Persistent Organic Pollutant exposure as a risk factor of Gestational
Diabetes Mellitus: A systematic review and meta-analysis.
Abstract
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.