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Systematic review and meta-analysis links METS-IR to gestational diabetes riskHigher metabolic score linked to increased gestational diabetes risk in pregnant women

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Key Takeaway
Consider METS-IR as an associative marker for higher GDM risk in pregnancy.

This is a systematic review and meta-analysis examining the association between the Metabolic Score for Insulin Resistance (METS-IR) and gestational diabetes mellitus (GDM) risk in pregnant women. The analysis pooled data from a total sample size of 93,995 participants.

The key synthesized finding is that a higher METS-IR score is associated with an increased risk of GDM. Compared to the lowest METS-IR category, the highest category had an odds ratio of 2.53 (95% CI: 2.14–3.00) for GDM risk. The analysis showed moderate heterogeneity (I2 = 57%).

The authors note that this is an observational association. The review does not report specific limitations, funding, or conflicts of interest. Safety data for METS-IR were not reported.

Clinically, this suggests that METS-IR may be a useful marker for identifying pregnant women at higher risk for GDM. However, the evidence is associative, and the review does not establish that modifying METS-IR would prevent GDM.

A major review of over 93,000 pregnant women looked at a measure called the Metabolic Score for Insulin Resistance (METS-IR). This score helps estimate how well the body uses insulin. The study compared women with the highest scores to those with the lowest scores.

The main finding was clear: women with the highest METS-IR scores had about two and a half times the risk of developing gestational diabetes compared to women with the lowest scores. This means their chance of getting the condition was significantly higher.

This research adds to our understanding of how metabolic health before and during pregnancy can affect the risk of gestational diabetes. It highlights the importance of monitoring metabolic factors in pregnant women.

The study was a meta-analysis, combining data from many different studies. While it shows a strong link, it does not prove that the score causes gestational diabetes. Other factors could also play a role.

What this means for you:
Pregnant women with a higher metabolic score have a much greater risk of developing gestational diabetes.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedMay 2026
View Original Abstract ↓
ObjectiveThis study aimed to systematically evaluate the association between the Metabolic Score for Insulin Resistance (METS-IR) and the risk of gestational diabetes mellitus (GDM).MethodsA systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library up to March 2026. Two independent reviewers completed study screening, data extraction, and quality assessment. Cohort studies were evaluated with the Newcastle-Ottawa Scale, and cross-sectional studies were assessed with the Agency for Healthcare Research and Quality checklist. Meta-analyses were performed using Stata 16.0 and Review Manager 5.4.1. Heterogeneity was examined using the Cochrane Q-test and I2 statistic, and a random-effects model was used to pool effect sizes. Subgroup analyses stratified by country, study design, and sample size were conducted to explore sources of heterogeneity. Sensitivity analysis was used to validate the robustness of pooled estimates, and publication bias was assessed using funnel plots and Egger’s test.ResultsA total of 6 studies involving 93,995 pregnant women were included. The overall pooled odds ratio (OR) for GDM risk in the highest versus lowest METS-IR category was 2.53 (95% CI: 2.14–3.00, I2 = 57%, p 
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