Endocrine-Disrupting Chemicals and the Risk of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis

Abstract Objective To conduct a comprehensive systematic review and meta-analysis to estimate the relationship between EDCs, including polychlorinated biphenyls (PCBs), poly-brominated diphenyl ethers (PBDEs), phthalates (PAEs), and per- and polyfluoroalkyl substances (PFAS) exposure and risk of gestational diabetes mellitus (GDM). Methods Relevant literatures were identified by searching Embase, Pubmed, and Web of Science through November 2021. The cohort and case-control studies reporting effect size with 95% confidence intervals (CIs) of EDCs exposure and GDM were selected. The heterogeneity among the included studies were quantified by I2 statistic. Publication bias was evaluated through the Begg’s and Egger’s tests. Results Twenty-five articles with a total of 23, 796 participants were finally identified. The results indicated that exposure to PCBs have a significant impact on the incidence of GDM (OR = 1.14; 95% CI = 1.00-1.31; n = 8). For PBDEs exposure, a positive association was observed for the risk of GDM (OR = 1.32; 95% CI=1.15-1.53; n = 4). Similarly, for PAEs and PFASs exposure, they were also positively associated with the risk of GDM, with summary ORs were 1.10 (95% CI = 1.03-1.16; n = 7 for PAEs) and 1.09 (95% CI = 1.02-1.16; n = 11 for PFASs), respectively. When only included the cohort studies, the summary OR between PCBs exposure and the risk of GDM was 0.99 (95% CI = 0.91-1.09; n = 5). While, for PBDEs, PAEs, and PFASs exposure, the summary ORs from cohort studies were 1.12 (95% CI = 1.00-1.26; n = 2), 1.08 (95% CI =1.02-1.15; n = 5), and 1.06 (95% CI = 1.00-1.12; n = 8), respectively. The Begg’s and Egger’s tests didn’t show publication bias and the sensitivity analyses didn’t change the results in the present meta-analysis. Conclusion These results support the notion that EDCs exposure increases the risk of GDM. Further large-sample epidemiologic researches and mechanistic studies are needed to verify the potential relationship and biological mechanisms. These results are of public health significance since daily EDCs exposure have been expected to increase the risk of GDM development.