Association between exposure to air pollution during preconception and risk of gestational diabetes mellitus: The role of anti-inflammatory diet

Authors：Ping Zu , Liqi Zhou , Wanjun Yin , Lei Zhang , Haixia Wang , Jirong Xu , Xiaomin Jiang , Ying Zhang , Ruixue Tao , Peng Zhu

Source：Environ Res. 2023 Jul 19;235:116561

DOI: 10.1016/j.envres.2023.116561

Abstract：

Background: Regarding the association between the sensitive time-windows of air pollution (AP) exposure and gestational diabetes mellitus (GDM), epidemiological findings are inconsistent. The dietary inflammatory potential has been implicated in the development of GDM, but it is unclear whether an anti-inflammatory diet during pregnancy reduces the association between AP and GDM.

Objective: We aimed to characterize the sensitive time-windows of AP to GDM risk. Further, to verify whether a maternal anti-inflammatory diet can reduce the risk of AP-induced GDM, by inhibiting inflammation.

Methods: A total of 8495 pregnant women were included between 2015 and 2021 in the Maternal & Infants Health in Hefei study. Weekly mean AP exposure to fine particles (PM2.5and PM10), SO2, and NO2was estimated from the data of Hefei City Ecology and Environment Bureau. High-sensitivity C-reactive protein (hs-CRP) concentrations were measured to evaluate systemic inflammation. The empirical dietary inflammatory pattern (EDIP) score based on a validated food frequency questionnaire was used to assess the dietary inflammatory potential of pregnant women. Logistic regression models with distributed lags were used to identify the sensitive time-window for the effect of AP on GDM. Mediation analysis estimated the mediated effect of hs-CRP, linking AP with GDM. Stratified analysis was used to investigate the potential effect of anti-inflammatory diet on GDM risk.

Results: The increased risks of GDM were found to be positively associated with exposure to PM2.5(OR = 1.11, 95% CI:1.07-1.15), PM10(OR = 1.12, 95% CI:1.09-1.16), and SO2(OR = 1.42, 95% CI:1.25-1.60) by distributed lag models, and the critical exposure windows were 21st to 28th weeks of preconception. The proportion of association between PM2.5,PM10,and SO2with GDM mediated by hs-CRP was 25.9%, 21.1%, and 19.4%, respectively, according to mediation analysis. In the stratified analyses by EDIP, the association between AP and GDM was not statistically significant among women those with anti-inflammatory diets.

Conclusions: Exposure to AP, especially in 21st to 28th week of preconception, is associated with risk of GDM, which is partly mediated by hs-CRP. Adherence to the anti-inflammatory dietary pattern may reduce the risk of AP-induced GDM.

摘要：

背景：关于空气污染（AP）暴露的敏感时间窗与妊娠糖尿病（GDM）之间的关系，流行病学研究结果并不一致。膳食中的炎症潜能被认为与 GDM 的发生有关，但尚不清楚孕期抗炎饮食是否会降低空气污染与 GDM 之间的关联。

目的：我们旨在确定 AP 与 GDM 风险之间的敏感时间窗。此外，我们还想验证母体抗炎饮食是否能通过抑制炎症来降低 AP 诱发 GDM 的风险。

方法：合肥市母婴健康研究共纳入了2015年至2021年间的8495名孕妇。根据合肥市生态环境局的数据估算了细颗粒物（PM2.5和PM10）、二氧化硫和二氧化氮的每周平均AP暴露量。测量高敏C反应蛋白（hs-CRP）浓度以评估全身炎症。根据有效的食物频率问卷调查得出的经验膳食炎症模式（EDIP）评分用于评估孕妇的膳食炎症潜力。采用分布式滞后的逻辑回归模型来确定 AP 对 GDM 影响的敏感时间窗。中介分析估计了 hs-CRP 的中介效应，将 AP 与 GDM 联系起来。分层分析用于研究抗炎饮食对 GDM 风险的潜在影响。

结果：通过分布式滞后模型发现，GDM风险的增加与暴露于PM2.5（OR = 1.11，95% CI:1.07-1.15）、PM10（OR = 1.12，95% CI:1.09-1.16）和SO2（OR = 1.42，95% CI:1.25-1.60）呈正相关，临界暴露窗口为孕前第21周至第28周。根据中介分析，PM2.5、PM10和SO2与GDM之间的关系由hs-CRP中介的比例分别为25.9%、21.1%和19.4%。在按EDIP进行的分层分析中，在采用抗炎饮食的妇女中，AP与GDM之间的关系没有统计学意义。

结论：接触 AP（尤其是在孕前第 21 至 28 周）与 GDM 风险有关，而这在一定程度上是由 hs-CRP 介导的。坚持抗炎饮食模式可降低AP诱发GDM的风险。