The association between adverse childhood experiences (ACEs) and gestational diabetes mellitus (GDM): A systematic review and meta-analysis

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 metaanalysis of observational studies on ACEs before age 18 and GDM, including doseresponse 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;I = 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.