Green space, air pollution and gestational diabetes mellitus: A retrospective cohort study in central China

Zengli Yu; Yang Feng; Yao Chen; Xiaoan Zhang; Xin Zhao; Hui Chang; Junxi Zhang; Zhan Gao; Huanhuan Zhang; Cunrui Huang

doi:10.1016/j.ecoenv.2022.114457

Green space, air pollution and gestational diabetes mellitus: A retrospective cohort study in central China

Ecotoxicol Environ Saf. 2023 Jan 1:249:114457. doi: 10.1016/j.ecoenv.2022.114457. Epub 2022 Dec 21.

Authors

Zengli Yu¹, Yang Feng², Yao Chen³, Xiaoan Zhang⁴, Xin Zhao⁴, Hui Chang⁴, Junxi Zhang⁵, Zhan Gao³, Huanhuan Zhang⁶, Cunrui Huang⁷

Affiliations

¹ School of Public Health, Zhengzhou University, Zhengzhou, China; NHC Key Laboratory of Birth Defects Prevention & Henan Key Laboratory of Population Defects Prevention, Zhengzhou, China.
² School of Public Health, Zhengzhou University, Zhengzhou, China.
³ The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁴ The Third Hospital of Zhengzhou University, Zhengzhou, China.
⁵ NHC Key Laboratory of Birth Defects Prevention & Henan Key Laboratory of Population Defects Prevention, Zhengzhou, China.
⁶ School of Public Health, Zhengzhou University, Zhengzhou, China. Electronic address: zhanghh@zzu.edu.cn.
⁷ Vanke School of Public Health, Tsinghua University, Beijing, China.

PMID: 38321676
DOI: 10.1016/j.ecoenv.2022.114457

Abstract

Emerging evidence suggests residential surrounding green space is beneficial for human health. The association between green space and GDM showed inconsistent results, and potential effect modification of green space with air pollution is still unclear. This study aims to evaluate the association between green space and GDM, and further explore potential interaction and medication effects. Participants were recruited from a retrospective cohort study between 2015 and 2020 in Henan, China. Residential green space based on normalized difference vegetation index (NDVI) and air pollution exposure were estimated using spatial-statistical models. Multivariate logistic regression was applied to evaluate the association between per 0.1 unit increase in NDVI with 4 buffer sizes (250 m, 500 m, 1000 m, 2000 m) and GDM. We examined potential interaction of green space and air pollutants on GDM. Mediating effects of air pollution associated with green space exposure on GDM were also investigated by causal mediation analyses. A total of 46,665 eligible pregnant women were identified. There were 4092 (8.8 %) women diagnosed with GDM according to the IADPSG criteria. We found that per 0.1-unit increment in NDVI_{250 m}, NDVI_{500 m}, NDVI_{1000 m} and NDVI_{2000 m} in second trimester were associated with the decreased risk of GDM, with adjusted OR of 0.921(95 %CI: 0.890-0.953), 0.922 (95 %CI: 0.891-0.953), 0.921 (95 %CI: 0.892-0.952) and 0.921 (95 %CI: 0.892-0.951), respectively. We identified significant interactions between second trimester PM_2.5 and O₃ exposure and NDVI for GDM (P_interaction < 0.001). The causal mediation analysis showed that PM_2.5 mediated approximately 2.5-5.5 % of the association between green space and GDM, while the estimated mediating effect of O₃ was approximately 30.1-38.5 %. In conclusion, our study indicates that residential green space was associated with a reduced risk of GDM, particularly second trimester. Green space may benefit to GDM partly mediated by a reduction in PM_2.5 and O₃.

Keywords: Air pollution; Effect modification; Gestational diabetes mellitus; Green space.

MeSH terms

Air Pollutants* / analysis
Air Pollution* / analysis
China
Diabetes, Gestational*
Environmental Exposure
Female
Humans
Male
Maternal Exposure
Parks, Recreational
Particulate Matter / analysis
Pregnancy
Retrospective Studies

Substances

Particulate Matter
Air Pollutants