Impact of phthalate exposure on gestational diabetes mellitus: a systematic review

Background Gestational Diabetes Mellitus (GDM) is a transient diabetogenic state that often leads to adverse maternal and fetal outcomes. The rising burden of exposure to endocrine-disrupting chemicals like phthalates essentially disrupts the tightly regulated endocrine system, thereby modulating the insulin signaling pathways, leading to GDM. Objective In the present work, a systematic review was performed to examine the probable relation between maternal exposure to phthalates, as endocrine-disrupting compounds, and GDM. Methods Relevant studies from their inception to April 2025 were identified by searching PubMed, Embase, Scopus, and Science Direct. The data were screened using the Rayyan tool, and the risk of bias was assessed using the New Castle Ottawa Scale selection tool. Results We identified 13 studies that showed a significant presence of phthalates in the urine samples of GDM patients. 5 phthalate secondary metabolites, Monoethyl Phthalate, Monobutyl phthalate, Mono-Isobutyl Phthalate, and Monobenzyl Phthalate and the primary phthalate Di(2-ethylhexyl) Phthalate were found to be most commonly present in the urine samples of the GDM patients. Conclusion Urinary phthalate levels can be used as a non-invasive biomarker for GDM, thereby also reducing the risk of associated adverse pregnancy outcomes. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420251023656.