Systematic review links gestational diabetes to higher maternal CKD risk in large cohort analysis

BACKGROUND: Gestational diabetes mellitus (GDM) may increase the risk of maternal chronic kidney disease (CKD). The association of GDM with maternal CKD has been heterogeneous across studies, and this association remains controversial. The aim of this systematic review was to investigate the association of GDM with the risk of maternal CKD. METHODS: MEDLINE/PubMed, EMBASE, Scopus and Web of Science were searched, with no time limit, up to 25 August 2025 by two independent investigators to identify studies that had assessed the association of GDM with maternal risk of CKD. Heterogeneity between studies was assessed using Cochrane's Q and I2 tests. Meta-regression was performed to identify factors associated with heterogeneity. RESULTS: Eleven cohort studies involving 21,313,434 participants (1,530,599 (7.2%) GDM) were included. Pooled estimates from eleven studies showed that GDM was significantly associated with an increased risk of maternal CKD (HR: 2.19; 95% CI: 1.7, 2.68; p: 0.001, I:92.2%). Further analyses restricted to studies adjusting for key confounders (HR: 2.47; 95% CI: 1.87, 3.08; p: 0.001, I2:24.2%) also showed a significant association. While pooled estimates from three studies did not show a significant association between GDM and an increased risk of AKI (HR: 1.1; 95% CI: 0.94, 1.26). Subgroup analyses showed that GDM was significantly associated with an increased risk of maternal CKD in both DM + (HR: 6.24) and DM - (HR: 1.4). CONCLUSION: Gestational diabetes mellitus (GDM) with and without DM was significantly associated with an increased risk of maternal CKD. GDM with DM had a synergistic effect on maternal CKD risk. Although GDM was not significantly associated with increased AKI, only three studies were included in the AKI analysis, which may have affected these results by random error and therefore lack sufficient power and evidence to draw conclusions.