Environmental health influences in pregnancy and risk of gestational diabetes mellitus: a systematic review

Abstract

Background Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications globally. Environmental risk factors may lead to increased glucose levels and GDM, which in turn may affect not only the health of the mother but assuming hypotheses of "fetal programming", also the health of the offspring. In addition to traditional GDM risk factors, the evidence is growing that environmental influences might affect the development of GDM. We conducted a systematic review analyzing the association between several environmental health risk factors in pregnancy, including climate factors, chemicals and metals, and GDM. Methods We performed a systematic literature search in Medline (PubMed), EMBASE, CINAHL, Cochrane Library and Web of Science Core Collection databases for research articles published until March 2021. Epidemiological human and animal model studies that examined GDM as an outcome and / or glycemic outcomes and at least one environmental risk factor for GDM were included. Results Of n = 91 studies, we classified n = 28 air pollution, n = 18 persistent organic pollutants (POP), n = 11 arsenic, n = 9 phthalate n = 8 bisphenol A (BPA), n = 8 seasonality, n = 6 cadmium and n = 5 ambient temperature studies. In total, we identified two animal model studies. Whilst we found clear evidence for an association between GDM and air pollution, ambient temperature, season, cadmium, arsenic, POPs and phthalates, the findings regarding phenols were rather inconsistent. There were clear associations between adverse glycemic outcomes and air pollution, ambient temperature, season, POPs, phenols, and phthalates. Findings regarding cadmium and arsenic were heterogeneous (n = 2 publications in each case). Conclusions Environmental risk factors are important to consider in the management and prevention of GDM. In view of mechanisms of fetal programming, the environmental risk factors investigated may impair the health of mother and offspring in the short and long term. Further research is needed.

Target Exposome for Characterizing Early Gestational Exposure to Contaminants of Emerging Concern and Association with Gestational Diabetes Mellitus

“…In addition, the existence of diverse groups of CECs in pregnant women raises our concern on the health effects of exposure to such a "cocktail" of environmental chemicals. Although there is growing evidence on the potential associations between environmental exposure and pregnancy complications, 36,37 none had evaluated the association between co-exposure to such a complexity of CECs and GDM risk to our best knowledge. Our BKMR analysis demonstrated a clear joint effect of co-exposure to various CECs on the GDM risk, which were mainly driven by the groups of PFAS, synthetic antioxidants, and non-PAE plasticizers.…”

Air pollution and global healthcare use for atopic dermatitis: A systematic review

“…Results were further stratified based on age, sex and temperature or season, if reported in the study (Table 3). Due to the wide heterogeneity of air pollution exposures (pollutant levels and characterization of exposure changes for statistical analyses) and types of measures of association reported among the studies, estimates of pooled effects were not calculated, as in other air pollution reviews 28–30 . Instead, the quantitative results presented in each study, as well as the approach for exposure characterization used and measure of association calculated, are presented in Table 4 for the air pollutants found to have overall positive associations (PM 2.5 , PM 10 , NO 2 and SO 2 ) and Table S2 for the air pollutants found to have overall inconclusive associations (O 3 and CO).…”

Comparing the gestational diabetes mellitus prevalence and oral glucose tolerance test characteristics before and after the COVID-19 outbreak in Hongshan District of Wuhan, China, 2018- 2021

“…This condition complicates pregnancies and increases the risk of long-term health issues for both mother and offspring, such as preeclampsia, macrosomia, cesarean sections, and type 2 diabetes mellitus 1 . The varying prevalence of GDM across geographic and ethnic groups highlights the intricate interplay of genetic factors, environmental conditions, and lifestyle choices in its etiology 3 .…”