Exposure to per- and polyfluoroalkyl substances (PFAS) may increase the risk of gestational diabetes, according to the most comprehensive systematic review and meta-analysis conducted to date. Researchers analysed decades of epidemiological evidence to better understand how these persistent environmental chemicals affect glucose regulation and diabetes-related outcomes.
Why PFAS Exposure Matters During Pregnancy
Gestational diabetes develops when glucose intolerance first appears during pregnancy and is associated with serious short- and long-term health risks for both mother and child. While genetic and lifestyle factors are well known contributors, environmental chemical exposures have remained less explored. PFAS, often referred to as forever chemicals, are widespread in consumer products, food packaging, drinking water, and household materials, leading to near-universal exposure.
What the Evidence Shows
The review evaluated 129 epidemiological studies published through July 2025, including data from more than one million participants worldwide. Meta-analyses revealed consistent associations between higher PFAS exposure and increased odds of gestational diabetes across multiple study designs. In particular, doubling concentrations of certain legacy PFAS, such as PFOS, were associated with statistically significant increases in gestational diabetes risk.
Beyond diagnosis, PFAS exposure was also linked to markers of altered glucose metabolism. These included higher levels of insulin resistance and increased pancreatic beta-cell activity, suggesting that PFAS may interfere with both insulin sensitivity and secretion. Associations with type 2 diabetes and long-term glucose markers were less consistent, highlighting pregnancy as a particularly sensitive window of risk.
Implications for Clinical Care and Research
Although the observed effect sizes were modest, the consistency of findings across studies suggests that PFAS exposure is a meaningful environmental contributor to gestational diabetes risk. Given the ubiquity of these chemicals and the rising prevalence of gestational diabetes globally, the findings carry important public health implications. Researchers emphasize the need for larger, life-course prospective studies that evaluate emerging PFAS and chemical mixtures.
Reference
Aldana SI et al. Associations of perfluoroalkyl and polyfluoroalkyl substances with markers of glycaemic control, insulin secretion and sensitivity, and diabetes risk: a systematic review and meta-analyses. eClinicalMedicine. 2026;DOI:10.1016/j.eclinm.2025.103747.
