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Research

Influence of environmental temperature on risk of gestational diabetes

Gillian L. Booth, Jin Luo, Alison L. Park, Denice S. Feig, Rahim Moineddin and Joel G. Ray
CMAJ May 15, 2017 189 (19) E682-E689; DOI: https://doi.org/10.1503/cmaj.160839
Gillian L. Booth
Departments of Medicine (Booth, Ray) and Obstetrics and Gynecology (Ray), St. Michael’s Hospital; Institute for Clinical Evaluative Sciences (Booth, Luo, Park, Feig, Moineddin, Ray); Department of Medicine (Feig), Mount Sinai Hospital; Department of Family and Community Medicine (Moineddin), and Department of Medicine (Booth, Feig, Ray), University of Toronto, Toronto, Ont.
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  • For correspondence: boothg@smh.ca
Jin Luo
Departments of Medicine (Booth, Ray) and Obstetrics and Gynecology (Ray), St. Michael’s Hospital; Institute for Clinical Evaluative Sciences (Booth, Luo, Park, Feig, Moineddin, Ray); Department of Medicine (Feig), Mount Sinai Hospital; Department of Family and Community Medicine (Moineddin), and Department of Medicine (Booth, Feig, Ray), University of Toronto, Toronto, Ont.
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Alison L. Park
Departments of Medicine (Booth, Ray) and Obstetrics and Gynecology (Ray), St. Michael’s Hospital; Institute for Clinical Evaluative Sciences (Booth, Luo, Park, Feig, Moineddin, Ray); Department of Medicine (Feig), Mount Sinai Hospital; Department of Family and Community Medicine (Moineddin), and Department of Medicine (Booth, Feig, Ray), University of Toronto, Toronto, Ont.
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Denice S. Feig
Departments of Medicine (Booth, Ray) and Obstetrics and Gynecology (Ray), St. Michael’s Hospital; Institute for Clinical Evaluative Sciences (Booth, Luo, Park, Feig, Moineddin, Ray); Department of Medicine (Feig), Mount Sinai Hospital; Department of Family and Community Medicine (Moineddin), and Department of Medicine (Booth, Feig, Ray), University of Toronto, Toronto, Ont.
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Rahim Moineddin
Departments of Medicine (Booth, Ray) and Obstetrics and Gynecology (Ray), St. Michael’s Hospital; Institute for Clinical Evaluative Sciences (Booth, Luo, Park, Feig, Moineddin, Ray); Department of Medicine (Feig), Mount Sinai Hospital; Department of Family and Community Medicine (Moineddin), and Department of Medicine (Booth, Feig, Ray), University of Toronto, Toronto, Ont.
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Joel G. Ray
Departments of Medicine (Booth, Ray) and Obstetrics and Gynecology (Ray), St. Michael’s Hospital; Institute for Clinical Evaluative Sciences (Booth, Luo, Park, Feig, Moineddin, Ray); Department of Medicine (Feig), Mount Sinai Hospital; Department of Family and Community Medicine (Moineddin), and Department of Medicine (Booth, Feig, Ray), University of Toronto, Toronto, Ont.
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  • Figure 1:
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    Figure 1:

    Creation of the study cohort.*Restricted to urban and suburban areas in Toronto and surrounding communities (Burlington, Oakville, Mississauga, Brampton, Richmond Hill, Vaughan, Markham, Pickering, Ajax, Whitby and Oshawa). †Among women who immigrated to Canada in 1985 or later. Values in brackets reflect the no. of women who gave birth. OHIP = Ontario Health Insurance Plan.

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    Figure 2:

    Mean daily outdoor air temperature over the 30-day period before screening for gestational diabetes mellitus (GDM) and corresponding crude prevalence (95% confidence interval [vertical bars]) of GDM. Data are shown for pregnancies (n = 555 911) that occurred in the Greater Toronto Area in Ontario, from 2002 to 2014. Crude and age-adjusted prevalences for GDM per 1°C rise in 30-day mean temperature were highly correlated (R2 = 0.997). Coldest (blue) to moderate (green) to hottest (red) temperatures are shown on the solid line. CI = confidence interval.

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    Figure 3:

    Relative odds of gestational diabetes mellitus (GDM; unadjusted [black squares] and adjusted [red circles] odds ratios [95% CI]) per 10°C increase in mean daily outdoor air temperature over a 30-day period before screening for GDM. The top 2 models (green text) include all pregnancies, by the 30-day period before 27 weeks gestation and the 30-day period before the actual date of screening, adjusted for maternal age, parity, income quintile, world region and year. The middle 2 models (blue text) include only women with 2 consecutive pregnancies, adjusted for maternal age and parity for each pregnancy. The bottom model (orange text) includes only the subgroup of women with serum glucose results for the 50-g glucose challenge test, adjusted for maternal age, parity, income quintile, world region and year. CI = confidence interval, OR = odds ratio.

