Association of Atmospheric Particulate Matter and Ozone With Gestational Diabetes Mellitus

Hui Hu; Sandie Ha; Barron H. Henderson; Tamara D. Warner; Jeffrey Roth; Haidong Kan; Xiaohui Xu

Environ Health Perspect. 2015;123(9):853-859.

Conclusion

Using Florida birth vital statistics records, we observed a positive association between increased prevalence of GDM and exposure to PM_2.5 and O₃ during each trimester of pregnancy and the full pregnancy among women giving birth in 2004 and 2005. This study suggests the need for greater attention on stronger air pollution controls to improve the health of pregnant women and their offspring.

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This work was supported by grant K01ES019177 from the National Institute of Environmental Health Sciences, National Institutes of Health (NIEHS/NIH). The data were provided by the Bureau of Vital Statistics, Florida Department of Health (DOH).

All conclusions are the authors' own and do not necessarily reflect the opinion of the NIEHS/NIH or the Florida DOH.

Table 1. Exposure information concerning PM _2.5 and O ₃ by GDM status among women who gave birth in 2004–2005 in Florida, USA ( n = 14,032 with GDM, n = 396,235 without GDM, and total n = 410,267).
Exposure/statistics	Trimester 1			Trimester 2			Full pregnancy
Exposure/statistics	GDM	No GDM	Total	GDM	No GDM	Total	GDM	No GDM	Total
PM_2.5 (μg/m³)
Mean ± SD	9.84 ± 2.16	9.72 ± 2.07	9.73 ± 2.07	9.94 ± 2.09	9.88 ± 2.06	9.88 ± 2.06	10.03 ± 1.71	9.93 ± 1.67	9.93 ± 1.67
Median	9.75	9.64	9.65	9.87	9.76	9.76	9.97	9.90	9.91
IQR	2.68	2.61	2.61	2.63	2.61	2.61	2.06	2.02	2.02
O₃ (ppb)
Mean ± SD	37.71 ± 6.14	37.20 ± 6.04	37.22 ± 6.04	38.17 ± 6.10	37.52 ± 6.10	37.54 ± 6.10	37.85 ± 4.01	37.38 ± 4.10	37.40 ± 4.10
Median	36.73	36.48	36.48	37.65	36.92	36.95	38.40	37.82	37.84
IQR	8.24	7.82	7.83	8.46	7.99	8.00	6.94	7.10	7.09
Correlation between PM_2.5 and O₃	0.39	0.39	0.39	0.35	0.34	0.34	0.21	0.22	0.22

IQR, interquartile range.

