Passive smoking at home increased the risk of gestational diabetes mellitus in China



Active smoking during pregnancy may increase the risk of gestational diabetes mellitus (GDM), but little is known about the potential association between passive smoking and risk of GDM. The present study investigated the association between passive smoking at home and/or in the workplace and risk of GDM among non-smoking Chinese women.


A population-based study including 995 pregnant women taking antenatal care from December 2015 to May 2016 was conducted. Screening was carried out after 24 gestational weeks, during which women were offered a 75-g 2-h oral glucose tolerance test (OGTT). Basic information and self-reported passive smoking were collected by a questionnaire. Passive smoking was classified as passive smoking at home, passive smoking in the workplace, or passive smoking at home and in the workplace. They were further classified by time period, total exposure time, and amount. Logistic regression was used to estimate both crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs).


The prevalence of passive smoking was 78.3%. Compared with women who were non-exposed to passive smoking, a passive smoker has an increased risk of GDM with an adjusted OR (95% CI) of 1.60 (1.09, 2.33). In addition, there was a strong association between passive smoking exposure at home and GDM (adjusted OR 1.59; 95% CI 1.13, 2.24), and significant dose–response relationships in total exposure time and amount of passive smoking at home were observed. However, there is no obvious evidence for the link between passive smoking in the workplace and GDM risk (adjusted OR 1.25; 95% CI 0.87, 1.80).


Passive smoking at home was associated with an increased risk of GDM among non-smoking Chinese women. These findings emphasize the importance of preventing passive smoking, especially at home.

This is a preview of subscription content, log in to check access.


  1. Al-Zoughool M, Pintos J, Richardson L, Parent MÉ, Ghadirian P, Krewski D, Siemiatycki J (2013) Exposure to environmental tobacco smoke (ETS) and risk of lung cancer in Montreal: a case–control study. Environ Health 12:112

    Article  Google Scholar 

  2. Ambrose JA, Barua RS (2004) The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 43(10):1731–1737

    CAS  Article  Google Scholar 

  3. Axelsson T, Jansson PA, Smith U, Eliasson B (2001) Nicotine infusion acutely impairs insulin sensitivity in type 2 diabetic patients but not in healthy subjects. J Intern Med 249(6):539–544

    CAS  Article  Google Scholar 

  4. Basri NI, Mahdy ZA, Ahmad S, Abdul Karim AK, Shan LP, Abdul Manaf MR, Ismail NAM (2018) The World Health Organization (WHO) versus The International Association of Diabetes and Pregnancy Study Group (IADPSG) diagnostic criteria of gestational diabetes mellitus (GDM) and their associated maternal and neonatal outcomes. Horm Mol Biol Clin Investig 34(1).

  5. England LJ, Levine RJ, Qian C, Soule LM, Schisterman EF, Yu KF, Catalano PM (2004) Glucose tolerance and risk of gestational diabetes mellitus in nulliparous women who smoke during pregnancy. Am J Epidemiol 160(12):1205–1213

    Article  Google Scholar 

  6. Goniewicz MŁ, Czogała J, Kośmider L, Koszowski B, Zielińska-Danch W, Sobczak A (2009) Exposure to carbon monoxide from second-hand tobacco smoke in Polish pubs. Cent Eur J Public Health 17(4):220–222

    CAS  Article  Google Scholar 

  7. Gu L, Li J, Pan G, Zhou X, Zhang J, Lai X, Liu J (2017) Effects of passive smoking on glycemic parameters and lipid profiles in a chinese female population. Clin Lab 63(7):1147–1152

    CAS  PubMed  Google Scholar 

  8. Higgins T, Cembrowski G, Tran D, Lim E, Chan J (2009) Influence of variables on hemoglobin A1c values and nonheterogeneity of hemoglobin A1c reference ranges. J Diabetes Sci Technol 3(4):644–648

    Article  Google Scholar 

  9. Hosseini E, Janghorbani M, Aminorroaya A (2018) Incidence, risk factors, and pregnancy outcomes of gestational diabetes mellitus using one-step versus two-step diagnostic approaches: a population-based cohort study in Isfahan. Iran Diabetes Res Clin Pract 140:288–294

    Article  Google Scholar 

  10. Kim SJ, Han KT, Lee SY, Chun SY, Park EC (2015) Is secondhand smoke associated with stress in smokers and non-smokers? BMC Public Health 15:1249

    Article  Google Scholar 

  11. Leng J, Wang P, Shao P, Zhang C, Li W, Li N, Wang L, Nan H, Yu Z, Hu G, Chan JC, Yang X (2017) Passive smoking increased risk of gestational diabetes mellitus independently and synergistically with prepregnancy obesity in Tianjin, China. Diabetes Metab Res Rev 33(3).

