山东省部分地区PM2.5和PM10暴露与妊娠期糖尿病的关联性分析

目的 探讨孕妇在孕前及孕期细颗粒物(PM_2.5)和可吸入颗粒物(PM₁₀)暴露与妊娠期糖尿病(GDM)发生风险的关系,并进一步分析其敏感暴露窗口。 方法 基于山东大学健康医疗大数据研究院山东省平台数据库孕产妇医疗数据,选取2018~2020年期间孕产妇资料;收集山东省64个监测站公布的PM_2.5、PM₁₀、NO₂和SO₂的逐日监测资料,选取研究对象各暴露时间段内的空气监测数据;根据孕妇家庭住址和监测站地址的经纬度坐标,采用反距离加权法(IDW)计算每位研究对象暴露时间段内逐日个体暴露浓度,进而获得每位研究对象在孕前期、孕早期和孕中期每个暴露窗口期内的平均暴露浓度;采用Logistic回归方法探讨PM_2.5和PM₁₀暴露与GDM发生风险的关系;进一步通过分布滞后非线性模型(DLNM)分析PM_2.5和PM₁₀的敏感暴露窗口。 结果 (1)符合纳入排除标准的研究对象18 407名,其中1 020例孕妇患有GDM,基于本健康医疗大数据GDM患病率为5.54%。(2)PM_2.5在孕中期的平均暴露浓度为(52.45±18.26)μg/m³,高于其在孕前期［(50.71±16.98)μg/m³］及孕早期［(51.08±17.15)μg/m³］的平均暴露浓度,差异有统计学意义(F=21.98,P<0.001);PM₁₀在孕前、孕早及孕中期的暴露浓度差异无统计学意义(F=2.36, P=0.124)。(3)调整协变量后,PM_2.5和PM₁₀在孕中期的平均暴露浓度与GDM发生风险呈正向关联,暴露浓度每增加10 μg/m³,GDM发生风险分别增加18%和15%(OR=1.18,95%CI: 1.07~1.31; OR=1.15,95%CI: 1.09~1.21)。(4)DLNM分析结果显示,PM_2.5和PM₁₀暴露导致GDM发生风险增加的敏感窗口期分别在第18~24孕周和第14~22孕周。 结论 孕中期PM_2.5和PM₁₀暴露明显增加GDM发生风险。

Association between PM2.5 and PM10 exposure with gestational diabetes mellitus in certain areas of Shandong Province

Objective To explore the relationship between fine particulate matter air pollution(PM_2.5)and inhalable particulate matter(PM₁₀)exposure before and during pregnancy with the risk of gestational diabetes mellitus(GDM), and to analyze the critical exposure window. Methods Based on the provincial platform database established by Health and Medical Research Institute of Shandong University, maternal data were collected from 2018 to 2020. With reference to daily monitoring data of PM_2.5, PM₁₀, NO₂ and SO₂ from 64 monitoring stations, and the longitude and latitude coordinates of pregnant womens addresses and monitoring station addresses, each subjects daily exposure concentration was calculated by inverse distance weighting(IDW)method to obtain the average exposure level before pregnancy, and in the first trimester and second trimester of pregnancy. The relationship between PM_2.5 and PM₁₀ exposure with the risk of GDM was analyzed with Logistic regression. The critical exposure window of PM_2.5 and PM₁₀ were determined with a distributed lag non-linear model. Results (1) A total of 18,407 people were eligible for inclusion, including 1,020 pregnant women with GDM, with a prevalence of 5.54%. (2) The average exposure concentration of PM_2.5 in the second trimester was(52.45±18.26)μg/m³, which was higher than that before pregnancy ［(50.71±16.98)μg/m³］ and in the first trimester ［(51.08±17.15)μg/m³］, and the difference was statistically significant (F=21.98, P<0.001). The exposure concentration of PM₁₀ before and during pregnancy had no statistically difference(F=2.36, P=0.124). (3) After the covariables were adjusted, the average exposure concentration of PM_2.5 and PM₁₀ in the second trimester were positively correlated with the risk of GDM, which increased by 18% and 15% with each increase of 10 μg/m³ exposure concentration(OR=1.18, 95%CI: 1.07-1.31; OR=1.15, 95%CI: 1.09-1.21). (4) The critical exposure window of PM_2.5 and PM₁₀ were 18-24 weeks and 14-22 weeks of pregnancy, respectively. Conclusion PM_2.5 and PM₁₀ exposure in the second trimester significantly increases the risk of GDM.