title: Gestational diabetes and preeclampsia in association with air pollution at levels below current air quality guidelines.
abstract: BACKGROUND
  Several studies have estimated associations between air pollution and birth outcomes, but few have evaluated potential effects on pregnancy complications.
  
  
  OBJECTIVE
  We investigated whether low-level exposure to air pollution is associated with gestational diabetes and preeclampsia.
  
  
  METHODS
  High-quality registry information on 81,110 singleton pregnancy outcomes in southern Sweden during 1999-2005 was linked to individual-level exposure estimates with high spatial resolution. Modeled exposure to nitrogen oxides (NOx), expressed as mean concentrations per trimester, and proximity to roads of different traffic densities were used as proxy indicators of exposure to combustion-related air pollution. The data were analyzed by logistic regression, with and without adjusting for potential confounders.
  
  
  RESULTS
  The prevalence of gestational diabetes increased with each NOx quartile, with an adjusted odds ratio (OR) of 1.69 (95% CI: 1.41, 2.03) for the highest (> 22.7 µg/m3) compared with the lowest quartile (2.5-8.9 µg/m3) of exposure during the second trimester. The adjusted OR for acquiring preeclampsia after exposure during the third trimester was 1.51 (1.32, 1.73) in the highest quartile of NOx compared with the lowest. Both outcomes were associated with high traffic density, but ORs were significant for gestational diabetes only.
  
  
  CONCLUSIONS
  NOx exposure during pregnancy was associated with gestational diabetes and preeclampsia in an area with air pollution levels below current air quality guidelines.
authors.affiliation: Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden. Ebba.Malmqvist@med.lu.se
authors.forename: Ebba
authors.initials: E
authors.lastname: Malmqvist
authors.forename: Kristina
authors.initials: K
authors.lastname: Jakobsson
authors.forename: Håkan
authors.initials: H
authors.lastname: Tinnerberg
authors.forename: Anna
authors.initials: A
authors.lastname: Rignell-Hydbom
authors.forename: Lars
authors.initials: L
authors.lastname: Rylander
mesh_terms: D000328:Adult; D000393:Air Pollutants / Q000032:analysis*; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000139:chemically induced / Q000453:epidemiology*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D016015:Logistic Models; D018811:Maternal Exposure; D008962:Models, Theoretical; D009017:Morbidity; D009589:Nitrogen Oxides / Q000032:analysis*; D016017:Odds Ratio; D011225:Pre-Eclampsia / Q000139:chemically induced / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D015995:Prevalence; D013548:Sweden / Q000453:epidemiology; D001335:Vehicle Emissions / Q000032:analysis*; D055815:Young Adult
chemical_list: D000393:Air Pollutants; D009589:Nitrogen Oxides; D001335:Vehicle Emissions
references.citation: Environ Health Perspect. 2011 Jun;119(6):886-92
references.pmid: 21262595
references.citation: Int J Health Geogr. 2009 Jan 20;8:2
references.pmid: 19154599
references.citation: Placenta. 2003 Apr;24 Suppl A:S21-7
references.pmid: 12842410
references.citation: Paediatr Perinat Epidemiol. 2012 Mar;26(2):91-100
references.pmid: 22324494
references.citation: Clin Sci (Lond). 2008 Sep;115(6):175-87
references.pmid: 18691154
references.citation: Environ Health Perspect. 2010 Sep;118(9):1273-9
references.pmid: 20504758
references.citation: Environ Res. 2011 Jul;111(5):685-92
references.pmid: 21453913
references.citation: Environ Health. 2009 Dec 22;8:59
references.pmid: 20028508
references.citation: Lancet. 2005 Feb 26-Mar 4;365(9461):785-99
references.pmid: 15733721
references.citation: BJOG. 2002 Nov;109(11):1227-31
references.pmid: 12452459
references.citation: Environ Health Perspect. 2000 Feb;108(2):173-6
references.pmid: 10656859
references.citation: Int J Health Geogr. 2007 Jun 04;6:19
references.pmid: 17547740
references.citation: Environ Health Perspect. 2009 Nov;117(11):1773-9
references.pmid: 20049131
references.citation: Environ Health Perspect. 2009 Aug;117(8):1313-21
references.pmid: 19672414
references.citation: J Occup Environ Med. 2008 Jan;50(1):32-8
references.pmid: 18188079
references.citation: Acta Obstet Gynecol Scand. 2007;86(12):1432-6
references.pmid: 17963051
references.citation: Am J Obstet Gynecol. 1997 Nov;177(5):1003-10
references.pmid: 9396883
references.citation: Environ Res. 2009 Apr;109(3):311-20
references.pmid: 19215915
references.citation: Environ Health Perspect. 2003 Nov;111(14):1773-8
references.pmid: 14594630
references.citation: Early Hum Dev. 2012 Mar;88(3):179-84
references.pmid: 21890288
references.citation: J Air Waste Manag Assoc. 2006 Jun;56(6):709-42
references.pmid: 16805397
references.citation: J Epidemiol Community Health. 2006 Mar;60(3):234-41
references.pmid: 16476754
references.citation: Hypertension. 2011 Mar;57(3):406-12
references.pmid: 21220700
references.citation: Popul Health Metr. 2012 Jun 09;10(1):10
references.pmid: 22681784
references.citation: J Air Waste Manag Assoc. 2009 Apr;59(4):392-404
references.pmid: 19418813
references.citation: Diabetes Metab. 2010 Dec;36(6 Pt 2):628-51
references.pmid: 21163426
references.citation: Environ Health Perspect. 2003 Feb;111(2):207-16
references.pmid: 12573907
references.citation: Am J Epidemiol. 2007 Nov 1;166(9):1045-52
references.pmid: 17675655
references.citation: Am J Med. 2009 Oct;122(10):890-5
references.pmid: 19786154
references.citation: Environ Health Perspect. 2011 Apr;119(4):553-8
references.pmid: 21212043
references.citation: J Toxicol Environ Health A. 2007 Feb 1;70(3-4):213-21
references.pmid: 17365583
references.citation: Matern Child Health J. 2013 Apr;17(3):545-55
references.pmid: 22544506
references.citation: Environ Health Perspect. 2011 Mar;119(3):384-9
references.pmid: 21118784
references.citation: Int J Health Geogr. 2005 Nov 16;4:30
references.pmid: 16288656
references.citation: J Clin Invest. 2005 May;115(5):1111-9
references.pmid: 15864338
references.citation: Acta Obstet Gynecol Scand. 2010 Dec;89(12):1532-7
references.pmid: 21050147
references.citation: J Am Soc Hypertens. 2009 Sep-Oct;3(5):332-50
references.pmid: 20409976
references.citation: Eur Rev Med Pharmacol Sci. 2010 Oct;14(10):809-21
references.pmid: 21222367