    Article  Google Scholar 

  12. International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Ad L, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJ, Omori Y, Schmidt MI (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33(3):676–682

    Article  Google Scholar 

  13. Moore STA, Szegda KL, Liao X, Pekow P, Markenson G, Chasan-Taber L (2014) Cigarette smoking and gestational diabetes mellitus in Hispanic woman. Diabetes Res Clin Pract 105(1):126–134

    Article  Google Scholar 

  14. Pan A, Wang Y, Talaei M, Hu FB, Wu T (2015) Relation of active, passive, and quitting smoking with incident type 2 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 3(12):958–967

    Article  Google Scholar 

  15. Prakash GT, Das AK, Habeebullah S, Bhat V, Shamanna SB (2017) Maternal and neonatal outcome in mothers with gestational diabetes mellitus. Indian J Endocrinol Metab 21(6):854–858

    Article  Google Scholar 

  16. Samuel VT, Shulman GI (2012) Mechanisms for insulin resistance: common threads and missing links. Cell 148(5):852–871

    CAS  Article  Google Scholar 

  17. Solomon CG, Willett WC, Carey VJ, Rich-Edwards J, Hunter DJ, Colditz GA, Stampfer MJ, Speizer FE, Spiegelman D, Manson JE (1997) A prospective study of pregravid determinants of gestational diabetes mellitus. JAMA 278(13):1078–1083

    CAS  Article  Google Scholar 

  18. Somm E, Schwitzgebel VM, Vauthay DM, Camm EJ, Chen CY, Giacobino JP, Sizonenko SV, Aubert ML, Hüppi PS (2008) Prenatal nicotine exposure alters early pancreatic islet and adipose tissue development with consequences on the control of body weight and glucose metabolism later in life. Endocrinology 149(12):6289–6299

    CAS  Article  Google Scholar 

  19. Song C, Lyu Y, Li C, Liu P, Li J, Ma RC, Yang X (2018) Long-term risk of diabetes in women at varying durations after gestational diabetes: a systematic review and meta-analysis with more than 2 million women. Obes Rev 19(3):421–429

    CAS  Article  Google Scholar 

  20. Sørhaug S, Steinshamn S, Nilsen OG, Waldum HL (2006) Chronic inhalation of carbon monoxide: effects on the respiratory and cardiovascular system at doses corresponding to tobacco smoking. Toxicology 228(2–3):280–290

    Article  Google Scholar 

  21. Terry PD, Weiderpass E, Ostenson CG, Cnattingius S (2003) Cigarette smoking and the risk of gestational and pregestational diabetes in two consecutive pregnancies. Diabetes Care 26(11):2994–2998

    Article  Google Scholar 

  22. Voormolen DN, de Wit L, van Rijn BB, DeVries JH, Heringa MP, Franx A, Groenendaal F, Lamain-de Ruiter M (2018) Neonatal hypoglycemia following diet-controlled and insulin-treated gestational diabetes mellitus. Diabetes Care 41:1385–1390

    CAS  Article  Google Scholar 

  23. Wei Y, Yang H, Zhu W, Yang H, Li H, Yan J, Zhang C (2014) International Association of Diabetes and Pregnancy Study Group criteria is suitable for gestational diabetes mellitus diagnosis: further evidence from China. Chin Med J 127(20):3553–3556

    PubMed  Google Scholar 

  24. WHO (2011) Global adults tobacco survey (GATS) China 2010 country report. WHO, Geneva.

  25. Wu L, Han L, Zhan Y, Cui L, Chen W, Ma L, Lv J, Pan R, Zhao D, Xiao Z (2018) Prevalence of gestational diabetes mellitus and associated risk factors in pregnant Chinese women: a cross-sectional study in Huangdao, Qingdao, China. Asia Pac J Clin Nutr 27(2):383–388

    PubMed  Google Scholar 

  26. Xiao L, Yang Y, Li Q, Wang CX, Yang GH (2010) Population-based survey of secondhand smoke exposure in China. Biomed Environ Sci 23(6):430–436

    Article  Google Scholar 

  27. Yang X, Hsu-Hage B, Zhang H, Yu L, Dong L, Li J, Shao P, Zhang C (2002) Gestational diabetes mellitus in women of single gravidity in Tianjin City, China. Diabetes Care 25(5):847–851

    Article  Google Scholar 

  28. Yuan S, Xue HL, Yu HJ, Huang Y, Tang BW, Yang XH, Li QX, He QQ (2018) Cigarette smoking as a risk factor for type 2 diabetes in women compared with men: a systematic review and meta-analysis of prospective cohort studies. J Public Health (Oxf)

Download references


This work was supported by National Natural Science Foundation of China (grant number: 81671471).

Author information



Corresponding author

Correspondence to Mei Zhao.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lu, H., Yuan, L., Yu, H. et al. Passive smoking at home increased the risk of gestational diabetes mellitus in China. J Public Health (Berl.) 27, 733–741 (2019).

Download citation


  • Gestational diabetes mellitus
  • Passive smoking
  • Home
  • Workplace
  • Chinese