PMID- 31864020
OWN - NLM
STAT- MEDLINE
DCOM- 20200903
LR  - 20200903
IS  - 1873-6750 (Electronic)
IS  - 0160-4120 (Linking)
VI  - 135
DP  - 2020 Feb
TI  - Exposure to multiple metals in early pregnancy and gestational diabetes mellitus: 
      A prospective cohort study.
PG  - 105370
LID - S0160-4120(19)32397-9 [pii]
LID - 10.1016/j.envint.2019.105370 [doi]
AB  - BACKGROUND: A growing number of epidemiologic studies have estimated associations 
      between type 2 diabetes mellitus and exposure to metals. However, studies on the 
      associations of internal assessments of metal exposure and gestational diabetes 
      mellitus (GDM) are limited in scope and have inconsistent outcomes. OBJECTIVES: 
      This investigation aimed to explore the associations between urinary nickel (Ni), 
      arsenic (As), cadmium (Cd), antimony (Sb), cobalt (Co), or vanadium (V) in early 
      pregnancy and the subsequent risk of GDM in Chinese pregnant women. METHODS: The 
      study population included 2090 women with singleton pregnancy from the Tongji 
      Maternal and Child Health Cohort (TMCHC). Urine samples were collected before 20 
      gestational weeks, and an oral glucose tolerance test (OGTT) was conducted at 
      24-28 gestational weeks to diagnose GDM. The concentrations of urinary metals 
      were measured using inductively coupled plasma mass spectrometry (ICP-MS) and 
      were corrected for urinary creatinine. The associations between the risk of GDM 
      and urinary metals were assessed using Poisson regression with a robust error 
      variance with generalized estimating equations (GEE) models and Bayesian kernel 
      machine regression (BKMR). RESULTS: A total of 241 participants (11.53%) were 
      diagnosed with GDM. Five metals (Ni, As, Sb, Co, and V) were found significantly 
      and positively associated with GDM based on single-metal models. In 
      multiple-metal models, for each unit increase of ln-transformed urinary Ni or Sb, 
      the risk of GDM increased 18% [relative risk (RR):1.18, 95%confidence interval 
      (CI): 1.00, 1.38 or RR: 1.18, 95%CI: 1.00, 1.39, respectively]. The BKMR analysis 
      revealed a statistically significant and positive joint effect of the six metals 
      on the risk of GDM, when the urinary levels of the six metals were all above the 
      55th percentile, compared to the median levels. The effect of metal Ni was 
      significant when the concentrations of the other metals were all fixed at their 
      25th percentile, and metal Sb displayed a significant and positive effect when 
      all the other metals were fixed at 25th, 50th, and 75th percentiles. CONCLUSIONS: 
      To the best of our knowledge, this study is the first to demonstrate that 
      increased concentrations of urinary Ni in early pregnancy are associated with an 
      elevated risk of GDM, either evaluated individually or as a metal mixture. All 
      six metals mixed exposure was positively associated with the risk of GDM, while 
      Sb and Ni were demonstrated more important effects than the other four metals in 
      the mixture.
CI  - Copyright (c) 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.
FAU - Wang, Xiaoyi
AU  - Wang X
AD  - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition 
      and Safety, Key Laboratory of Environment and Health (HUST), Ministry of 
      Education & Ministry of Environmental Protection, School of Public Health, Tongji 
      Medical College, Huazhong University of Science and Technology, Wuhan 430030, 
      Hubei, China.
FAU - Gao, Duan
AU  - Gao D
AD  - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition 
      and Safety, Key Laboratory of Environment and Health (HUST), Ministry of 
      Education & Ministry of Environmental Protection, School of Public Health, Tongji 
      Medical College, Huazhong University of Science and Technology, Wuhan 430030, 
      Hubei, China.
FAU - Zhang, Guofu
AU  - Zhang G
AD  - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition 
      and Safety, Key Laboratory of Environment and Health (HUST), Ministry of 
      Education & Ministry of Environmental Protection, School of Public Health, Tongji 
      Medical College, Huazhong University of Science and Technology, Wuhan 430030, 
      Hubei, China; School of Public Health, Xinxiang Medical University, Xinxiang 
      453003, Henan, China.
FAU - Zhang, Xu
AU  - Zhang X
AD  - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition 
      and Safety, Key Laboratory of Environment and Health (HUST), Ministry of 
      Education & Ministry of Environmental Protection, School of Public Health, Tongji 
      Medical College, Huazhong University of Science and Technology, Wuhan 430030, 
      Hubei, China.
FAU - Li, Qian
AU  - Li Q
AD  - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition 
      and Safety, Key Laboratory of Environment and Health (HUST), Ministry of 
      Education & Ministry of Environmental Protection, School of Public Health, Tongji 
      Medical College, Huazhong University of Science and Technology, Wuhan 430030, 
      Hubei, China.
FAU - Gao, Qin
AU  - Gao Q
AD  - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition 
      and Safety, Key Laboratory of Environment and Health (HUST), Ministry of 
      Education & Ministry of Environmental Protection, School of Public Health, Tongji 
      Medical College, Huazhong University of Science and Technology, Wuhan 430030, 
      Hubei, China.