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    Table 1:

    No. of births to women who underwent screening for gestational diabetes in the Greater Toronto Area in Ontario (2002–2014), by maternal characteristic

    Maternal characteristicNo. of births (%)*
    n = 555 911†
    Age, mean ± SD; yr30.9 ± 5.4
    No. of previous births
     0259 258 (46.6)
     1198 578 (35.7)
     ≥ 298 075 (17.6)
    World region of birth
     Canada307 254 (55.3)
     Western Nations and Europe32 312 (5.8)
     Hispanic America18 350 (3.3)
     Caribbean15 872 (2.9)
     Sub-Saharan Africa17 795 (3.2)
     Middle East and North Africa19 737 (3.6)
     East Asia and Pacific62 352 (11.2)
     South Asia82 239 (14.8)
    Neighbourhood income
     Q1 (lowest)150 727 (27.1)
     Q2123 193 (22.2)
     Q3102 297 (18.4)
     Q491 686 (16.5)
     Q5 (highest)88 008 (15.8)
    Year child was born‡
     200233 594 (6.0)
     200337 844 (6.8)
     200449 696 (8.9)
     200549 599 (8.9)
     200649 597 (8.9)
     200750 140 (9.0)
     200848 416 (8.7)
     200947 965 (8.6)
     201047 103 (8.5)
     201147 466 (8.5)
     201247 807 (8.6)
     201346 684 (8.4)
    • Note: Q = quintile, SD = standard deviation.

    • ↵* Unless specified otherwise.

    • ↵† Total no. of births to 396 828 women.

    • ↵‡ Fiscal year, from Apr. 1 of the indicated year to Mar. 31 of the subsequent year, as defined by Ontario’s Ministry of Health and Long-Term Care.

    • View popup
    Table 2:

    Odds ratios for gestational diabetes mellitus, by characteristics of the index pregnancy among included births to women who underwent screening in the Greater Toronto Area in Ontario (2002–2014)*

    CharacteristicUnadjusted OR (95% CI)Adjusted OR (95% CI)†
    Mean outdoor air temperature over the 30-day period before 27th wk of pregnancy per 10°C increment1.07 (1.06–1.08)1.06 (1.05–1.07)
    Age per 1-yr increment1.08 (1.07–1.08)1.09 (1.09–1.10)
    Parity
     01.00 (ref)1.00 (ref)
     11.12 (1.09–1.14)0.87 (0.85–0.89)
     ≥ 21.45 (1.41–1.49)0.92 (0.89–0.94)
    Neighbourhood income
     Q1 (lowest)1.00 (ref)1.00 (ref)
     Q20.90 (0.87–0.92)0.93 (0.90–0.96)
     Q30.79 (0.77–0.82)0.85 (0.82–0.88)
     Q40.66 (0.64–0.69)0.73 (0.71–0.76)
     Q5 (highest)0.51 (0.49–0.53)0.55 (0.53–0.58)
    World region of birth
     Canada1.00 (ref)1.00 (ref)
     Western Nations and Europe0.94 (0.88–1.00)0.89 (0.85–0.95)
     Hispanic America1.55 (1.46–1.65)1.49 (1.40–1.60)
     Caribbean1.42 (1.32–1.52)1.42 (1.32–1.53)
     Sub-Saharan Africa1.50 (1.40–1.60)1.27 (1.19–1.36)
     Middle East and North Africa1.47 (1.38–1.56)1.38 (1.30–1.47)
     East Asia and Pacific2.04 (1.97–2.12)1.70 (1.64–1.76)
     South Asia2.80 (2.72–2.89)2.95 (2.85–3.04)
    Year child was born‡
     20021.00 (ref)1.00 (ref)
     20031.05 (0.98–1.13)1.02 (0.95–1.09)
     20041.33 (1.25–1.41)1.21 (1.14–1.29)
     20051.40 (1.32–1.49)1.26 (1.18–1.33)
     20061.51 (1.42–1.60)1.33 1.25–1.41)
     20071.47 (1.39–1.56)1.27 (1.19–1.35)
     20081.78 (1.68–1.89)1.53 (1.44–1.62)
     20091.84 (1.74–1.95)1.56 (1.46–1.65)
     20101.76 (1.66–1.87)1.46 (1.37–1.56)
     20111.79 (1.68–1.90)1.48 (1.39–1.57)
     20121.86 (1.75–1.97)1.53 (1.44–1.62)
     20131.62 (1.52–1.72)1.33 (1.25–1.41)
    • Note: CI = confidence interval, OR = odds ratios, Q = quintile, ref = referent.

    • ↵* No. of included births, n = 555 911; no. of included women, n = 396 828.

    • ↵† Odds ratios are adjusted for all variables listed in the table.

    • ↵‡ Fiscal year, from Apr. 1 of the indicated year to Mar. 31 of the subsequent year, as defined by Ontario’s Ministry of Health and Long-Term Care.

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Canadian Medical Association Journal: 189 (19)
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Influence of environmental temperature on risk of gestational diabetes
Gillian L. Booth, Jin Luo, Alison L. Park, Denice S. Feig, Rahim Moineddin, Joel G. Ray
CMAJ May 2017, 189 (19) E682-E689; DOI: 10.1503/cmaj.160839

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Influence of environmental temperature on risk of gestational diabetes
Gillian L. Booth, Jin Luo, Alison L. Park, Denice S. Feig, Rahim Moineddin, Joel G. Ray
CMAJ May 2017, 189 (19) E682-E689; DOI: 10.1503/cmaj.160839
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