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There was a time when pregnant women who developed diabetes were chastised by their doctors for eating too much. Now gestational diabetes is known to be influenced by purely external factors, such as air pollution.

Gestational diabetes, or diabetes that is triggered by the grown of the unborn child and ends when the child is born, is an extremely common complication of pregnancy. Worldwide, it affects about one in seven pregnancies. In the United States, there are about 200,000 cases of gestational diabetes every year.

Developing diabetes during pregnancy can have serious consequences for both mother and child. Children whose mothers were diabetic when they were in the womb have about a one in three chance of developing type 2 diabetes later in life. Mothers who had gestational diabetes are more likely to develop cardiovascular diseases later in life.

There are also serious short-term complications due to the condition. It is not unusual for the offspring of a mother who had diabetes during pregnancy to exhibit macrosomia, unusually large body mass. My own grandmother had diabetes during her last two pregnancies, bearing children who weighed 17 pounds (about 8 kilos) and 19 pounds (over 9 kilos). My aunt and uncle died within a few hours of their births, and my grandmother herself succumbed to heart disease a few years later.

Gestational diabetes can cause complications during delivery. Shoulder dystocia, a condition in which the head of the child passes through the birth canal but the shoulders cannot pass the pubic bone because the child is too large, can require significant manipulation of the baby to enable birth. There is a danger the child will suffocate during the procedure. Some babies born to mothers who have gestational diabetes are born diabetic, and many face developmental issues in childhood. Intellectual development of the child may be slower than expected.

The Persistent Problem Of Air Pollution

In the United States, air quality has been improving for over 50 years, since the passage of the Clean Air Act in 1963. When I was a child on holidays in Los Angeles, for example, these taking place about 1963, it was not unusual to see brown, shiny, metallic clouds of air pollution hanging near the mountains. Mountains nearly 10,000 feet (3,000 meters) high just a twenty-minute drive from the city would be invisible. 
Entire cities could be enveloped in a deadly smoggy haze in industrial areas in the United States, especially in the steel mill towns in Pennsylvania. Air quality in the United States was by and large bad.

Links Between Air Pollution And Diabetes

Air quality today is vastly improved over the conditions of the twentieth century, but problems persist. About 41 percent of Americans live in counties with poor air quality. People who live in those counties are at higher risk for lung diseases, but they are also at higher risk for diabetes.
With regard to diabetes, the problem pollutants are nitric oxide and particulate matter. Nitric oxide is "burnt nitrogen" forming at high temperatures inside internal combustion engines. This unnatural chemical forms smog and the clouds that release acid rain. It breaks down in a way that changes oxygen into ozone. Particulate matter, in this context, refers to tiny particles of soot, so small they are not filtered by our body's natural defenses before they enter the lungs. Together these pollutants cause metabolic syndrome, insulin resistance (and weight gain), prediabetes, and diabetes.
Continue reading after recommendations

  • Andersen ZJ, Raaschou-Nielsen O, Ketzel M, Jensen SS, Hvidberg M, Loft S, et al. 2012. Diabetes incidence and long-term exposure to air pollution: a cohort study. Diabetes Care 35:92–98.
  • Brook RD, Jerrett M, Brook JR, Bard RL, Finkelstein MM. 2008. The relationship between diabetes mellitus and traffic-related air pollution. J Occup Environ Med 50:32–38.
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