Gestational diabetes mellitus (GDM) remains a major pregnancy complication with important consequences for maternal and offspring health. A systematic review and meta-analysis published in Diabetes Research and Clinical Practice found that adverse childhood experiences (ACEs) before age 18 were associated with higher odds of later GDM, with risk increasing as ACE burden accumulated.

The review searched nine databases from inception through May 30, 2025, under a PROSPERO-registered protocol (CRD420251035754). Observational studies evaluating ACE exposure and gestational-onset diabetes were eligible. Two independent reviewers conducted study screening, data extraction, and risk-of-bias assessment using Risk Of Bias In Non-randomized Studies of Exposures (ROBINS-E). Random-effects models generated pooled adjusted odds ratios (aORs), and dose-response analyses used the Greenland-Longnecker method.

Thirteen studies met eligibility criteria, and 11 studies involving 326,797 participants were included in the meta-analysis. ACE exposure was associated with higher odds of GDM (aOR 1.15; 95% confidence interval [CI] 1.12-1.18; I²=0%). A cumulative dose-response association was also observed, with each additional ACE linked to higher GDM odds (aOR 1.13; 95% CI 1.08-1.19).

The analysis added updated pooled estimates from recent cohorts, incorporated dose-response modeling, and focused specifically on the pregnancy risk window. Overall, the findings support a life-course perspective in maternity care.