A recent review of nearly 130 studies has found strong evidence that exposure to per- and polyfluoroalkyl substances (PFAS), often referred to as “forever chemicals,” is linked to an increased risk of gestational diabetes. The research, published in eClinicalMedicine, evaluated associations between PFAS exposure and various diabetes outcomes.
The systematic review analyzed data from 129 studies, most of which were conducted in the United States and China. Researchers focused on population-based observational studies that examined connections between PFAS and different forms of diabetes. The chemicals studied included common types such as perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS).
According to the findings, several PFAS were associated with higher odds of gestational diabetes. "Specifically, each doubling of PFOS and perfluorobutanesulfonic acid (PFBS) levels was linked to increased GDM risk in prospective studies." Other long-chain and emerging PFAS also showed positive associations with gestational diabetes in certain study designs.
For type 2 diabetes, the results were less clear, with no significant associations observed overall, though some chemicals indicated a possible link in specific analyses. Associations with markers like insulin resistance and β-cell function were noted for some PFAS, but effect sizes were generally small.
Most included studies measured adult or prenatal exposures to PFAS. Only three studies addressed type 1 diabetes, yielding inconsistent results.
The review highlighted that while there is moderate-quality evidence connecting certain long-chain or legacy PFAS with selected metabolic outcomes—particularly gestational diabetes—the quality of evidence for short-chain or emerging compounds remains low. The researchers concluded that more prospective research is needed to clarify these relationships.
"Overall, the evidence suggests that exposure to some PFAS is associated with an increased GDM risk and modest changes in insulin sensitivity and secretion in the general population," according to the authors.
