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. 2026 Mar;17(3):527-534.
doi: 10.1111/jdi.70228. Epub 2025 Dec 28.

The association between COVID-19 and incident gestational diabetes (GDM): A population-based case-control study of the National Health Insurance Research Database in Taiwan

Liang-Yu Lin  1   2 , Chi-Jen Chen  3 , Mei-Huei Chen  4 , Chun-Wei Chen  5 , Pau-Chung Chen  1   2   6
Affiliations

The association between COVID-19 and incident gestational diabetes (GDM): A population-based case-control study of the National Health Insurance Research Database in Taiwan

Liang-Yu Lin et al. J Diabetes Investig. 2026 Mar.

Abstract

Background: Reports suggested that diabetes could be a complication arising from COVID-19; however, the relationship between COVID-19 and the development of gestational diabetes mellitus (GDM) remains unclear.

Objectives: This study aimed to investigate the association between COVID-19 infections and the risk of incident GDM in pregnant women.

Methods: We analyzed data from Taiwan's National Health Insurance Research Database (NHIRD), which is linked to the Birth Reporting Database and the COVID-19 testing database between 2020 and 2022. A case-control study was conducted, matching pregnant women by age and region. We employed multivariable logistic regression, adjusting for matching factors and potential confounders. The findings were further validated through a sensitivity analysis using a cohort design with landmark analysis.

Results: The study included 134,375 pregnant women, comprising 26,875 GDM cases and 107,500 matched controls. After adjusting for covariates, we found no evidence supporting an association between prior COVID-19 infection and incident GDM (adjusted odds ratio [aOR] = 0.95, 95% confidence interval [CI] = 0.89-1.01). Notably, some evidence showed that receiving at least one COVID-19 vaccination was associated with a decreased risk of GDM (aOR = 0.90, 95% CI = 0.87-0.93). These results remained consistent in the sensitivity analysis.

Conclusion: Despite COVID-19 now being endemic with less virulent variants, ongoing vigilance regarding potential pregnancy-related impacts of SARS-CoV-2 is essential. It is also critical to promote vaccination among women of childbearing age, and further research is necessary to explore COVID-19-related complications during pregnancy.

Keywords: COVID‐19; electronic health records; gestational diabetes; long COVID.

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Conflict of interest statement

The authors declare that there are no conflicts of interest.

Approval of the research protocol: N/A.

Informed Consent: N/A.

Approval date of Registry and the Registration No. of the study/trial: N/A.

Animal Studies: N/A.

Figures

Figure 1
Figure 1
Illustration of study design and variable assessment time windows. GA, gestational weeks; GDM, gestational diabetes.
Figure 2
Figure 2
The flow chart of selecting the study population.
Figure 3
Figure 3
The association between COVID‐19 infections and incident GDM. The model adjusted for age, region of residence, morbid obesity, PCOS, nationality, income, and COVID‐19 vaccination.
See this image and copyright information in PMC

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