Abstract
BACKGROUND: Emerging evidence suggests a potential association between ambient air pollution and risk of gestational diabetes mellitus (GDM), but results have been inconsistent. Accordingly, we assessed the associations between ambient fine particulate matter (PM(2.5)) and nitrogen dioxide (NO(2)) levels with risk of GDM. METHODS: Using linked data from birth certificates, hospital discharge diagnoses, and air pollution estimates informed by the New York City Community Air Survey, we fit conditional logistic regression models to evaluate the association between residential levels of PM(2.5) and NO(2) with risk of GDM among 256,372 singleton live births of non-smoking mothers in New York City born 2008-2010, adjusting for sociodemographic factors and stratified on zip code of maternal address. RESULTS: GDM was identified in 17,065 women, yielding a risk of GDM in the study sample of 67 per 1000 deliveries. In single pollutant models, 1st and 2nd trimester PM(2.5) was associated with a lower and higher risk of GDM, respectively. In models mutually adjusting for PM(2.5) levels in both trimesters, GDM was associated with PM(2.5) levels in the 2nd trimester (OR: 1.06, 95% CI: 1.02, 1.10 per interquartile range increase in PM(2.5)), but not the 1st trimester (OR: 0.99, 95% CI: 0.96, 1.02). Conversely, GDM was associated with NO(2) during the 1st trimester (OR: 1.05, 95% CI: 1.01, 1.09), but not the 2nd trimester (OR: 1.02, 95% CI: 0.98, 1.06). The positive associations between pollutants and GDM were robust to different model specifications. PM(2.5) in the 2nd trimester was more strongly associated with GDM among mothers who were aged <35 years and not Medicaid recipients. NO(2) in the 1st trimester was more strongly associated with GDM among overweight and parous women. CONCLUSIONS: In this large cohort of singleton births in New York City, NO(2) in the 1st trimester and PM(2.5) in the 2nd trimester were associated with higher odds of GDM, while 1st trimester PM(2.5) was weakly and inconsistently associated with lower odds of GDM.