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Persistent Organic Pollutant exposure as a risk factor of Gestational Diabetes Mellitus: A systematic review and meta-analysis.
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  • Malak Kouiti,
  • María Ángeles Castillo-Hermoso,
  • Ibtissam Youlyouz-Marfak,
  • Khalid Khan,
  • Shakila Thangaratinam,
  • Rocío Olmedo-Requena,
  • Javier Zamora,
  • José Juan Jiménez-Moleón
Malak Kouiti
Universidad de Granada
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María Ángeles Castillo-Hermoso
Universidad de Granada
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Ibtissam Youlyouz-Marfak
Universite Hassan 1er
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Khalid Khan
Universidad de Granada
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Shakila Thangaratinam
University of Birmingham
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Rocío Olmedo-Requena
Universidad de Granada
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Javier Zamora
Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica
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José Juan Jiménez-Moleón
Universidad de Granada

Corresponding Author:[email protected]

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Background: The findings of individual epidemiological studies that suggest an association between some Persistent Organic Pollutants (POPs) and Gestational Diabetes Mellitus (GDM) are inconclusive. Objectives: To estimate the strength of the association between POPs exposure and GDM in a systematic review with meta-analysis. Search strategy: MEDLINE, Scopus, and Web of Science were searched until 2022. Selection criteria: Cohort and case-control studies analyzing the association between POPs and GDM in healthy pregnant women. Data collection and analysis: Quality was assessed using QUIPS scale and standardized mean differences (SMD) and 95% confidence intervals (CI) was pooled using random-effect model. Main results: Fourteen articles including 11,422 participants were selected. The risk of bias of included studies was high in 4 (28.6%), moderate in 9 (64.3%) and low in 1 (7.14%). Only six POPs showed a significative SMD between GDM cases and controls: Perfluorobutanesulfonic acid (PFBS) 0.33 (95% CI 0.23, 0.43; I2=0%); Perfluorodecanoic acid (PFDA) -0.11 (95% CI -0.20, -0.01, I2 = 0.0%); 2,2’,3,4,4’,5,5’-Heptachlorobiphenyl (PCB 180) 0.37 (95% CI 0.19, 0.56; I2=25.3%); 2,2’,4,4’,5-Decabromodiphenyl ether (BDE 99) 0.36 (95% CI 0.14, 0.59; I2=0%); 2,2’,4,4’,6-Decabromodiphenyl ether (BDE 100) 0.42 (95% CI 0.19, 0.38; I2=0%); and, Hexachlorobenzene (HCB) 0.22 (95% CI 0.01, 0.42, I2=39.6%). For other POPs, no statistically significant association was observed. Conclusion: The available evidence is variable on quality and results were heterogeneous making impossible to establish a clear association between POPs exposure and risk of GDM. Improve the methodology of epidemiological studies assessing the association of POPs and risk of adverse clinical outcomes are needed.
17 Mar 2023Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
25 Mar 2023Submission Checks Completed
25 Mar 2023Assigned to Editor
25 Mar 2023Review(s) Completed, Editorial Evaluation Pending
26 Mar 2023Reviewer(s) Assigned
14 Jul 2023Editorial Decision: Revise Major
05 Oct 20231st Revision Received
13 Oct 2023Assigned to Editor
13 Oct 2023Submission Checks Completed
13 Oct 2023Review(s) Completed, Editorial Evaluation Pending
21 Oct 2023Editorial Decision: Revise Minor
01 Nov 20232nd Revision Received
02 Nov 2023Assigned to Editor
02 Nov 2023Submission Checks Completed
02 Nov 2023Review(s) Completed, Editorial Evaluation Pending
10 Nov 2023Editorial Decision: Accept