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Gestational diabetes mellitus, prenatal air pollution exposure, and autism spectrum disorder.
Environ Int. 2019 12; 133(Pt A):105110.EI

Abstract

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.

Authors+Show Affiliations

Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America.Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America.Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America.Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America; Department of Epidemiology, University of Colorado School of Public Health, United States of America.Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America.Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America.Sonoma Technology, Inc., Petaluma, CA, United States of America.Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America.Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America.Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America. Electronic address: rmcconne@usc.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31610366

Citation

Jo, Heejoo, et al. "Gestational Diabetes Mellitus, Prenatal Air Pollution Exposure, and Autism Spectrum Disorder." Environment International, vol. 133, no. Pt A, 2019, p. 105110.
Jo H, Eckel SP, Chen JC, et al. Gestational diabetes mellitus, prenatal air pollution exposure, and autism spectrum disorder. Environ Int. 2019;133(Pt A):105110.
Jo, H., Eckel, S. P., Chen, J. C., Cockburn, M., Martinez, M. P., Chow, T., Lurmann, F. W., Funk, W. E., Xiang, A. H., & McConnell, R. (2019). Gestational diabetes mellitus, prenatal air pollution exposure, and autism spectrum disorder. Environment International, 133(Pt A), 105110. https://doi.org/10.1016/j.envint.2019.105110
Jo H, et al. Gestational Diabetes Mellitus, Prenatal Air Pollution Exposure, and Autism Spectrum Disorder. Environ Int. 2019;133(Pt A):105110. PubMed PMID: 31610366.
* Article titles in AMA citation format should be in sentence-case
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, Y1 - 2019/10/11/ PY - 2019/06/14/received PY - 2019/08/10/revised PY - 2019/08/19/accepted PY - 2019/10/15/pubmed PY - 2020/2/27/medline PY - 2019/10/15/entrez KW - Air pollution KW - Autism KW - Gestational diabetes mellitus KW - Pregnancy SP - 105110 EP - 105110 JF - Environment international JO - Environ Int VL - 133 IS - Pt A 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. SN - 1873-6750 UR - https://www.unboundmedicine.com/medline/citation/31610366/Gestational_diabetes_mellitus_prenatal_air_pollution_exposure_and_autism_spectrum_disorder_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0160-4120(19)31937-3 DB - PRIME DP - Unbound Medicine ER -