title: A Case-Cohort Study of Cadmium Body Burden and Gestational Diabetes Mellitus in American Women.
abstract: BACKGROUND
  Environmental cadmium (Cd) exposure is associated with type 2 diabetes. However, the association of Cd and gestational diabetes mellitus (GDM) is unknown.
  
  
  OBJECTIVE
  We examined the association between body burden of Cd and GDM risk.
  
  
  METHODS
  We used 140 GDM cases and 481 randomly selected noncase subcohort members from the Omega Study to conduct a case-cohort study. Creatinine (Cr)-corrected Cd in early pregnancy urine (U-Cd) was measured by inductively coupled plasma mass spectrometry. Tertiles (< 0.29; 0.29-0.42; ≥ 0.43 μg/g Cr) were defined using the subcohort's U-Cd distribution. GDM was diagnosed using the 2004 American Diabetes Association guidelines. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression.
  
  
  RESULTS
  GDM cases had higher geometric mean U-Cd (0.39 μg/g Cr; 95% CI: 0.37, 0.41) than noncases (0.31 μg/g Cr; 95% CI: 0.29, 0.33). Odds ratios for GDM increased with increasing U-Cd tertile (OR = 1.64; 95% CI: 0.88, 3.05 for middle vs. low tertile; OR = 2.07; 95% CI: 1.15, 3.73 for high vs. low tertile; p-trend = 0.015). Overweight/obesity (body mass index ≥ 25 kg/m(2)) did not modify the association between U-Cd and GDM (p = 0.26).
  
  
  CONCLUSIONS
  Our findings suggest that body burden of Cd increases risk of GDM in a dose-dependent manner. Improved understanding of environmental factors influencing GDM may facilitate early identification of women at high risk of GDM.
authors.affiliation: Department of Epidemiology, Brown University, Providence, Rhode Island, USA.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Romano
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Enquobahrie
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Simpson
authors.forename: Harvey
authors.initials: H
authors.lastname: Checkoway
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Williams
mesh_terms: D000328:Adult; D001822:Body Burden; D015992:Body Mass Index; D002104:Cadmium / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced / Q000453:epidemiology*; D016640:Diabetes, Gestational / Q000139:chemically induced / Q000453:epidemiology*; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D016015:Logistic Models; D009765:Obesity / Q000139:chemically induced / Q000453:epidemiology; D050177:Overweight / Q000139:chemically induced / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D014861:Washington / Q000453:epidemiology; D055815:Young Adult
chemical_list: D002104:Cadmium