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Environ Res. 2019 Mar;170:160-167. doi: 10.1016/j.envres.2018.12.031. Epub 2018 Dec 15.

Prenatal exposure to air pollution, maternal diabetes and preterm birth.

Author information

1
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA. Electronic address: amy.padula@ucsf.edu.
2
Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
3
Sonoma Technology, Inc., Petaluma, CA, USA.
4
Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
5
Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.

Abstract

Prenatal exposure to ambient air pollution has been associated with preterm birth in several studies. Associations between air pollution and gestational or pre-existing diabetes have been hypothesized but are not well established. We examined the association between air pollution exposure in pregnancy and gestational diabetes and whether the association between air pollution and preterm birth is modified by diabetes (gestational or pre-existing) in a highly polluted area of California. Birth certificates and hospital discharge data from all singleton births from 2000 to 2006 to women living in four counties in the San Joaquin Valley of California were linked to criteria air pollution and traffic density measurements at the geocoded maternal residence. Air pollutants were dichotomized at the highest quartile and compared to the lower three quartiles. Logistic regression models were adjusted for maternal race-ethnicity, age, education, payment of birth expenses, and prenatal care. There were consistent inverse associations between exposure to air pollution during the first two trimesters and gestational diabetes (statistically significant odds ratios (OR) less than 1). When stratified by any diabetes (gestational or pre-existing), associations between air pollution exposure during pregnancy and categories of preterm birth (20-27, 28-31, 32-33, 34-36 weeks) were generally similar with few exceptions of exposures to carbon monoxide (CO) and particulate matter < 2.5 µm (PM2.5). Those with diabetes and exposure higher levels of CO (in first trimester or entire pregnancy) or PM2.5 (in first trimester) had higher risk of extremely preterm birth (20-27 weeks) compared with those without diabetes. The associations between traffic-related air pollution and gestational diabetes were in the unexpected ("protective") direction. Among those with any diabetes, associations were stronger between CO and PM2.5 and extremely preterm birth.

KEYWORDS:

Air pollution; Diabetes; Pregnancy; Preterm birth

PMID:
30579990
PMCID:
PMC6373725
[Available on 2020-03-01]
DOI:
10.1016/j.envres.2018.12.031

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