Air pollution exposure and risk of adverse obstetric and neonatal outcomes among women with type 1 diabetes
04/2021
Journal Article
Authors:
Williams, A. D.;
Kanner, J.;
Grantz, K. L.;
Ouidir, M.;
Sheehy, S.;
Sherman, S.;
Robledo, C.;
Mendola, P.
Volume:
197
Journal:
Environ Res
PMID:
33844969
URL:
https://www.ncbi.nlm.nih.gov/pubmed/33844969
DOI:
10.1016/j.envres.2021.111152
Keywords:
*Air Pollutants/analysis/toxicity *Air Pollution/adverse effects/analysis *Diabetes Mellitus, Type 1/chemically induced/epidemiology Female Humans Infant Infant, Newborn Maternal Exposure/adverse effects Nitrogen Dioxide/analysis/toxicity
Particulate Matter/analysis/toxicity Pregnancy *Premature Birth Air pollution Neonatal Obstetrics Type 1 diabetes
Abstract:
AIMS/HYPOTHESIS: Women with type 1 diabetes have increased risk for poor obstetric outcomes. Prenatal air pollution exposure is also associated with adverse outcomes for women and infants. We examined whether women with type 1 diabetes are more vulnerable than other women to pollution-associated risks during pregnancy. METHODS: In singleton deliveries from the Consortium on Safe Labor (2002-2008), obstetric and neonatal outcomes were compared for women with type 1 diabetes (n = 507) and women without autoimmune disease (n = 204,384). Preconception, trimester, and whole pregnancy average air pollutant exposure (ozone (O(3)), carbon monoxide (CO), particulate matter >10 mum (PM(10)), PM > 2.5 mum (PM(2.5)), sulfur dioxide (SO(2)), nitrogen oxides (NO(x))) were estimated using modified Community Multiscale Air Quality models. Poisson regression models with diabetes*pollutant interaction terms estimated relative risks and 95% confidence intervals for adverse outcomes, adjusted for maternal characteristics and geographic region. RESULTS: For whole pregnancy exposure to SO(2), women with type 1 diabetes had 15% increased risk (RR:1.15 95%CI:1.01,1.31) and women without autoimmune disease had 5% increased risk (RR:1.05 95%CI:1.05,1.06) for small for gestational age birth (p(interaction) = 0.09). Additionally, whole pregnancy O(3) exposure was associated with 10% increased risk (RR:1.10 95%CI:1.02,1.17) among women with type 1 diabetes and 2% increased risk (RR:1.02 95%CI:1.00,1.04) among women without autoimmune disease for perinatal mortality (p(interaction) = 0.08). Similar patterns were observed between PM(2.5) exposure and spontaneous preterm birth. CONCLUSIONS: Pregnant women with type 1 diabetes may be at greater risk for adverse outcomes when exposed to air pollution than women without autoimmune disease.