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Adrienne S. Ettinger,^1,2,3 Ami R. Zota,¹ Chitra J. Amarasiriwardena,^1,2 Marianne R. Hopkins,¹ Joel Schwartz,^1,2 Howard Hu,^1,3 and Robert O. Wright^1,2,3,4

¹Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA; ²Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA; ³University of Michigan School of Public Health, Ann Arbor, Michigan, USA; ⁴Department of Medicine, Children’s Hospital Boston, Boston, Massachusetts, USA

Abstract
Background: Accumulating evidence has shown an increased risk of type 2 diabetes in general populations exposed to arsenic, but little is known about exposures during pregnancy and the association with gestational diabetes (GD) .

Objectives: We studied 532 women living proximate to the Tar Creek Superfund Site to investigate whether arsenic exposure is associated with impaired glucose tolerance during pregnancy.

Methods: Blood glucose was measured between 24 and 28 weeks gestation after a 1-hr oral glucose tolerance test (GTT) as part of routine prenatal care. Blood and hair were collected at delivery and analyzed for arsenic using inductively coupled plasma mass spectrometry with dynamic reaction cell.

Results: Arsenic concentrations ranged from 0.2 to 24.1 µg/L (ppb) (mean ± SD, 1.7 ±1.5) and 1.1 to 724.4 ng/g (ppb) (mean ± SD, 27.4 ± 61.6) in blood and hair, respectively. One-hour glucose levels ranged from 40 to 284 mg/dL (mean ± SD, 108.7 ± 29.5) ; impaired glucose tolerance was observed in 11.9% of women when using standard screening criterion (> 140 mg/dL) . Adjusting for age, Native-American race, prepregnancy body mass index, Medicaid use, and marital status, women in the highest quartile of blood arsenic exposure had 2.8 higher odds of impaired GTT than women in the lowest quartile of exposure (95% confidence interval, 1.1–6.9) (p-trend = 0.008) .

Conclusions: Among this population of pregnant women, arsenic exposure was associated with increased risk of impaired GTT at 24–28 weeks gestation and therefore may be associated with increased risk of GD.

Key words: arsenic, gestational diabetes, impaired glucose tolerance, pregnancy, Superfund. Environ Health Perspect 117:1059–1064 (2009) . doi:10.1289/ehp.0800533 available via http://dx.doi.org/ [Online 11 March 2009]

Address correspondence to A.S. Ettinger, Harvard School of Public Health, Exposure, Epidemiology and Risk Program, Landmark Center West, Room 421, 401 Park Dr., Boston, MA 02215 USA. Telephone: (617) 384-8834. Fax: (617) 384-8859. E-mail: aettinge@hsph.harvard.edu

We acknowledge the active involvement and continued cooperation of our community partners: Local Environmental Action Demanded (L.E.A.D.) Agency and Integris Baptist Medical Center, Miami, OK.

A.S.E. was supported by National Institute of Environmental Health Sciences (NIEHS) grant K01-ES014907. This study was supported by NIEHS, National Institutes of Health (NIH) grants P42-ES05947, P30-ES00002, P01-ES012874, R01-ES014930, and R01-ES013744, and U.S. Environmental Protection Agency (EPA) STAR Research Assistance Agreement RD-83172501. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIEHS, NIH, or U.S. EPA.

The authors declare they have no competing financial interests.

Received 30 December 2008 ; accepted 11 March 2009.