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Human epidemiological evidence about the association between air pollution exposure and gestational diabetes mellitus: Systematic review and meta-analysis.
Environ Res. 2020 01; 180:108843.ER

Abstract

BACKGROUND

Previous studies have shown that ambient air pollution exposure can increase the risk of type 2 diabetes mellitus (T2DM) significantly. In consideration of the common underlying pathophysiologic mechanisms, exposure to air pollution may also increase the risk of gestational diabetes mellitus (GDM), but the current evidence was inconsistent and has not well been systematically reviewed. Our goal was to perform a systematic review and meta-analysis assessing the association between air pollution exposure and GDM.

METHODS

An extensive literature search was conducted in selected electronic databases for related human epidemiological studies published in English language. Summary effect estimates were calculated using random-effect models for a) risk per unit increase in continuous air pollutant concentration and b) risk of high versus low exposure level in individual study if each exposure that had been examined in ≥2 studies. We evaluated the heterogeneity using Cochran's Q test and quantified it by I2 statistic. Publication bias was also evaluated through the funnel plot when sufficient number of studies are available.

RESULTS

A total of 11 studies evaluating the association between GDM and exposure to air pollution were identified finally. The summary odds ratio (OR) for incidence of GDM following a 10 μg/m3 increase in PM2.5 exposure during the second trimester was 1.04 (95% Confidence Interval (CI): 1.01, 1.09) and in NOx during the first trimester was 1.03 (95%CI: 1.00, 1.07) per 10 ppb increase, while for high versus low SO2 exposure during the second trimester was 1.25 (95%CI: 1.02, 1.53). High heterogeneity among study-specific results in majority of the analyses were observed, and attributed to different exposure assessment methods, populations, study locations, and covariates adjustment. Publication bias cannot be excluded because of the inclusion of small number of studies.

CONCLUSIONS

The present study supports the evidence that air pollution exposure increases the risk the GDM, albeit the existence of high heterogeneity. Further studies are necessary to elaborate the suggestive associations. These results are of public health significance since worsening air pollution in developing countries has been expected to increase the risk of GDM development.

Authors+Show Affiliations

Department of Humanistic Medicine, School of Humanistic Medicine, Anhui Medical University, 81# Meishan Road, Hefei, 230032, China; Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81# Meishan Road, Hefei, 230032, China.Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678# Furong Road, Hefei, 230601, China.Department of Public Health, Erasmus MC University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands.Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81# Meishan Road, Hefei, 230032, China.Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81# Meishan Road, Hefei, 230032, China.Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81# Meishan Road, Hefei, 230032, China.Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81# Meishan Road, Hefei, 230032, China.Department of Obstetrics and Gynecology, Maternal and Child Health Hospital Affiliated to Anhui Medical University, 15# Yimin Road, Hefei, 230001, China.Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678# Furong Road, Hefei, 230601, China. Electronic address: jiangzhengxuan@ahmu.edu.cn.Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81# Meishan Road, Hefei, 230032, China. Electronic address: zhangxiujun@ahmu.edu.cn.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

31670082

Citation

Hu, Cheng-Yang, et al. "Human Epidemiological Evidence About the Association Between Air Pollution Exposure and Gestational Diabetes Mellitus: Systematic Review and Meta-analysis." Environmental Research, vol. 180, 2020, p. 108843.
Hu CY, Gao X, Fang Y, et al. Human epidemiological evidence about the association between air pollution exposure and gestational diabetes mellitus: Systematic review and meta-analysis. Environ Res. 2020;180:108843.
Hu, C. Y., Gao, X., Fang, Y., Jiang, W., Huang, K., Hua, X. G., Yang, X. J., Chen, H. B., Jiang, Z. X., & Zhang, X. J. (2020). Human epidemiological evidence about the association between air pollution exposure and gestational diabetes mellitus: Systematic review and meta-analysis. Environmental Research, 180, 108843. https://doi.org/10.1016/j.envres.2019.108843
Hu CY, et al. Human Epidemiological Evidence About the Association Between Air Pollution Exposure and Gestational Diabetes Mellitus: Systematic Review and Meta-analysis. Environ Res. 2020;180:108843. PubMed PMID: 31670082.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Human epidemiological evidence about the association between air pollution exposure and gestational diabetes mellitus: Systematic review and meta-analysis. AU - Hu,Cheng-Yang, AU - Gao,Xiang, AU - Fang,Yuan, AU - Jiang,Wen, AU - Huang,Kai, AU - Hua,Xiao-Guo, AU - Yang,Xiao-Jing, AU - Chen,Hong-Bo, AU - Jiang,Zheng-Xuan, AU - Zhang,Xiu-Jun, Y1 - 2019/10/21/ PY - 2019/06/13/received PY - 2019/10/17/revised PY - 2019/10/18/accepted PY - 2019/11/2/pubmed PY - 2020/9/5/medline PY - 2019/11/1/entrez KW - Air pollution KW - Gestational diabetes mellitus KW - Meta-analysis KW - Systematic review SP - 108843 EP - 108843 JF - Environmental research JO - Environ. Res. VL - 180 N2 - BACKGROUND: Previous studies have shown that ambient air pollution exposure can increase the risk of type 2 diabetes mellitus (T2DM) significantly. In consideration of the common underlying pathophysiologic mechanisms, exposure to air pollution may also increase the risk of gestational diabetes mellitus (GDM), but the current evidence was inconsistent and has not well been systematically reviewed. Our goal was to perform a systematic review and meta-analysis assessing the association between air pollution exposure and GDM. METHODS: An extensive literature search was conducted in selected electronic databases for related human epidemiological studies published in English language. Summary effect estimates were calculated using random-effect models for a) risk per unit increase in continuous air pollutant concentration and b) risk of high versus low exposure level in individual study if each exposure that had been examined in ≥2 studies. We evaluated the heterogeneity using Cochran's Q test and quantified it by I2 statistic. Publication bias was also evaluated through the funnel plot when sufficient number of studies are available. RESULTS: A total of 11 studies evaluating the association between GDM and exposure to air pollution were identified finally. The summary odds ratio (OR) for incidence of GDM following a 10 μg/m3 increase in PM2.5 exposure during the second trimester was 1.04 (95% Confidence Interval (CI): 1.01, 1.09) and in NOx during the first trimester was 1.03 (95%CI: 1.00, 1.07) per 10 ppb increase, while for high versus low SO2 exposure during the second trimester was 1.25 (95%CI: 1.02, 1.53). High heterogeneity among study-specific results in majority of the analyses were observed, and attributed to different exposure assessment methods, populations, study locations, and covariates adjustment. Publication bias cannot be excluded because of the inclusion of small number of studies. CONCLUSIONS: The present study supports the evidence that air pollution exposure increases the risk the GDM, albeit the existence of high heterogeneity. Further studies are necessary to elaborate the suggestive associations. These results are of public health significance since worsening air pollution in developing countries has been expected to increase the risk of GDM development. SN - 1096-0953 UR - https://www.unboundmedicine.com/medline/citation/31670082/Human_epidemiological_evidence_about_the_association_between_air_pollution_exposure_and_gestational_diabetes_mellitus:_Systematic_review_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0013-9351(19)30640-1 DB - PRIME DP - Unbound Medicine ER -