Table 4.
Adjusted relative risks and their 95% confidence intervals (95% CI) for the association between 1 IQR increase in ozone, particulate matter2.5, and sulfur dioxide exposure and adverse obstetric and neonatal outcomes among women with type 1 diabetes and their infants in the Consortium of Safe Labor Singleton Pregnancies, 2002-2008
| Ozone | Preconception | First Trimester | Second Trimester | Whole Pregnancy | ||||
|---|---|---|---|---|---|---|---|---|
| Type I Diabetes RR (95% CI) (n=507) |
No Autoimmune RR (95% CI) (n= 204,384) |
Type I Diabetes RR (95% CI) (n=507) |
No Autoimmune RR (95% CI) (n= 204,384) |
Type I Diabetes RR (95% CI) (n=507) |
No Autoimmune RR (95% CI) (n= 204,384) |
Type I Diabetes RR (95% CI) (n=507) |
No Autoimmune RR (95% CI) (n= 204,384) |
|
| Cesarean | 1.01 (1.00, 1.01) | 0.99 (0.99, 0.99) | 1.00 (1.00, 1.01) | 0.99 (0.99, 0.99) | 1.00 (1.00, 1.01) | 0.99 (0.99, 0.99) | 1.00 (1.00, 1.01) | 0.99 (0.99, 0.99) |
| Prelabor | 0.99 (0.99, 1.00) | 0.99 (0.99, 0.99) | 0.99 (0.99, 1.00) | 0.99 (0.99, 0.99) | 0.99 (0.99, 0.99) | 0.99 (0.99, 0.99) | 0.99 (0.99, 0.99) | 0.99 (0.99, 0.99) |
| After Induction | 0.99 (0.97, 1.01) | 0.98 (0.98, 0.98) | 0.98 (0.96, 1.00) | 0.98 (0.98, 0.98) | 0.97 (0.95, 0.99) | 0.98 (0.98, 0.98) | 0.95 (0.93, 0.98) | 0.96 (0.95, 0.96) |
| After Spontaneous | 1.01 (1.00, 1.03) | 0.99 (0.99, 0.99) | 1.01 (1.00, 1.03) | 0.99 (0.99, 1.00) | 1.02 (1.00, 1.03) | 0.99 (0.99, 1.00) | 1.01 (1.00 (1.03) | 0.99 (0.99, 0.99) |
| Preterm | 1.00 (0.99, 1.02) | 1.00 (1.00, 1.00) | 1.01 (1.00, 1.03) | 0.99 (0.99, 1.00) | 1.00 (0.98, 1.01) | 1.00 (1.00, 1.00) | 1.01 (0.99, 1.03) | 1.01 (1.00, 1.01) |
| Indicated | 1.01 (0.98, 1.04) | 0.99 (0.98, 0.99) | 1.04 (1.01, 1.07) | 0.99 (0.99, 0.99) | 1.03 (0.99, 1.06) | 0.99 (0.98, 0.99) | 1.00 (0.97, 1.03) | 0.98 (0.97, 0.99) |
| Spontaneous | 1.00 (0.98, 1.02) | 1.00 (1.00, 1.01) | 1.00 (0.98, 1.02) | 1.00 (1.00, 1.01) | 0.99 (0.97, 1.01) | 1.01 (1.00, 1.01) | 1.02 (1.00, 1.04) | 1.02 (1.01, 1.02) |
| Preeclampsia | 1.00 (0.99, 1.00) | 0.99 (0.99, 0.99) | 0.99 (0.99, 1.00) | 0.99 (0.99, 0.99) | 0.99 (0.99, 1.00) | 0.99 (0.99, 0.99) | 0.99 (0.99, 1.00) | 0.99 (0.99, 0.99) |
| Small for Gestational Age | 0.99 (0.94, 1.03) | 0.99 (0.99, 0.99) | 1.01 (0.97, 1.05) | 0.99 (0.99, 1.00) | 1.01 (0.97, 1.05) | 0.99 (0.99, 0.99) | 1.01 (0.96, 1.07) | 0.99 (0.98, 0.99) |
| Neonatal Respiratory Distress Syndrome | 1.00 (0.98, 1.03) | 1.00 (1.00, 1.00) | 1.00 (0.97, 1.03) | 1.01 (1.01, 1.01) | 0.99 (0.96, 1.02) | 1.01 (1.01, 1.02) | 1.00 (0.95, 1.04) | 1.03 (1.03, 1.04) |
| NICU Admission | 0.99 (0.99, 1.00) | 1.00 (1.00, 1.00) | 0.99 (0.99, 1.00) | 1.00 (1.00, 1.00) | 1.00 (0.99, 1.00) | 1.00 (1.00, 1.00) | 0.99 (0.99, 1.00) | 1.00 (1.00, 1.00) |
