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

Fadhilah, SN ORCID: 0009-0002-8583-8111, Burton, S ORCID: 0000-0003-3823-3275, Wilson, CA and Benton, M (2026) The association between adverse childhood experiences (ACEs) and gestational diabetes mellitus (GDM): A systematic review and meta-analysis. Diabetes Research and Clinical Practice. ISSN 0168-8227 (Accepted)

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Abstract

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.

Item Type:	Article
Uncontrolled Keywords:	1103 Clinical Sciences; 1117 Public Health and Health Services; 1701 Psychology; Endocrinology & Metabolism; 3202 Clinical sciences; 4206 Public health; 5203 Clinical and health psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RG Gynecology and obstetrics R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Divisions:	Psychology (from Sep 2019)
Publisher:	Elsevier
Date of acceptance:	15 April 2026
Date of first compliant Open Access:	22 April 2026
Date Deposited:	22 Apr 2026 13:40
Last Modified:	22 Apr 2026 13:40
DOI or ID number:	10.1016/j.diabres.2026.113269
URI:	https://researchonline.ljmu.ac.uk/id/eprint/28424

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