Exposição a poluição por metais pesados e diabetes mellitus gestacional: uma revisão sistemática

Abstract

Gestational diabetes mellitus (GDM) constitutes a metabolic complication which is associated with multiple adverse pregnancy outcomes. Humans' exposure to heavy metals has increased in recent years and studies have suggested that they may modify the risk of GDM. The aim of this review is to provide a comprehensive overview of published evidence on the association between heavy metals and GDM. The expression ((heavy metal) OR (heavy metal exposure) OR (environmental exposure)) AND ((gestational diabetes) OR (gestational diabetes mellitus) OR (GDM)) was searched in PubMed, Web of Science and Scopus databases in March 2021 without any time or language restriction. Studies that didn´t focus on heavy metals effects, didn´t assess GDM as an outcome or were performed in animals were excluded. Of the initial 847 papers, 26 fulfilled the inclusion criteria. 13 articles were prospective cohort studies, 7 were case-control studies, 3 were cross-sectional studies, 2 were retrospective cohort studies and 1 was a semi-ecological study. Moreover, a total of 16 studies measured only one type of heavy metal. Cadmium (Cd), arsenic (As), lead (Pb), antimony (Sb), thallium (Tl) and mercury (Hg) were the mainly evaluated heavy metals. The scientific interest in heavy metals as a potential risk factor for GDM seems to be growing. Although more studies with higher standardization are required, Cd, As, Sb and Tl showed the most robust evidence suggesting a positive association with the risk of GDM.