背景：從2009年在荷蘭鹿特丹所進行的研究開始，愈來愈多研究關注空氣污染對妊娠糖尿病發生風險的影響。雖然其因果相關性尚未被證實，但許多之研究皆傾向指出空氣污染物暴露會增加妊娠糖尿病發生的風險。然而，過去的研究欠缺同時探討多個空氣污染物之影響，有關空氣污染與妊娠糖尿病之間的劑量反應關係也較少有著墨。此外，台灣地區細懸浮微粒以及懸浮微粒等空氣污染嚴重程度遠高於過去研究所在的歐美地區，加上不同種族罹患妊娠糖尿病風險也有差異，因此，國外研究數據是否能夠外推至台灣之情況或有存疑。另外，過去曾有研究顯示，不同群族（包括：年齡、性別、種族以及社會經濟地位）對於空氣污染暴露所造成之健康危害存在差異，但尚未有研究針對妊娠糖尿病此一健康危害效應部分進行探討。
目的：探討台灣懷孕婦女於懷孕前，以及懷孕期間內各空氣污染物暴露濃度對於妊娠糖尿病發生風險之影響，並且進一步討論兩者之間的劑量反應關係。此外，本研究也分析空氣污染物濃度與分娩年齡及社會經濟地位是否對罹患妊娠糖尿病發生風險產生交互作用？
方法：本研究使用巢式病例對照研究設計，使用全民健康保險資料2005年百萬人承保歸人檔，納入2006-2013年所有經歷分娩之孕婦，病例組選取懷孕期間初次罹患妊娠糖尿病之孕婦，對照組則以1:5的數目比例隨機選取與病例組同年分娩、同分娩年齡且未曾罹患妊娠糖尿病之孕婦作為對照組。本研究回溯研究對象在懷孕前12週期間、第一妊娠期以及第二妊娠期不同空氣污染物（包括：PM2.5、PM10、SO2、O3、NO2、與CO）的日平均暴露濃度。本研究使用之空氣污染物濃度資料則是取自我國環境保護署空氣品質監測站資料，並根據研究對象分娩年之就醫情形推估個案綜合就醫地（鄉鎮市區），以作為估計研究個案空氣污染暴露資料之依據，並以地理資訊系統之一般克利金（Ordinary Kriging）空間分析方法模擬出各鄉鎮市區各種空氣污染物濃度之日平均值。空氣污染物暴露濃度以四分位數與十分位數做分類，同時以四分位間距（Inter-Quartile Range, IQR）與每單位標準差為單位做呈現。本研究藉由廣義估計方程式進行統計分析，估計不同期間空氣污染暴露與妊娠糖尿病發生風險之勝算比（Odds Ratio，OR）及其95%信賴區間（Confidence Interval，CI）。
結果：本研究共納入6,717名初次罹患妊娠糖尿病之病例組個案，以及33,585人次之對照組個案。在控制潛在干擾因子以及其他空氣污染物之下，在孕前12周內每增加一個四分位間距濃度的細懸浮微粒、懸浮微粒、與二氧化硫將會顯著增加10%（OR=1.10，95% CI= 1.04-1.15）、16%（OR=1.16，95% CI=1.11-1.23）、與35%（OR=1.36，95% CI=1.30-1.40）的妊娠糖尿病發生勝算；但每增加一個四分位間距濃度的二氧化氮與一氧化碳則會顯著降低29%（OR=0.71，95% CI=0.67-0.76）與20%（OR=0.80，95% CI=0.76-0.85）的風險。每增加一個四分位間距濃度的臭氧則是與妊娠糖尿病風險無顯著相關（OR=1.01，95% CI=0.97-1.06）。若是以每增加一個標準差的濃度來分析，前述空氣污染物質的相對應勝算比分別為1.08（1.03-1.12）、1.13（1.09-1.18）、1.30（1.26-1.35）、0.79（0.75-0.82）、0.86（0.83-0.90）、與1.01（0.98-1.04）。懷孕前12週期間細懸浮微粒以及懸浮微粒最大濃度之四分位數（大於75百分位組）暴露所相對應的妊娠糖尿病校正勝算比分別為1.22（1.11-1.35）與1.17（1.05-1.30），細懸浮微粒以及懸浮微粒暴露濃度與妊娠糖尿病之間相關性均呈現先降後升之U字型關係，在濃度高於40μg/m3以及67μg/m3後妊娠糖尿病發生勝算比明顯增加，似乎顯示有閾值的存在。二氧化硫以及臭氧在懷孕前12週期間濃度>75百分位則分別顯示妊娠糖尿病發生勝算比為1.63（1.50-1.78）與1.15（1.06-1.26），暴露濃度與妊娠糖尿病之間分別呈現J字型以及線性之劑量反應關係。相反地，懷孕前12週期間濃度>75百分位的二氧化氮與一氧化碳濃度則是有顯著較低的妊娠糖尿病發生風險，其相對應之勝算比分別為0.71（0.64-0.78）與0.80（0.73-0.89）。各空氣污染物在第一妊娠期以及第二妊娠期期間暴露濃度與懷孕前12週期間暴露濃度對妊娠糖尿病發生風險的影響很類似。本研究也發現<25歲之年輕孕婦更容易受到細懸浮微粒、懸浮微粒以及二氧化硫等空氣污染物暴露之影響而增加妊娠糖尿病發生的風險。
結論：本研究發現台灣婦女孕前以及第一與第二妊娠期暴露於較高濃度細懸浮微粒、懸浮微粒、二氧化硫、以及臭氧等空氣污染物皆會顯著提高妊娠糖尿病之發生風險。但二氧化氮與一氧化碳的暴露卻會顯著降低妊娠糖尿病發生的風險。不過，詳細分析細懸浮微粒與懸浮微粒與罹患妊娠糖尿病之相關性發現U字型的劑量反應關係。

This case-control study, including 6,717 women with gestational diabetes mellitus (GDM) and 33,585 matched controls identified from medical calims of 1-million Taiwan’s Natinal Health Inusrance program beneficiaries in 2006-2003, was conducted to investigate the relationships between air pollutants exposure prior to and after pregnancy and risk of GDM; and to evaluate whether the air pollutantion and GDM relationships can be modified by maternal age and socioeconomic status. After controlling for potential confounders, an increase of 1 IQR and SD in exposures to PM2.5, PM10, and SO2 during the 12-week period prior to pregnancy significantly increased the risk of developing GDM; but similar exposures to NO2 and CO on the other hand significantly decreased the risk of GDM. While preconception exposure was further categorized into quartile, we noted a U-shaped dose-response relationship between exposures to PM2.5 and PM10 and GDM risk. The analytical results for exposures at the first and second trimester were essentially unchanged. We also found that maternal exposure to PM2.5, PM10, and SO2 at the time periods prior to and after pregnancy could pose a greater risk of GDM in women yougher than 25 years than in women aged 25 years and older.

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