Impact of bisphenol A exposure on the risk of gestational diabetes: a meta-analysis of observational studies

Abstract

Purpose: A growing number of evidence have assessed the association between bisphenol A (BPA) as an endocrine-disrupting agent and the risk of gestational diabetes (GDM). This meta-analysis aimed to reassess the data on the association of BPA levels in women with GDM compared to the control.

Methods: A comprehensive literature search was conducted in Medline, Embase, Scopus, and Web of Science to extract relevant published studies up to May 2024. 12 articles were included in the meta-analysis. DerSimonian and Liard random-effects model was used to estimate the pooled odds ratio (OR). Sensitivity analysis was conducted to assess the robustness of the pooled results by removing each study from the pooled effect size. Subgroup analyses were performed depending on the subgroups of gestational age, GDM trimester, BMI, study design and geographical area.

Results: The results showed that there was no significant association between circulating and urinary BPA concentrations with the risk of GDM (OR: 0.79; 95% CI 0.60-1.04; P = 0.095). No significant heterogeneity was found among the studies. Using Begg's correlation (P = 0.95) and Egger's linear regression (P = 0.86) tests, no publication bias was observed. The sensitivity analysis shows that our findings were completely robust and stable. Meta-regression indicated a significant association between BPA levels and study design and geometric mean as an index of the risk of GDM.

Conclusion: The present meta-analysis demonstrates exposure to BPA was associated with a reduced risk of GDM. Further studies are needed for obtain the reliable results.

Keywords: Bisphenol A; Gestational diabetes; Meta-analysis; Pregnancy.

Fig. 1

Flow chart of PRISMA for search strategy and study selection from electronic databases

Fig. 2

Forest plot assessing the OR of BPA levels in women with GDM using random-effects model

Fig. 3

Unrestricted maximum likelihood meta-regression plots of the association between the odds ratio of BPA levels and gestational diabetes, GDM trimester, BMI, study design, sample size, geographical area and geometric mean

Fig. 4

Funnel plot evaluating publication bias in the studies reporting the BPA levels in women with GDM. Open circle and black circle represented observed and trimming-fill studies. respectively.