Comprehensive Evaluation of Gestational Diabetes Patients Against Exposure on PFAS and Its Derivatives: An Updated Systematical Review and Meta-Analysis

Background and Aims: Gestational diabetes mellitus(GDM) is characterised by insulin resistance thatfirst manifests during pregnancy. This study aimed to evaluate PFAS exposure as a risk factor for GDM. Methods: Descriptive Boolean queries were used to search PubMed, Scopus, and Web of Science for articles published between January 2015 to 2023 with "PFAS" OR "per-and polyfluoro alkyl" AND "gestational diabetes" keywords. A total of 10 studies were included. Results: There were no statistically significant difference between the patient and control groups for PFOS (MD = 0.36, 95% CI = [0.30, 1.02], Z=1.06, P=0.29), PFHxS (MD = -0.02, 95% CI = [-0.11, 0.07], Z=0.39, P=0.69), PFNA (MD = 0.00, 95% CI = [-0.02, 0.04], Z=0.10, P=0.92), PFHpA (MD = 0.01, 95% CI = [-0.00, 0.02], Z=1.63, P=0.10) and PFDA (MD = 0.00, 95% CI = [-0.03, 0.03], Z=0.15, P=0.88). A statistically significant difference was observed between the patient and control groups for PFOA (MD = 1.79, 95% CI = [0.99, 2.58], Z=4.42, P<0.001) and PFUnDA (MD = 0.10, 95% CI = [0.01, 0.19], Z=2.23, P=0.03). Conclusion: Our meta-analysis has shown a strong correlation between PFUnDA and PFOA levels in connection with GDM. A total of 10 randomised controlled trials (RCTs) were assessed to investigate the relationship between GDM and PFAS. Consistent with previous research, the presence of long-chain chemicals such as PFUnDA and PFOA may disrupt the normal functioning of beta cells, leading to the development of GDM. These results can enhance future research on the relationship between GDM and hazardous exposures.