Table 2. Maternal characteristics by GDM status among women who gave birth in 2004–2005 in Florida, USA [ n (%)].
Maternal characteristic	GDM (n = 14,032)	No GDM (n = 396,235)	Total (n = 410,267)
Maternal age (years)
< 20	451 (3.2)	44,064 (11.1)	44,515 (10.9)
20–24	2,125 (15.1)	103,600 (26.2)	105,725 (25.8)
25–29	3,466 (24.7)	103,679 (26.2)	107,145 (26.1)
30–34	4,265 (30.4)	87,758 (22.2)	92,023 (22.4)
35–39	2,844 (20.3)	44,608 (11.3)	47,452 (11.6)
≥ 40	880 (6.3)	12,482 (3.2)	13,362 (3.3)
Missing	1 (0.0)	44 (0.0)	45 (0.0)
Race/ethnicity
Non-Hispanic white	6,674 (47.6)	188,029 (47.5)	194,703 (47.5)
Non-Hispanic black	2,041 (14.6)	70,355 (17.8)	72,396 (17.7)
Mexican American	1,253 (8.9)	28,370 (7.2)	29,623 (7.2)
Puerto Rican	634 (4.5)	18,831 (4.8)	19,465 (4.7)
Cuban American	590 (4.2)	20,123 (5.1)	20,713 (5.1)
Haitian American	541 (3.9)	12,573 (3.2)	13,114 (3.2)
Other	2,299 (16.4)	57,948 (14.6)	60,247 (14.7)
Missing	0 (0.0)	6 (0.0)	6 (0.0)
Maternal education
< High school	2,524 (18.0)	83,066 (21.0)	85,590 (20.9)
High school or equivalent	4,207 (30.0)	126,013 (31.8)	130,220 (31.7)
> High school	7,213 (51.4)	183,423 (46.3)	190,636 (46.5)
Missing	88 (0.6)	3,733 (0.9)	3,821 (0.9)
Marital status
Married	9,697 (69.1)	232,727 (58.7)	242,424 (59.1)
Not married	4,335 (30.9)	163,425 (41.2)	167,760 (40.9)
Missing	0 (0.0)	83 (0.0)	83 (0.0)
Smoking during pregnancy
No	12,769 (91.0)	360,016 (90.9)	372,785 (90.9)
Yes, < 10 cigarettes/day	483 (3.4)	14,163 (3.6)	14,646 (3.6)
Yes, ≥ 10 cigarettes/day	581 (4.1)	16,852 (4.3)	17,433 (4.3)
Missing	199 (1.4)	5,204 (1.3)	5,403 (1.3)
Season of conception
Warm	6,942 (49.5)	192,430 (48.6)	199,372 (48.6)
Cool	7,090 (50.5)	203,805 (51.4)	210,895 (51.4)
Year of conception
2003	4,131 (29.4)	142,945 (36.1)	147,076 (35.9)
2004	7,479 (53.3)	199,682 (50.4)	207,161 (50.5)
2005	2,422 (17.3)	53,608 (13.5)	56,030 (13.7)
Prenatal care began
No care	59 (0.4)	4,987 (1.3)	5,046 (1.2)
First trimester	7,698 (54.9)	188,869 (47.7)	196,567 (47.9)
Second trimester	2,022 (14.4)	57,504 (14.5)	59,526 (14.5)
Third trimester	570 (4.1)	14,115 (3.6)	14,685 (3.6)
Missing	3,683 (26.3)	130,760 (33.0)	134,443 (32.8)
Residential area
Urban	12,017 (85.6)	342,936 (86.6)	354,953 (86.5)
Rural	2,015 (14.4)	53,299 (13.5)	55,314 (13.5)
Median household income (US$)
< 29,663	3,326 (23.7)	99,224 (25.0)	102,550 (25.0)
29,663–38,056	3,494 (24.9)	99,047 (25.0)	102,541 (25.0)
38,056–49,375	3,648 (26.0)	98,825 (24.9)	102,473 (25.0)
≥ 49,375	3,564 (25.4)	99,139 (25.0)	102,703 (25.0)

Table 3. ORs (95% CIs) for risk of GDM by air pollutants (PM _2.5 and O ₃) and pregnancy period of exposure among women who gave birth in 2004–2005 in Florida, USA.
Exposure	n (GDM/total)	Unadjusted OR (95% CI)	n (GDM/total)^a	Adjusted OR^b (95% CI)
PM_2.5 (per 5 μg/m³)
Trimester 1	14,032/410,267	1.15 (1.10, 1.19)	13,943/406,334	1.16 (1.11, 1.21)
Trimester	2 14,032/410,267	1.08 (1.04, 1.12)	13,943/406,334	1.15 (1.10, 1.20)
Full pregnancy	14,032/410,267	1.19 (1.13, 1.25)	13,943/406,334	1.20 (1.13, 1.26)
O₃ (per 5 ppb)
Trimester	1 14,032/410,267	1.07 (1.06, 1.09)	13,943/406,334	1.09 (1.07, 1.11)
Trimester 2	14,032/410,267	1.09 (1.08, 1.10)	13,943/406,334	1.12 (1.10, 1.14)
Full pregnancy	14,032/410,267	1.16 (1.13, 1.18)	13,943/406,334	1.18 (1.15, 1.21)

^aWomen with complete data for all covariates. ^bAdjusted for maternal age, race, education, marital status, season of conception, year of conception, prenatal care began, urbanization, and median household income.