Exposure to per- and polyfluoroalkyl substances, commonly known as PFAS or “forever chemicals,” may increase the risk of gestational diabetes, according to the largest and most comprehensive review of the evidence to date.
Researchers from the Icahn School of Medicine at Mount Sinai analyzed data from dozens of studies examining PFAS exposure in relation to diabetes risk and markers of glucose regulation across the lifespan. Their findings were published in EClinicalMedicine, part of The Lancet family.
PFAS are a group of synthetic chemicals used for decades in a wide range of products, including food packaging, nonstick cookware, stain- and water-resistant fabrics, and industrial applications. Because they break down extremely slowly, PFAS persist in the environment and accumulate in the human body over time.
The review focused on how PFAS exposure relates to diabetes outcomes and underlying metabolic markers, such as insulin resistance and insulin secretion. The strongest and most consistent associations emerged during pregnancy.
Across studies, higher PFAS exposure was linked to a greater likelihood of developing gestational diabetes, as well as changes in insulin resistance and insulin secretion that precede disease. By contrast, evidence linking PFAS exposure to type 1 or type 2 diabetes later in life was mixed and inconclusive.
“This is the most comprehensive synthesis of evidence to date examining how PFAS exposure relates not only to diabetes risk, but also to the underlying clinical markers that precede disease,” said Sandra India-Aldana, a postdoctoral fellow at Mount Sinai and co-first author of the study. “Our findings suggest that pregnancy may be a particularly sensitive window during which PFAS exposure may increase risk for gestational diabetes.”
Gestational diabetes affects blood sugar regulation during pregnancy and is associated with higher risks for pregnancy complications, as well as long-term health consequences for both mother and child, including an increased likelihood of developing type 2 diabetes later in life.
Damaskini Valvi, professor of environmental medicine and public health at Mount Sinai and senior author of the study, said the findings are concerning given how widespread PFAS exposure is and the long-term health implications gestational diabetes can have for both mothers and children.
Importantly, the authors emphasize that PFAS exposure is largely systemic rather than the result of individual behavior. PFAS can enter the body through multiple routes, including contaminated food and beverages, household products, and environmental sources, making complete avoidance unrealistic.
The findings suggest that environmental exposure history may be relevant in preconception and prenatal care, particularly as part of broader efforts to understand and reduce preventable metabolic risk during pregnancy. However, the researchers caution that the results reflect population-level associations and do not mean that PFAS exposure will inevitably lead to gestational diabetes in any individual.
The authors also highlight significant gaps in the current evidence, particularly regarding PFAS exposure and type 1 or type 2 diabetes outside of pregnancy. They call for larger, long-term studies to better understand how environmental chemical exposures interact with metabolism across different life stages.
The study was supported by funding from the U.S. National Institutes of Health.