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Embryo Culture Duration Is an Independent Risk Factor for Gestational Diabetes in Frozen Embryo Transfer Pregnancies
Huijun Chen1,2, Shujuan Ma2, Yvonne Liu1,2
1Department of Nephrology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany.
Journal of the Endocrine Society
|February 2, 2026
Summary
Prolonged embryo culture increases gestational diabetes risk in frozen embryo transfer pregnancies. Extended embryo development stages are linked to higher GDM incidence, especially in women with metabolic issues.
Area of Science:
- Reproductive Endocrinology
- Maternal-Fetal Medicine
- Metabolic Disorders
Background:
- Gestational diabetes mellitus (GDM) is a significant complication of pregnancy.
- Frozen embryo transfer (FET) is a common assisted reproductive technology (ART) procedure.
- The impact of embryo culture duration on maternal metabolic health post-FET is not fully understood.
Purpose of the Study:
- To determine if prolonged embryo culture duration during FET increases the risk of developing GDM.
- To investigate the association between embryo developmental stage and GDM incidence.
Main Methods:
- Retrospective cohort study of 26,100 FET pregnancies (2018-2022).
- GDM diagnosis via 75-g oral glucose tolerance test.
- Analysis of embryo culture duration (Day 3, 5, 6) and morphology.
- Multivariable logistic regression and interaction analyses adjusted for maternal factors.
Main Results:
- GDM occurred in 14.0% of pregnancies.
- Blastocyst-stage transfers (Day 5/6) showed significantly higher GDM risk compared to cleavage-stage (Day 3).
- Prolonged culture (Day 5/6) was an independent risk factor for GDM (OR 1.045, P < .01).
- Combined effect of blastocyst transfer and maternal metabolic risk factors elevated GDM incidence.
Conclusions:
- Prolonged embryo culture is an independent risk factor for GDM following FET.
- Embryo developmental stage influences maternal glucose metabolism.
- Consideration of embryo development stage in ART protocols may benefit women with metabolic vulnerabilities.
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