Potentially toxic elements (PTEs), including heavy metal exposures, have been associated with numerous negative pregnancy and birth outcomes. However, the association between PTE exposure and gestational diabetes mellitus (GDM) has not yet undergone a comprehensive systematic review. Consequently, this study undertook the first-ever systematic review and meta-analysis of observational studies concerning this association. All relevant articles published in English were searched in Scopus, PubMed, and Web of Science until November 6, 2023, adhering to the MOOSE guidelines. The quality of retrieved studies was evaluated based on the Gascon et al. method. The meta-analysis of association estimates was performed using random effects meta-analysis. Egger’s regression was employed to evaluate publication bias. In total, 16 articles (n = 116,728 participants) were included in our review, with 11 eligible for meta-analysis. Quality assessment categorized five studies (31%) as excellent, nine studies (56%) as good, and two studies (13%) as fair. Maternal high levels of Hg during pregnancy were associated with an increased risk of GDM (for each one-quartile increase in Hg: 1.20, 95% CI 1.08, 1.31), while serum Cd levels during the second trimester were associated with a lower risk of GDM (for each one-quartile increase in Cd: 0.76, 95% CI 0.65, 0.87). Furthermore, exposure to Pb was not associated with higher risk of GDM. In summary, our comprehensive review and meta-analysis underscore the possible negative influence of Hg exposure on GDM.

潜在有毒元素（PTE），包括重金属暴露，与许多不良妊娠和分娩结果有关。然而，PTE 暴露与妊娠糖尿病 (GDM) 之间的关联尚未经过全面的系统评价。因此，本研究对有关这种关联的观察性研究进行了首次系统回顾和荟萃分析。截至 2023 年 11 月 6 日，所有以英文发表的相关文章均按照 MOOSE 指南在 Scopus、PubMed 和 Web of Science 中进行检索。检索到的研究的质量根据 Gascon 等人进行了评估。方法。使用随机效应荟萃分析进行关联估计的荟萃分析。Egger 回归用于评估发表偏倚。 我们的综述总共纳入了16 篇文章（n = 116,728 名参与者），其中 11 篇符合荟萃分析条件。质量评估将五项研究 (31%) 评为优秀，九项研究 (56%) 评为良好，两项研究 (13%) 评为一般。母亲怀孕期间汞含量高与 GDM 风险增加相关（汞每增加四分位：1.20，95% CI 1.08，1.31），而妊娠中期血清镉水平与妊娠期糖尿病风险降低相关。 GDM（镉每增加四分位：0.76，95% CI 0.65，0.87）。此外，接触 Pb 与 GDM 风险较高无关。总之，我们的全面回顾和荟萃分析强调了汞暴露对 GDM 可能产生的负面影响。