The association between adverse childhood experiences (ACEs) and gestational diabetes mellitus (GDM): A systematic...

Gestational diabetes mellitus (GDM) has consequences for maternal and offspring health. Adverse childhood experiences (ACEs) contribute to GDM risk, but findings have been inconsistent. We synthesised evidence using a systematic review and meta-analysis of observational studies on ACEs before age 18 and GDM, including dose-response effects. Nine databases were searched from inception to 30 May 2025 based on a PROSPERO-registered protocol (CRD420251035754). Studies without extractable estimates or assessing diabetes not restricted to gestational onset were excluded. Two reviewers independently screened studies, extracted data, and assessed risk of bias using ROBINS-E. Random-effects models pooled adjusted odds ratios (aORs), with dose-response analyses using the Greenland-Longnecker method. Thirteen studies met eligibility criteria, 11 contributed to meta-analysis (n = 326,797). ACE exposure was associated with higher odds of GDM (aOR 1.15, 95% CI 1.12-1.18; I² = 0%). A cumulative dose-response effect was observed, with each additional ACE increasing GDM odds (aOR 1.13, 95% CI 1.08-1.19). This study extends prior work by incorporating dose-response modelling, updated pooled estimates from recent cohorts, a pregnancy-focused risk window, and consideration of mediating and moderating pathways. Overall, ACEs are associated with increased risk of GDM, supporting a life-course approach to maternity care.