Metalloestrogens exposure and risk of gestational diabetes mellitus: Evidence emerging from the systematic review and meta-analysis
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Metals
Metals
Heavy metals play a significant and multifaceted role in the pathogenicity of microbial species.
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Karen Pendergrass
What Was Reviewed?
The systematic review and meta-analysis examined the relationship between exposure to metalloestrogens—specifically arsenic (As), antimony (Sb), chromium (Cr), cadmium (Cd), copper (Cu), selenium (Se), and mercury (Hg)—and the risk of developing gestational diabetes mellitus (GDM). This review aimed to aggregate findings from observational studies to better understand how these metals, which have estrogenic properties, impact the development of GDM. A comprehensive search of PubMed, Web of Science, and Embase databases was conducted to collect relevant studies up until December 2023.
Who Was Reviewed?
The meta-analysis included a total of 33 observational studies, which involved 141,175 subjects, comprising 9,450 cases of GDM and 131,725 controls. The review covered a wide geographic distribution, with studies conducted in multiple countries and varying methodologies for exposure assessment. Biological specimens such as blood, urine, and other tissues were analyzed to measure levels of metalloestrogens in pregnant women and correlate them with the occurrence of GDM.
What Were the Most Important Findings of This Review?
The meta-analysis revealed that exposure to certain metalloestrogens, specifically arsenic (As), antimony (Sb), and copper (Cu), is associated with an increased risk of GDM. Arsenic exposure exhibited a risk ratio (OR = 1.28, 95% CI [1.08, 1.52]), antimony a higher risk (OR = 1.73, 95% CI [1.13, 2.65]), and copper was also linked with a modest increase in GDM risk (OR = 1.29, 95% CI [1.02, 1.63]). However, high heterogeneity in these studies was noted, with substantial variability in the results for arsenic (I2 = 64.1%), antimony (I2 = 80.9%), and copper (I2 = 71.6%). Other metalloestrogens, such as selenium, cadmium, chromium, and mercury, did not show a statistically significant association with GDM in this analysis.
What Are the Greatest Implications of This Review?
The greatest implication of this review is the emerging recognition that environmental exposure to metalloestrogens could be a significant contributor to the risk of GDM. This finding underscores the importance of considering environmental and occupational exposure to harmful metals in pregnancy, which could lead to metabolic disturbances that increase the likelihood of GDM. The results suggest that public health policies should place greater emphasis on reducing environmental contamination by metalloestrogens, especially in populations at higher risk of GDM. Additionally, it points to the need for more targeted research on how different metals disrupt estrogenic pathways and influence insulin signaling and pancreatic function, which may open new avenues for preventive strategies, early diagnosis, and novel treatments for GDM.
The high heterogeneity in the studies also highlights the complexity of the relationship between metalloestrogens and GDM. Variations in exposure levels, methods of measurement, and geographical factors call for standardized approaches in future research to better clarify these associations. Furthermore, the study suggests the necessity for increased awareness and education among healthcare providers regarding environmental factors in pregnancy, encouraging efforts to mitigate exposure in vulnerable populations.