Air pollution exposure and risk of adverse obstetric and neonatal outcomes among women with type 1 diabetes

Aims/Hypothesis: Women with type 1 diabetes have increased risk for poor obstetric outcomes. Prenatal air pollution exposure is also associated with adverse outcomes for women and infants. We examined whether women with type 1 diabetes are more vulnerable than other women to pollution-associated risks during pregnancy. Methods: In singleton deliveries from the Consortium on Safe Labor (2002–2008), obstetric and neonatal outcomes were compared for women with type 1 diabetes (n = 507) and women without autoimmune disease (n = 204,384). Preconception, trimester, and whole pregnancy average air pollutant exposure (ozone (O₃), carbon monoxide (CO), particulate matter >10 μm (PM₁₀), PM > 2.5 μm (PM_2.5), sulfur dioxide (SO₂), nitrogen oxides (NO_x)) were estimated using modified Community Multiscale Air Quality models. Poisson regression models with diabetes*pollutant interaction terms estimated relative risks and 95% confidence intervals for adverse outcomes, adjusted for maternal characteristics and geographic region. Results: For whole pregnancy exposure to SO₂, women with type 1 diabetes had 15% increased risk (RR:1.15 95%CI:1.01,1.31) and women without autoimmune disease had 5% increased risk (RR:1.05 95%CI:1.05,1.06) for small for gestational age birth (p_interaction = 0.09). Additionally, whole pregnancy O₃ exposure was associated with 10% increased risk (RR:1.10 95%CI:1.02,1.17) among women with type 1 diabetes and 2% increased risk (RR:1.02 95%CI:1.00,1.04) among women without autoimmune disease for perinatal mortality (p_interaction = 0.08). Similar patterns were observed between PM_2.5 exposure and spontaneous preterm birth. Conclusions: Pregnant women with type 1 diabetes may be at greater risk for adverse outcomes when exposed to air pollution than women without autoimmune disease.