围孕期空气污染物暴露与妊娠期糖尿病的关联研究

Prospective cohort study on association between peri-conceptional air pollution exposure and gestational diabetes mellitus

目的探讨围孕期主要空气污染物暴露与妊娠期糖尿病(GDM)的关联。方法2015年3月至2018年4月,在合肥市第一人民医院、安徽医科大学第一附属医院和安徽省妇幼保健院招募4 817名孕妇为研究对象。通过问卷调查收集人口学特征、健康状况和生活方式等信息,根据《中国2型糖尿病防治指南(2017版)》诊断GDM。采用多因素logistic回归模型分别分析孕前期(孕前12周)和孕早期(末次月经至孕12周)空气污染物(PM2.5、PM10、SO2、NO2、CO)月平均浓度值和高浓度污染物暴露时间与GDM患病的关联。结果研究对象年龄为(29.14±4.19)岁,GDM的患病率为21.4%(1 030例)。多因素logistic回归模型分析结果显示,调整相关混杂因素后,与孕前期不处于高浓度污染物暴露期相比,随高浓度污染物暴露时间的延长,GDM发生风险逐步增加(χ^2=61.28,P趋势<0.001),暴露时间为1、2和3个月的OR(95%CI)值分别为1.42(1.10~1.84)、1.73(1.29~2.33)和2.51(1.75~3.59)。孕前期PM2.5和PM10月平均浓度值分别每升高10 μg/m^3,GDM的患病风险OR(95%CI)值分别为1.14(1.08~1.20)、1.13(1.08~1.19);SO2和CO分别每增加1 μg/m^3和0.10 mg/m^3,GDM的患病风险OR(95%CI)值分别为1.03(1.01~1.05)、1.07(1.01~1.13)。孕早期SO2月平均浓度值每增加1 μg/m^3,GDM的患病风险OR(95%CI)值为1.02(1.01~1.05)。结论孕前期PM2.5、PM10、SO2和CO暴露和孕早期SO2暴露与GDM患病风险间有关联。

Objective To explore the association between the exposure to major air pollutants in pre-pregnancy and early pregnancy (peri-conceptional period) and gestational diabetes mellitus (GDM). Methods From March 2015 to April 2018, 4 817 pregnancies were recruited at three prenatal check-ups hospital in Hefei (Hefei First People′s Hospital, Hefei. Maternal and Child Care Hospital and the First Affiliated Hospital of Anhui Medical University), China. Questionnaire was used to collect the demographic data, the health status and lifestyle of pregnant women. GDM was diagnosed according to the Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2017 Edition). Logistic regression was used to investigate the association of exposure to major air pollutants (PM2.5, PM10, SO2, CO and NO2) during different periods of pre-pregnancy (12 weeks before pregnancy) and first trimester (12 weeks after last menstruation) and duration of exposure to high levels of pollutants with GDM. Results The mean±SD of the age of subjects was (29.14±4.19) years old and the prevalence of GDM was 21.4%(n=1 030). The results of multivariate logistic regression analysis showed that after adjusting for confounding factors, the risk of GDM increased gradually with the prolonged exposure time of high-concentration pollutants compared with pregnant women who were not exposed to high pollution during the pre-pregnancy (χ^2=61.28, Ptrend<0.001) with the OR (95%CI) values for exposure time of 1, 2, and 3 months about 1.42 (1.10-1.84), 1.73 (1.29-2.33), and 2.51 (1.75-3.59), respectively. In the pre-pregnancy period, in every 10 μg/m^3 increase of PM2.5 and PM10, the OR (95%CI) values of GDM were 1.14 (1.08-1.20) and 1.13 (1.08-1.19), respectively;for each increase of 1 μg/m^3 and 0.10 mg/m^3 of SO2 and CO, the OR (95% CI) values of GDM were 1.03 (1.01-1.05) and 1.07 (1.01-1.13), respectively. For every 1 μg/m^3 increase in the average concentration of SO2 in the first trimester, the OR (95%CI) value of GDM was 1.02 (1.01-1.05). Conclusion PM2.5, PM10, SO2 and CO exposure during the pre-pregnancy and SO2 exposure in first trimester were positively correlated with the risk of GDM.