FAU - Chen, Renjuan
AU  - Chen R
AD  - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition 
      and Safety, Key Laboratory of Environment and Health (HUST), Ministry of 
      Education & Ministry of Environmental Protection, School of Public Health, Tongji 
      Medical College, Huazhong University of Science and Technology, Wuhan 430030, 
      Hubei, China.
FAU - Xu, Shangzhi
AU  - Xu S
AD  - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition 
      and Safety, Key Laboratory of Environment and Health (HUST), Ministry of 
      Education & Ministry of Environmental Protection, School of Public Health, Tongji 
      Medical College, Huazhong University of Science and Technology, Wuhan 430030, 
      Hubei, China.
FAU - Huang, Li
AU  - Huang L
AD  - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition 
      and Safety, Key Laboratory of Environment and Health (HUST), Ministry of 
      Education & Ministry of Environmental Protection, School of Public Health, Tongji 
      Medical College, Huazhong University of Science and Technology, Wuhan 430030, 
      Hubei, China.
FAU - Zhang, Yu
AU  - Zhang Y
AD  - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition 
      and Safety, Key Laboratory of Environment and Health (HUST), Ministry of 
      Education & Ministry of Environmental Protection, School of Public Health, Tongji 
      Medical College, Huazhong University of Science and Technology, Wuhan 430030, 
      Hubei, China.
FAU - Lin, Lixia
AU  - Lin L
AD  - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition 
      and Safety, Key Laboratory of Environment and Health (HUST), Ministry of 
      Education & Ministry of Environmental Protection, School of Public Health, Tongji 
      Medical College, Huazhong University of Science and Technology, Wuhan 430030, 
      Hubei, China.
FAU - Zhong, Chunrong
AU  - Zhong C
AD  - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition 
      and Safety, Key Laboratory of Environment and Health (HUST), Ministry of 
      Education & Ministry of Environmental Protection, School of Public Health, Tongji 
      Medical College, Huazhong University of Science and Technology, Wuhan 430030, 
      Hubei, China.
FAU - Chen, Xi
AU  - Chen X
AD  - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition 
      and Safety, Key Laboratory of Environment and Health (HUST), Ministry of 
      Education & Ministry of Environmental Protection, School of Public Health, Tongji 
      Medical College, Huazhong University of Science and Technology, Wuhan 430030, 
      Hubei, China.
FAU - Sun, Guoqiang
AU  - Sun G
AD  - Obstetrics Department, Maternal and Child Health Care Hospital of Hubei Province, 
      Wuhan 430070, Hubei, China.
FAU - Song, Yang
AU  - Song Y
AD  - Medical College, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China.
FAU - Yang, Xuefeng
AU  - Yang X
AD  - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition 
      and Safety, Key Laboratory of Environment and Health (HUST), Ministry of 
      Education & Ministry of Environmental Protection, School of Public Health, Tongji 
      Medical College, Huazhong University of Science and Technology, Wuhan 430030, 
      Hubei, China.
FAU - Hao, Liping
AU  - Hao L
AD  - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition 
      and Safety, Key Laboratory of Environment and Health (HUST), Ministry of 
      Education & Ministry of Environmental Protection, School of Public Health, Tongji 
      Medical College, Huazhong University of Science and Technology, Wuhan 430030, 
      Hubei, China.
FAU - Yang, Hongying
AU  - Yang H
AD  - Hubei Provincial Center for Disease Control and Prevention, Wuhan 430079, Hubei, 
      China.
FAU - Yang, Lei
AU  - Yang L
AD  - Medical College, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China.
FAU - Yang, Nianhong
AU  - Yang N
AD  - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition 
      and Safety, Key Laboratory of Environment and Health (HUST), Ministry of 
      Education & Ministry of Environmental Protection, School of Public Health, Tongji 
      Medical College, Huazhong University of Science and Technology, Wuhan 430030, 
      Hubei, China. Electronic address: zynh@mails.tjmu.edu.cn.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20191218
PL  - Netherlands
TA  - Environ Int
JT  - Environment international
JID - 7807270
RN  - 0 (Metals)
SB  - IM
MH  - Bayes Theorem
MH  - Diabetes Mellitus, Type 2
MH  - *Diabetes, Gestational
MH  - Female
MH  - Humans
MH  - Metals
MH  - Pregnancy
MH  - Prospective Studies
OTO - NOTNLM
OT  - BKMR models
OT  - GDM
OT  - Multiple-metal models
OT  - Single-metal models
OT  - Urinary metals
EDAT- 2019/12/22 06:00
MHDA- 2020/09/04 06:00
CRDT- 2019/12/22 06:00
PHST- 2019/07/12 00:00 [received]
PHST- 2019/11/24 00:00 [revised]
PHST- 2019/11/27 00:00 [accepted]
PHST- 2019/12/22 06:00 [pubmed]
PHST- 2020/09/04 06:00 [medline]
PHST- 2019/12/22 06:00 [entrez]
AID - S0160-4120(19)32397-9 [pii]
AID - 10.1016/j.envint.2019.105370 [doi]
PST - ppublish
SO  - Environ Int. 2020 Feb;135:105370. doi: 10.1016/j.envint.2019.105370. Epub 2019 
      Dec 18.