1016/j.envint.2019.105110
M3 - Article
C2 - 31610366
AN - SCOPUS:85073021028
SN - 0160-4120
VL - 133
JO - Environment international
JF - Environment international
M1 - 105110
ER -