| Perinatal Mortality | 0.92 (0.84, 1.01) | 0.99 (0.99, 1.00) | 0.93 (0.85, 1.02) | 1.01 (1.00, 1.02) | 0.94 (0.86, 1.02) | 1.01 (1.00, 1.02) | 1.10 (1.02, 1.17) | 1.02 (1.00, 1.04) |
| Particulate Matter 2.5 | Preconception | First Trimester | Second Trimester | Whole Pregnancy | ||||
| Type I Diabetes RR (95% CI) (n=507) |
No Autoimmune RR (95% CI) (n= 204,384) |
Type I Diabetes RR (95% CI) (n=507) |
No Autoimmune RR (95% CI) (n= 204,384) |
Type I Diabetes RR (95% CI) (n=507) |
No Autoimmune RR (95% CI) (n= 204,384) |
Type I Diabetes RR (95% CI) (n=507) |
No Autoimmune RR (95% CI) (n= 204,384) |
|
| Cesarean | 1.00 (0.98, 1.02) | 1.00 (0.99, 1.00) | 1.00 (0.98, 1.02) | 0.99 (0.99, 1.00) | 1.00 (0.98, 1.02) | 0.99 (0.99, 1.00) | 1.00 (0.98, 1.02) | 0.99 (0.99, 1.00) |
| Prelabor | 1.01 (1.00, 1.02) | 1.00 (1.00, 1.00) | 1.01 (1.01, 1.02) | 1.00 (1.00, 1.00) | 1.01 (1.01, 1.02) | 1.00 (1.00, 1.00) | 1.01 (1.01, 1.02) | 1.00 (1.00, 1.00) |
| After Induction | 0.96 (0.90, 1.02) | 1.02 (1.01, 1.02) | 0.96 (0.90 (1.03) | 1.01 (1.01, 1.02) | 0.96 (0.90 (1.03) | 1.01 (1.01, 1.02) | 0.97 (0.91, 1.04) | 1.02 (1.02, 1.03) |
| After Spontaneous | 1.02 (0.99, 1.05) | 0.99 (0.99, 0.99) | 1.02 (0.99, 1.05) | 0.99 (0.99, 0.99) | 1.02 (0.99, 1.05) | 0.99 (0.99, 0.99) | 1.01 (0.99, 1.05) | 0.98 (0.98, 0.99) |
| Preterm | 0.98 (0.94, 1.01) | 0.97, 0.96, 0.97) | 1.01 (0.98, 1.04) | 0.97 (0.96, 0.97) | 0.99 (0.95, 1.01) | 0.97 (0.97, 0.97) | 1.00 (0.96, 1.05) | 0.95 (0.95, 0.96) |
| Indicated | 0.88 (0.81, 0.96) | 0.98 (0.97, 0.99) | 0.98 (0.91, 1.06) | 0.99 (0.98, 1.00) | 0.88 (0.81, 0.97) | 0.99 (0.98, 1.01) | 0.88 (0.81, 0.97) | 0.99 (0.98, 1.01) |
| Spontaneous | 1.01 (0.96, 1.07) | 0.96 (0.96, 0.97) | 1.05 (1.00, 1.10) | 0.96 (0.96, 0.97) | 1.07 (1.02, 1.13) | 0.96 (0.96, 0.97) | 1.06 (1.00, 1.11) | 0.94 (0.93, 0.95) |
| Preeclampsia | 0.99 (0.98, 1.00) | 1.00 (1.00, 1.00) | 0.99 (0.98, 1.00) | 1.00 (1.00, 1.00) | 0.99 (0.98, 1.00) | 1.00 (1.00, 1.00) | 0.99 (0.98, 1.00) | 1.00 (1.00, 1.00) |
| Small for Gestational Age | 1.10 (0.98, 1.24) | 1.00 (1.00, 1.01) | 1.06 (0.95, 1.17) | 1.00 (1.00, 1.01) | 1.12 (0.99, 1.26) | 1.00 (1.00, 1.00) | 1.15 (0.99, 1.33) | 1.01 (1.00, 1.01) |
| Neonatal Respiratory Distress Syndrome | 0.99 (0.92, 1.06) | 0.95 (0.94, 0.96) | 0.99 (0.98, 1.00) | 1.00 (1.00, 1.00) | 0.99 (0.92, 1.07) | 0.96 (0.95, 0.96) | 0.98 (0.89, 1.08) | 0.93 (0.92, 0.94) |
| NICU Admission | 1.00 (0.99, 1.01) | 0.99 (0.99, 0.99) | 1.00 (0.99, 1.01) | 0.99 (0.99, 0.99) | 1.00 (0.99, 1.01) | 0.99 (0.99, 0.99) | 1.00 (099, 1.01) | 0.99 (0.99, 0.99) |
| Perinatal Mortality | 0.85 (0.72, 1.02) | 0.96 (0.95, 0.98) | 0.84 (0.71, 0.99) | 0.96 (0.94, 0.98) | 0.85 (0.72, 1.00) | 0.98 (0.96, 1.00) | 1.07 (0.76, 1.49) | 0.95 (0.93, 0.98) |
| Sulfur Dioxide | Preconception | First Trimester | Second Trimester | Whole Pregnancy | ||||
