Air Pollution Exposure and Gestational Diabetes Mellitus Risk: A Retrospective Case-Control Study with Multi-Pollutant Analysis in Wuhan, Hubei Province

Abstract

Ambient air pollution has been associated with gestational diabetes mellitus (GDM); however, evidence regarding trimester-specific effects from China remains limited. This case-control study study analyzed data from pregnant women who delivered in Wuhan, China, between 2017 and 2022 (164 GDM cases and 731 controls), integrating geographic information, air quality measurements, and maternal characteristics. Using Inverse Distance Weighting interpolation and Generalized Linear Mixed Models (GLMM), we assessed associations between air pollutant exposure and GDM across different gestational periods. Results indicated that NO₂ demonstrated the strongest association with GDM compared to other pollutants. Specifically, increased NO₂ exposure was consistently associated with higher GDM risk throughout pregnancy. PM_2.5 exposure showed significant associations during early and mid-pregnancy, while SO₂ exposure was significantly associated with GDM risk exclusively in early pregnancy. Sensitivity analyses stratified by urban maternity status and maternal age revealed the stability of the study's findings. These findings underscore the importance of reducing air pollution exposure during pregnancy and implementing targeted interventions for high-risk populations to prevent GDM development.

Keywords: air pollution; case–control study; gestational diabetes mellitus; nitrogen dioxide; pregnancy trimester.

Figure 1

Distribution of monitoring stations and cases.

Figure 2

Pearson correlation coefficient between air pollutants, ** p < 0.01.