The relationship between emerging contaminants and gestational diabetes mellitus: a review

Emerging contaminants (ECs) have garnered growing attention as potential contributors to adverse metabolic outcomes during pregnancy, particularly gestational diabetes mellitus (GDM). Despite increasing recognition of their endocrine-disrupting capabilities, the precise relationship between EC exposure and glucose dysregulation in the gestational context remains inadequately characterized. The scarcity of longitudinal human studies, along with limited mechanistic elucidation, highlights a critical gap in understanding how these ubiquitous environmental pollutants may perturb maternal metabolic homeostasis. This review consolidates current epidemiological evidence linking key classes of ECs, including per- and polyfluoroalkyl substances (PFAS), polychlorinated biphenyls (PCBs), phthalates (PAEs), bisphenols, organochlorine pesticides (OCPs), parabens, and alkylphenols, with GDM risk and impaired glycemic control. Parallel examination of in vivo and in vitro studies reveals plausible biological mechanisms, including oxidative stress, mitochondrial dysfunction, inflammatory signaling, and insulin resistance (IR), through which these compounds may mediate their effects. By integrating data across human and experimental research domains, this review underscores the urgent need for high-resolution exposure assessments, mixture toxicity frameworks, and mechanistic validation. Such insight is essential for advancing etiological understanding, informing regulatory action, and guiding preventive strategies to mitigate the impact of environmental exposures on maternal-fetal metabolic health.