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Observational Study
. 2025 Jan 2;8(1):e2454319.
doi: 10.1001/jamanetworkopen.2024.54319.

Radon Exposure and Gestational Diabetes

Yijia Zhang  1   2 , Meghan Angley  1   2 , Liping Lu  1   2   3 , Brian J Smith  4 , William Grobman  5 , Blair J Wylie  1   6 , Noelia M Zork  1 , Mary E D'Alton  1 , Becky McNeil  7 , Brian M Mercer  8 , Robert M Silver  9 , Hyagriv N Simhan  10 , David M Haas  11 , George R Saade  12 , Samuel Parry  13 , Uma Reddy  1 , Ka Kahe  1   2
Affiliations
Observational Study

Radon Exposure and Gestational Diabetes

Yijia Zhang et al. JAMA Netw Open. .

Abstract

Importance: Understanding environmental risk factors for gestational diabetes (GD) is crucial for developing preventive strategies and improving pregnancy outcomes.

Objective: To examine the association of county-level radon exposure with GD risk in pregnant individuals.

Design, setting, and participants: This multicenter, population-based cohort study used data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) cohort, which recruited nulliparous pregnant participants from 8 US clinical centers between October 2010 and September 2013. Participants who had pregestational diabetes or were missing data on GD or county-level radon measurements were excluded from the current study. Data were analyzed from September 2023 to January 2024.

Exposures: County-level radon data were created by the Lawrence Berkeley National Laboratory based on the Environmental Protection Agency's short- and long-term indoor home radon assessments. Radon exposure was categorized into 3 groups: less than 1, 1 to less than 2, and 2 or more picocuries (pCi)/L (to convert to becquerels per cubic meter, multiply by 37). Because radon, smoking, and fine particulate matter air pollutants (PM2.5) may share similar biological pathways, participants were categorized by joint classifications of radon level (<2 and ≥2 pCi/L) with smoking status (never smokers and ever smokers) and radon level with PM2.5 level (above or below the median).

Main outcomes and measures: The main outcome was GD, identified based on glucose tolerance testing and information from medical record abstraction. Multiple logistic regression models were used to assess the association between radon exposure and GD.

Results: Among the 9107 participants, mean (SD) age was 27.0 (5.6) years; 3782 of 9101 (41.6%) had ever used tobacco. The mean (SD) county-level radon concentration was 1.6 (0.9) pCi/L, and 382 participants (4.2%) had GD recorded. After adjusting for potential confounders, individuals living in counties with the highest radon level (≥2 pCi/L) had higher odds of developing GD compared with those living in counties with the lowest radon level (<1 pCi/L) (odds ratio [OR], 1.37; 95% CI, 1.02-1.84); after additional adjustment for PM2.5, the OR was 1.36 (95% CI, 1.00-1.86). Elevated odds of GD were also observed in ever smokers living in counties with a higher (≥2 pCi/L) radon level (OR, 2.09; 95% CI, 1.41-3.11) and participants living in counties with higher radon and PM2.5 levels (OR, 1.93; 95% CI, 1.31-2.83), though no statistically significant interactions were observed.

Conclusions and relevance: This cohort study suggests that higher radon exposure is associated with greater odds of GD in nulliparous pregnant individuals. Further studies are needed to confirm the results and elucidate the underlying mechanisms, especially with individual-level residential radon exposure assessment.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr D’Alton reported serving on the board of directors for Merck for Mothers and as a board member for March for Moms outside the submitted work. Dr McNeil reported receiving grants from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH) during the conduct of the study. Dr Mercer reported receiving grants from the NIH during the conduct of the study. Dr Silver reported receiving grants from the NIH during the conduct of the study. Dr Simhan reported receiving grants from the NIH during the conduct of the study and being a cofounder of Naima Health and receiving personal fees from Organon outside the submitted work. Dr Parry reported receiving grants from the NIH during the conduct of the study. Dr Kahe reported receiving grants from the NIH during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Radon Levels and Study Participants in the Contiguous US, by County
Radon-level data are from the Lawrence Berkeley National Laboratory. Counties shaded gray had no radon data available (A) or included no Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) participants (B). Both maps were created using R, version 4.4.1 (R Project for Statistical Computing). To convert picocuries (pCi) per liter to becquerels (Bq) per cubic meter, multiply by 37.
Figure 2.
Figure 2.. Study Population Flowchart
GD indicates gestational diabetes; nuMoM2b, Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be.
Figure 3.
Figure 3.. Multivariable Odds Ratios of Developing Gestational Diabetes by Smoking Status, Radon Exposure, and Fine Particulate Matter Air Pollutants (PM2.5) Exposure
A, Nonsmokers with low radon exposure was the reference group. B, The group with low radon and low PM2.5 exposure was the reference group. High radon level was considered to be 2 picocuries (pCi)/L or greater and low, less than 2 pCi/L (to convert to becquerels per cubic meter, multiply by 37). High PM2.5 level was considered to be above the median and low, below the median.
See this image and copyright information in PMC

Comment in

  • doi: 10.1001/jamanetworkopen.2024.54327

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