| Type I Diabetes RR (95% CI) (n=507) |
No Autoimmune RR (95% CI) (n= 204,384) |
Type I Diabetes RR (95% CI) (n=507) |
No Autoimmune RR (95% CI) (n= 204,384) |
Type I Diabetes RR (95% CI) (n=507) |
No Autoimmune RR (95% CI) (n= 204,384) |
Type I Diabetes RR (95% CI) (n=507) |
No Autoimmune RR (95% CI) (n= 204,384) |
|
| Cesarean | 0.97 (0.94, 1.00) | 0.96 (0.96, 0.96) | 0.96 (0.93, 0.99) | 0.96 (0.95, 0.96) | 0.96 (0.93, 0.99) | 0.96 (0.95, 0.96) | 0.95 (0.92, 0.98) | 0.94 (0.93, 0.94) |
| Prelabor | 1.00 (0.99, 1.02) | 0.99 (0.99, 0.99) | 1.00 (0.99, 1.02) | 0.99 (0.99, 0.99) | 1.00 (0.99, 1.02) | 0.99 (0.99, 0.99) | 1.00 (0.99, 1.01) | 0.99 (0.99, 0.99) |
| After Induction | 0.92 (0.82, 1.02) | 0.96 (0.95, 0.97) | 0.91 (0.82, 1.02) | 0.96 (0.95, 0.97) | 0.91 (0.82, 1.01) | 0.96 (0.95, 0.97) | 0.90 (0.80, 1.00) | 0.94 (0.93, 0.95) |
| After Spontaneous | 1.00 (0.95, 1.05) | 0.96 (0.96, 0.97) | 0.99 (0.94, 1.04) | 0.96 (0.95, 0.96) | 0.98 (0.93, 1.03) | 0.96 (0.95, 0.96) | 0.97 (0.92, 1.02) | 0.94 (0.93, 0.94) |
| Preterm | 0.97 (0.92, 1.03) | 0.95 (0.94, 0.95) | 0.97 (0.92, 1.03) | 0.95 (0.94, 0.95) | 0.96 (0.90, 1.01) | 0.95 (0.94, 0.96) | 0.96 (0.90, 1.02) | 0.94 (0.93, 0.94) |
| Indicated | 1.00 (0.99, 1.02) | 0.99 (0.99, 0.99) | 0.99 (0.98, 1.01) | 0.99 (0.99, 0.99) | 0.99 (0.98, 1.01) | 0.99 (0.99, 0.99) | 1.00 (0.99, 1.02) | 0.99 (0.99, 0.99) |
| Spontaneous | 1.02 (0.94, 1.11) | 0.94 (0.93, 0.95) | 1.04 (0.96, 1.12) | 0.94 (0.93, 0.95) | 1.01 (0.95, 1.08) | 0.94 (0.93, 0.95) | 0.99 (0.92, 1.08) | 0.92 (0.91, 0.94) |
| Preeclampsia | 0.99 (0.97, 1.00) | 1.00 (1.00, 1.00) | 0.99 (0.97, 1.00) | 1.00 (1.00, 1.00) | 0.99 (0.97, 1.00) | 1.00 (1.00, 1.00) | 0.99 (0.97, 1.00) | 1.00 (1.00, 1.00) |
| Small for Gestational Age | 1.14 (1.00, 1.31) | 1.03 (1.02, 1.03) | 1.13 (1.01, 1.26) | 1.03 (1.02, 1.03) | 1.10 (1.00,1.22) | 1.03 (1.03, 1.04) | 1.15 (1.01, 1.31) | 1.05 (1.05, 1.06) |
| Neonatal Respiratory Distress Syndrome | 0.92 (0.80, 1.05) | 0.92 (0.90, 0.94) | 0.91 (0.80, 1.04) | 0.92 (0.90, 0.93) | 0.92 (0.81, 1.04) | 0.91 (0.89, 0.93) | 0.91 (0.79, 1.04) | 0.89 (0.87, 0.91) |
| NICU Admission | 1.01 (0.99, 1.02) | 0.99 (0.99, 0.99) | 1.02 (1.00, 1.03) | 0.99 (0.99, 0.99) | 1.00 (0.99, 1.02) | 0.99 (0.99, 0.99) | 1.01 (0.99, 1.02) | 0.99 (0.99, 0.99) |
| Perinatal Mortality | 1.16 (0.82, 1.65) | 0.97 (0.94, 1.00) | 1.14 (0.81, 1.62) | 0.96 (0.93, 0.99) | 1.15 (0.81, 1.62) | 0.97 (0.93, 1.00) | 1.14 (0.80, 1.62) | 0.95 (0.91, 1.00) |
Models adjusted for maternal age, maternal race/ethnicity, preconception body mass index, health insurance, marital status, smoking in pregnancy, alcohol use in pregnancy, other chronic diseases, and census region. Bold indicates statistically significant interaction (p<.10) between air pollution and type 1 diabetes status.